The value of saccade metrics and VOR gain in detecting a vestibular stroke

OBJECTIVE

A normal video Head Impulse Test is the gold standard in the emergency department to rule-in patients with an acute vestibular syndrome and a stroke. We aimed to compare the diagnostic accuracy of vHIT metrics regarding the vestibulo-ocular reflex gain and the corrective saccades in detecting vestibular strokes.

METHODS

Prospective cross-sectional study (convenience sample) of patients presenting with acute vestibular syndrome in the emergency department of a tertiary referral centre between February 2015 and May 2020. We screened 1677 patients and enrolled 76 patients fulfilling the inclusion criteria of acute vestibular syndrome. All patients underwent video head impulse test with automated and manual data analysis. A delayed MRI served as a gold standard for vestibular stroke confirmation.

RESULTS

Out of 76 patients, 52 were diagnosed with acute unilateral vestibulopathy and 24 with vestibular strokes. The overall accuracy of detecting stroke with an automated vestibulo-ocular reflex gain was 86.8%, compared to 77.6% for cumulative saccade amplitude and automatic saccade mean peak velocity measured by an expert and 71% for cumulative saccade amplitude and saccade mean peak velocity measured automatically. Gain misclassified 13.1% of the patients as false positive or false negative, manual cumulative saccade amplitude and saccade mean peak velocity 22.3%, and automated cumulative saccade amplitude and saccade mean peak velocity 28.9% respectively.

CONCLUSIONS

We found a better accuracy of video head impulse test for the diagnosis of vestibular strokes when using the vestibulo-ocular reflex gain than using saccade metrics. Nevertheless, saccades provide an additional and important information for video head impulse test evaluation. The automated saccade detection algorithm is not yet perfect compared to expert analysis, but it may become a valuable tool for future non-expert video head impulse test evaluations.

Measuring the Influence of Magnetic Vestibular Stimulation on Nystagmus, Self-Motion Perception, and Cognitive Performance in a 7T MRT

Strong magnetic fields induce dizziness, vertigo, and nystagmus due to Lorentz forces acting on the cupula in the semi-circular canals, an effect called magnetic vestibular stimulation (MVS). In this article, we present an experimental setup in a 7T MRT scanner (MRI scanner) that allows the investigation of the influence of strong magnetic fields on nystagmus as well as perceptual and cognitive responses. The strength of MVS is manipulated by altering the head positions of the participants. The orientation of the participants' semicircular canals with respect to the static magnetic field is assessed by combining a 3D magnetometer and 3D constructive interference in steady-state (3D-CISS) images. This approach allows to account for intra- and inter-individual differences in participants' responses to MVS. In the future, MVS can be useful for clinical research, for example, in the investigation of compensatory processes in vestibular disorders. Furthermore, it could foster insights into the interplay between vestibular information and cognitive processes in terms of spatial cognition and the emergence of self-motion percepts under conflicting sensory information. In fMRI studies, MVS can elicit a possible confounding effect, especially in tasks influenced by vestibular information or in studies comparing vestibular patients with healthy controls.

Artificial intelligence for early stroke diagnosis in acute vestibular syndrome

Objective

Measuring the Vestibular-Ocular-Reflex (VOR) gains with the video head impulse test (vHIT) allows for accurate discrimination between peripheral and central causes of acute vestibular syndrome (AVS). In this study, we sought to investigate whether the accuracy of artificial intelligence (AI) based vestibular stroke classification applied in unprocessed vHIT data is comparable to VOR gain classification.

Methods

We performed a prospective study from July 2015 until April 2020 on all patients presenting at the emergency department (ED) with signs of an AVS. The patients underwent vHIT followed by a delayed MRI, which served as a gold standard for stroke confirmation. The MRI ground truth labels were then applied to train a recurrent neural network (long short-term memory architecture) that used eye- and head velocity time series extracted from the vHIT examinations.

Results

We assessed 57 AVS patients, 39 acute unilateral vestibulopathy patients (AUVP) and 18 stroke patients. The overall sensitivity, specificity and accuracy for detecting stroke with a VOR gain cut-off of 0.57 was 88.8, 92.3, and 91.2%, respectively. The trained neural network was able to classify strokes with a sensitivity of 87.7%, a specificity of 88.4%, and an accuracy of 87.9% based on the unprocessed vHIT data. The accuracy of these two methods was not significantly different (p = 0.09).

Conclusion

AI can accurately diagnose a vestibular stroke by using unprocessed vHIT time series. The quantification of eye- and head movements with the use of machine learning and AI can serve in the future for an automated diagnosis in ED patients with acute dizziness. The application of different neural network architectures can potentially further improve performance and enable direct inference from raw video recordings.

Influence of Soldiers' Cardiorespiratory Fitness on Physiological Responses and Dropouts During a Loaded Long-distance March

INTRODUCTION

In military service, marching is an important, common, and physically demanding task. Minimizing dropouts, maintaining operational readiness during the march, and achieving a fast recovery are desirable because the soldiers have to be ready for duty, sometimes shortly after an exhausting task. The present field study investigated the influence of the soldiers' cardiorespiratory fitness on physiological responses during a long-lasting and challenging 34 km march.

MATERIALS AND METHODS

Heart rate (HR), body core temperature (BCT), total energy expenditure (TEE), energy intake, motivation, and pain sensation were investigated in 44 soldiers (20.3 ± 1.3 years, 178.5 ± 7.0 cm, 74.8 ± 9.8 kg, body mass index: 23.4 ± 2.7 kg × m-2, peak oxygen uptake ($\dot{\rm{V}}$O2peak): 54.2 ± 7.9 mL × kg-1 × min-1) during almost 8 hours of marching. All soldiers were equipped with a portable electrocardiogram to record HR and an accelerometer on the hip, all swallowed a telemetry pill to record BCT, and all filled out a pre- and post-march questionnaire. The influence of aerobic capacity on the physiological responses during the march was examined by dividing the soldiers into three fitness groups according to their $\dot{\rm{V}}$O2peak.

RESULTS

The group with the lowest aerobic capacity ($\dot{\rm{V}}$O2peak: 44.9 ± 4.8 mL × kg-1 × min-1) compared to the group with the highest aerobic capacity ($\dot{\rm{V}}$O2peak: 61.7 ± 2.2 mL × kg-1 × min-1) showed a significantly higher (P < .05) mean HR (133 ± 9 bpm and 125 ± 8 bpm, respectively) as well as peak BCT (38.6 ± 0.3 and 38.4 ± 0.2 °C, respectively) during the march. In terms of recovery ability during the break, no significant differences could be identified between the three groups in either HR or BCT. The energy deficit during the march was remarkably high, as the soldiers could only replace 22%, 26%, and 36% of the total energy expenditure in the lower, middle, and higher fitness group, respectively. The cardiorespiratory fittest soldiers showed a significantly higher motivation to perform when compared to the least cardiorespiratory fit soldiers (P = .002; scale from 1 [not at all] to 10 [extremely]; scale difference of 2.3). A total of nine soldiers (16%) had to end marching early: four soldiers (21%) in the group with the lowest aerobic capacity, five (28%) in the middle group, and none in the highest group.

CONCLUSION

Soldiers with a high $\dot{\rm{V}}$O2peak showed a lower mean HR and peak BCT throughout the long-distance march, as well as higher performance motivation, no dropouts, and lower energy deficit. All soldiers showed an enormous energy deficit; therefore, corresponding nutritional strategies are recommended.

Detecting Soldiers' Fatigue Using Eye-Tracking Glasses: Practical Field Applications and Research Opportunities

INTRODUCTION

Objectively determining soldiers' fatigue levels could help prevent injuries or accidents resulting from inattention or decreased alertness. Eye-tracking technologies, such as optical eye tracking (OET) and electrooculography (EOG), are often used to monitor fatigue. Eyeblinks-especially blink frequency and blink duration-are known as easily observable and valid biomarkers of fatigue. Currently, various eye trackers (i.e., eye-tracking glasses) are available on the market using either OET or EOG technologies. These wearable eye trackers offer several advantages, including unobtrusive functionality, practicality, and low costs. However, several challenges and limitations must be considered when implementing these technologies in the field to monitor fatigue levels. This review investigates the feasibility of eye tracking in the field focusing on the practical applications in military operational environments.

MATERIALS AND METHOD

This paper summarizes the existing literature about eyeblink dynamics and available wearable eye-tracking technologies, exposing challenges and limitations, as well as discussing practical recommendations on how to improve the feasibility of eye tracking in the field.

RESULTS

So far, no eye-tracking glasses can be recommended for use in a demanding work environment. First, eyeblink dynamics are influenced by multiple factors; therefore, environments, situations, and individual behavior must be taken into account. Second, the glasses' placement, sunlight, facial or body movements, vibrations, and sweat can drastically decrease measurement accuracy. The placement of the eye cameras for the OET and the placement of the electrodes for the EOG must be chosen consciously, the sampling rate must be minimal 200 Hz, and software and hardware must be robust to resist any factors influencing eye tracking.

CONCLUSION

Monitoring physiological and psychological readiness of soldiers, as well as other civil professionals that face higher risks when their attention is impaired or reduced, is necessary. However, improvements to eye-tracking devices' hardware, calibration method, sampling rate, and algorithm are needed in order to accurately monitor fatigue levels in the field.

Validation of ambulatory monitoring devices to measure energy expenditure and heart rate in a military setting

Objectives.To investigate the validity of different devices and algorithms used in military organizations worldwide to assess physical activity energy expenditure (PAEE) and heart rate (HR) among soldiers.Design.Device validation study.Methods. Twenty-three male participants serving their mandatory military service accomplished, firstly, nine different military specific activities indoors, and secondly, a normal military routine outdoors. Participants wore simultaneously an ActiHeart, Everion, MetaMax 3B, Garmin Fenix 3, Hidalgo EQ02, and PADIS 2.0 system. The PAEE and HR data of each system were compared to the criterion measures MetaMax 3B and Hidalgo EQ02, respectively.Results. Overall, the recorded systematic errors in PAEE estimation ranged from 0.1 (±1.8) kcal.min^-1to -1.7 (±1.8) kcal.min^-1for the systems PADIS 2.0 and Hidalgo EQ02 running the Royal Dutch Army algorithm, respectively, and in the HR assessment ranged from -0.1 (±2.1) b.min^-1to 0.8 (±3.0) b.min^-1for the PADIS 2.0 and ActiHeart systems, respectively. The mean absolute percentage error (MAPE) in PAEE estimation ranged from 29.9% to 75.1%, with only the Everion system showing an overall MAPE <30%, but all investigated devices reported overall MAPE <1.4% in the HR assessment.Conclusions. The present study demonstrated poor to moderate validity in terms of PAEE estimation, but excellent validity in all investigated devices in terms of HR assessment. Overall, the Everion performed among the best in both parameters and with a device placement on the upper arm, the Everion system is particularly useful during military service, as it does not interfere with other relevant equipment.

Self-Reported Emotion Regulation Is Associated With Response to Test of Cardiac Vagal Function

Abstract. Parasympathetic function and emotional self-regulation (ESR) share neuroanatomic structures. Based on Porges’ Polyvagal Theory and the Neurovisceral Integration Model (NIM), we compared vagally mediated heart-rate variability (vmHRV) with psychometrically assessed ESR. We hypothesized that vmHRV and ESR would be associated during rest, a vagal function test, and recovery from that test. A significant association would justify the psychometric measuring of parasympathetic health, which is less burdensome than its psychophysiological assessment. Two hundred thirteen healthy males (aged: 18–26 years, M = 20.29 years) took part in the present study. They completed the Emotion Regulation Questionnaire (ERQ) and underwent the Cold Face Test (CFT) for 4 min wearing ambulatory electrocardiograms. A High frequency (HF) band was used as a measure of vmHRV before, during, and after the CFT. Associations between the HF band and ESR were analyzed with partial rank correlations. There was no significant association between ERQ scores and the response to the CFT itself. But there was an almost significant association between the ERQ scale Cognitive Appraisal and baseline vmHRV, and a significant association between Cognitive Appraisal and cardiac recovery from the CFT, that is, participants with higher scores on that ESR scale revealed a tendency to exhibit greater vmHRV during baseline and they exhibited greater vagal withdrawal during recovery from the CFT. Cognitive appraisal as a psychometrically assessed emotion regulatory process was reflected in a more flexible parasympathetic activity (i.e., better cardiac vagal health) during recovery from an exclusively physiological stressor. This lends convergent validity to self-reported emotion regulation, and justification for its use as a measure of ESR as a trait, offering further support for the Polyvagal Theory and NIM.

Impaired fixation suppression of horizontal vestibular nystagmus during smooth pursuit: pathophysiology and clinical implications

Background and purpose

A peripheral spontaneous nystagmus (SN) is typically enhanced or revealed by removing fixation. Conversely, failure of fixation suppression of SN is usually a sign of a central disorder. Based on Luebke and Robinson (Vision Res 1988, vol. 28 (8), pp. 941–946), who suggested that the normal fixation mechanism is disengaged during pursuit, it is hypothesized that vertical tracking in the light would bring out or enhance a horizontal SN.

Methods

Eighteen patients with acute vestibular neuritis were studied. Eye movements were recorded using video‐oculography at straight‐ahead gaze with and without visual fixation, and during smooth pursuit. The slow‐phase velocity and the fixation suppression indices of nystagmus (relative to SN in darkness) were compared in each condition.

Results

During vertical tracking, the slow‐phase velocity of horizontal SN with eyes near straight‐ahead gaze was significantly higher (median 2.7°/s) than under static visual fixation (median 1.2°/s). Likewise, the fixation index was significantly higher (worse suppression) during pursuit (median 48%) than during fixation (median 26%). A release of SN was also suggested during horizontal pursuit, if one assumes superposition of SN on a normal and symmetrical pursuit capability.

Resilience as a Protective Factor in Basic Military Training, a Longitudinal Study of the Swiss Armed Forces

For recruits, basic military training (BMT) can be experienced as a stressful episode in which relevant protective factors such as resilience might be essential for successful completion of the training. The present study examined whether resilience would act as a protective factor during BMT in the Swiss Armed Forces. To this end, we conducted a cross-sectional and longitudinal study of resilience and psychological burden. At the beginning of the BMT and at week 11, 525 male recruits (mean age: 20.3 years) completed a series of questionnaires covering demographic information and assessing resilience, perceived stress and mental distress. In parallel, their superiors rated recruits' military performance in week 13. Dropout rates were also registered. Cross-sectionally and longitudinally, higher resilience scores predicted lower scores for perceived stress, mental distress, and better military performance. Higher self-rated resilience was moderately associated with military performance, as rated by recruits' superiors. Resilience scores, perceived stress and mental distress did not differ between those recruits continuing their BMT and dropouts. In support of our assumptions, resilience acted as a protective factor during Swiss Armed Forces BMT.

Stroke Prediction Based on the Spontaneous Nystagmus Suppression Test in Dizzy Patients: A Diagnostic Accuracy Study

OBJECTIVE

Failure of fixation suppression of spontaneous nystagmus is sometimes seen in patients with vestibular strokes involving the cerebellum or brainstem; however, the accuracy of this test for the discrimination between peripheral and central causes in patients with an acute vestibular syndrome (AVS) is unknown.

METHODS

Patients with AVS were screened and recruited (convenience sample) as part of a prospective cross-sectional study in the emergency department between 2015 and 2020. All patients received neuroimaging, which served as a reference standard. We recorded fixation suppression with video-oculography (VOG) for forward, right, and left gaze. The ocular fixation index (OFI) and the spontaneous nystagmus slow velocity reduction was calculated.

RESULTS

We screened 1,646 patients reporting dizziness in the emergency department and tested for spontaneous nystagmus in 148 patients with AVS. We analyzed 56 patients with a diagnosed acute unilateral vestibulopathy (vestibular neuritis) and 28 patients with a confirmed stroke. There was a complete nystagmus fixation suppression in 49.5% of patients with AVS, in 40% of patients with vestibular neuritis, and in 62.5% of patients with vestibular strokes. OFI scores had no predictive value for detecting strokes; however, a nystagmus reduction of less than 2 °/s showed a high accuracy of 76.9% (confidence interval 0.59-0.89) with a sensitivity of 62.2% and specificity of 84.8% in detecting strokes.

CONCLUSIONS

The presence of fixation suppression does not rule out a central lesion. The magnitude of suppression was lower compared to patients with vestibular neuritis. The nystagmus suppression test predicts vestibular strokes accurately provided that eye movements are recorded with VOG.

CLASSIFICATION OF EVIDENCE

This study provides Class II evidence that in patients with an AVS, decreased fixation suppression recorded with VOG occurred more often in stroke (76.9%) than in vestibular neuritis (37.8%).

Eyeblink Detection in the Field: A Proof of Concept Study of Two Mobile Optical Eye-Trackers

Introduction

High physical and cognitive strain, high pressure, and sleep deficit are part of daily life for military professionals and civilians working in physiologically demanding environments. As a result, cognitive and physical capacities decline and the risk of illness, injury, or accidents increases. Such unfortunate outcomes could be prevented by tracking real-time physiological information, revealing individuals’ objective fatigue levels. Oculometrics, and especially eyeblinks, have been shown to be promising biomarkers that reflect fatigue development. Head-mounted optical eye-trackers are a common method to monitor these oculometrics. However, studies measuring eyeblink detection in real-life settings have been lacking in the literature. Therefore, this study aims to validate two current mobile optical eye-trackers in an unrestrained military training environment.

Materials and Method

Three male participants (age 20.0 ± 1.0) of the Swiss Armed Forces participated in this study by wearing three optical eye-trackers, two VPS16s (Viewpointsystem GmbH, Vienna, Austria) and one Pupil Core (Pupil Labs GmbH, Berlin, Germany), during four military training events: Healthcare education, orienteering, shooting, and military marching. Software outputs were analyzed against a visual inspection (VI) of the video recordings of participants’ eyes via the respective software. Absolute and relative blink numbers were provided. Each blink detected by the software was classified as a “true blink” (TB) when it occurred in the software output and the VI at the same time, as a “false blink” (FB) when it occurred in the software but not in the VI, and as a “missed blink” (MB) when the software failed to detect a blink that occurred in the VI. The FBs were further examined for causes of the incorrect recordings, and they were divided into four categories: “sunlight,” “movements,” “lost pupil,” and “double-counted”. Blink frequency (i.e., blinks per minute) was also analyzed.

Results

Overall, 49.3% and 72.5% of registered eyeblinks were classified as TBs for the VPS16 and Pupil Core, respectively. The VPS16 recorded 50.7% of FBs and accounted for 8.5% of MBs, while the Pupil Core recorded 27.5% of FBs and accounted for 55.5% of MBs. The majority of FBs—45.5% and 73.9% for the VPS16 and Pupil Core, respectively—were erroneously recorded due to participants’ eye movements while looking up, down, or to one side. For blink frequency analysis, systematic biases (±limits of agreement) stood at 23.3 (±43.5) and −4.87 (±14.1) blinks per minute for the VPS16 and Pupil Core, respectively. Significant differences in systematic bias between devices and the respective VIs were found for nearly all activities (P < .05).

Conclusion

An objective physiological monitoring of fatigue is necessary for soldiers as well as civil professionals who are exposed to higher risks when their cognitive or physical capacities weaken. However, optical eye-trackers’ accuracy has not been specified under field conditions—especially not in monitoring fatigue. The significant overestimation and underestimation of the VPS16 and Pupil Core, respectively, demonstrate the general difficulty of blink detection in the field.

Device-Based Measures of Sedentary Time and Physical Activity Are Associated With Physical Fitness and Body Fat Content

Introduction/Purpose: Physical activity and sedentary time may associate with physical fitness and body composition. Yet, there exists some observational studies that have investigated the associations of device-based measures of sedentary time and physical activity (PA) with cardiorespiratory fitness (CRF) and body composition but associations with muscular fitness (MF) are less studied.

Methods: Objective sedentary time and physical activity was measured by a hip worn accelerometer from 415 young adult men (age: mean 26, standard deviation 7 years). Cardiorespiratory fitness (VO₂max) (CRF) was determined using a graded cycle ergometer test until exhaustion. Maximal force of lower extremities was measured isometrically and lower body power was assessed using standing long jump (MF). Body composition was determined with bioimpedance method. Single and compositional approach was used in regression analysis.

Results: Mean sedentary time was 707 (standard deviation 133) minutes per day (77 ± 8% of the wear time). Volumes of all PA intensities were positively associated with CRF and associations showed linearly increasing magnitudes with higher intensities in single regression models adjusted for age and smoking (p < 0.001). Similarly, PA intensities were positively associated with lower body MF, however, with weaker associations (p < 0.005). After further adjustment for resistance training, the associations remained significant. The associations of the relative distribution of time within sedentary behavior (SB), light intensity PA (LPA) and moderate-to-vigorous PA (MVPA) behaviors as a whole with using compositional analysis further revealed that within the composition MVPA and SB were positively associated with CRF and MF (p < 0.001), while LPA was not. In addition, within the composition, accumulated PA bouts lasting more than 3 min were consistently associated with CRF and MF, and with all body composition variables (p < 0.001), while sedentary time was associated with body fat percentage (p < 0.001).

Conclusion: Promoting physical activity and reducing sedentary time may have positive influence on physical fitness and body fat content, and thereby may offer positive health effects. Physical activity of higher intensities may offer greater benefits.

Alexander's Law During High-Speed, Yaw-Axis Rotation: Adaptation or Saturation?

Objective: Alexander's law (AL) states the intensity of nystagmus increases when gaze is toward the direction of the quick phase. What might be its cause? A gaze-holding neural integrator (NI) that becomes imperfect as the result of an adaptive process, or saturation in the discharge of neurons in the vestibular nuclei? Methods: We induced nystagmus in normal subjects using a rapid chair acceleration around the yaw (vertical) axis to a constant velocity of 200°/second [s] and then, 90 s later, a sudden stop to induce post-rotatory nystagmus (PRN). Subjects alternated gaze every 2 s between flashing LEDs (right/left or up/down). We calculated the change in slow-phase velocity (ΔSPV) between right and left gaze when the lateral semicircular canals (SCC) were primarily stimulated (head upright) or, with the head tilted to the side, stimulating the vertical and lateral SCC together. Results: During PRN AL occurred for horizontal eye movements with the head upright and for both horizontal and vertical components of eye movements with the head tilted. AL was apparent within just a few seconds of the chair stopping when peak SPV of PRN was reached. When slow-phase velocity of PRN faded into the range of 6-18°/s AL could no longer be demonstrated. Conclusions: Our results support the idea that AL is produced by asymmetrical responses within the vestibular nuclei impairing the NI, and not by an adaptive response that develops over time. AL was related to the predicted plane of eye rotations in the orbit based on the pattern of SCC activation.

Management of acute and chronic aortic disease during the COVID-19 pandemic-Results from a web-based ad hoc platform

Background

To share the results of a web‐based expert panel discussion focusing on the management of acute and chronic aortic disease during the coronavirus (COVID‐19) pandemic.

Methods

A web‐based expert panel discussion on April 18, 2020, where eight experts were invited to share their experience with COVID‐19 disease touching several aspects of aortic medicine. After each talk, specific questions were asked by the online audience, and results were immediately evaluated and shared with faculty and participants.

Results

As of April 18, 73.3% answered that more than 200 patients have been treated at their respective settings. Sixty‐four percent were reported that their hospital was well prepared for the pandemic. In 57.7%, the percentage of infected healthcare professionals was below 5% whereas 19.2% reported the percentage to be between 10% and 20%. Sixty‐seven percent reported the application of extracorporeal membrane oxygenation in less than 2% of COVID‐19 patients whereas 11.8% reported application in 5%–10% of COVID‐19 patients. Thirty percent of participants reported the occurrence of pulmonary embolism in COVID‐19 patients. Three percent reported to have seen aortic ruptures in primarily elective patients having been postponed because of the anticipated need to provide sufficient ICU capacity because of the pandemic. Nearly 70% reported a decrease in acute aortic syndrome referrals since the start of the pandemic.

Conclusion

The current COVID‐19 pandemic has—besides the stoppage of elective referrals—also led to a decrease of referrals of acute aortic syndromes in many settings. The reluctance of patients seeking medical help seems to be a major driver. The number of patients, who have been postponed due to the provisioning of ICU resources but having experienced aortic rupture in the waiting period, is still low. Further, studies are needed to learn more about the influence that the COVID‐19 pandemic has on the treatment of patients with acute and chronic aortic disease.

Residential Altitude Associates With Endurance but Not Muscle Power in Young Swiss Men

Introduction

Physical fitness benefits health. However, there is a research gap on how physical fitness, particularly aerobic endurance capacity and muscle power, is influenced by residential altitude, blood parameters, weight, and other cofactors in a population living at low to moderate altitudes (300–2100 masl).

Materials and Methods

We explored how endurance and muscle power performance changes with residential altitude, Body Mass Index (BMI), hemoglobin and creatinine levels among 108,677 Swiss men aged 18–22 years (covering >90% of Swiss birth cohorts) conscripted to the Swiss Armed Forces between 2007 and 2012. The test battery included a blood test of about 65%, a physical evaluation of about 85%, and the BMI of all conscripts.

Results

Residential altitude was significantly associated with endurance (p < 0.001) but not with muscle power performance (p = 0.858) after adjusting for all available cofactors. Higher BMI showed the greatest negative association with both endurance and muscle power performance. For muscle power performance, the association with creatinine levels was significant. Elevated C-reactive protein (CRP) and hemoglobin levels were stronger contributors in explaining endurance than muscle power performance.

Conclusion

We found a significant association between low to moderate residential altitude and aerobic endurance capacity even after adjustment for hemoglobin, creatinine, BMI and sociodemographic factors. Non-assessed factors such as vitamin D levels, air pollution, and lifestyle aspects may explain the presented remaining association partially and could also be associated with residential altitude. Monitoring the health and fitness of young people and their determinants is important and of practical concern for disease prevention and public health implications.

Accuracy of Distance Recordings in Eight Positioning-Enabled Sport Watches: Instrument Validation Study

Background

Elite athletes and recreational runners rely on the accuracy of global navigation satellite system (GNSS)–enabled sport watches to monitor and regulate training activities. However, there is a lack of scientific evidence regarding the accuracy of such sport watches.

Objective

The aim was to investigate the accuracy of the recorded distances obtained by eight commercially available sport watches by Apple, Coros, Garmin, Polar, and Suunto when assessed in different areas and at different speeds. Furthermore, potential parameters that affect the measurement quality were evaluated.

Methods

Altogether, 3 × 12 measurements in urban, forest, and track and field areas were obtained while walking, running, and cycling under various outdoor conditions.

Results

The selected reference distances ranged from 404.0 m to 4296.9 m. For all the measurement areas combined, the recorded systematic errors (±limits of agreements) ranged between 3.7 (±195.6) m and –101.0 (±231.3) m, and the mean absolute percentage errors ranged from 3.2% to 6.1%. Only the GNSS receivers from Polar showed overall errors <5%. Generally, the recorded distances were significantly underestimated (all P values <.04) and less accurate in the urban and forest areas, whereas they were overestimated but with good accuracy in 75% (6/8) of the sport watches in the track and field area. Furthermore, the data assessed during running showed significantly higher error rates in most devices compared with the walking and cycling activities.

Conclusions

The recorded distances might be underestimated by up to 9%. However, the use of all investigated sport watches can be recommended, especially for distance recordings in open areas.

Distal Stent Graft-Induced New Entry After TEVAR or FET: Insights Into a New Disease From EuREC

BACKGROUND

The study sought to learn about incidence and reasons for distal stent graft-induced new entry (dSINE) after thoracic endovascular aortic repair (TEVAR) or after frozen elephant trunk (FET) implantation, and develop prevention algorithms.

METHODS

In an analysis of an international multicenter registry (EuREC [European Registry of Endovascular Aortic Repair Complications] registry), we found 69 dSINE patients of 1430 (4.8%) TEVAR patients with type B aortic dissection and 6 dSINE patients of 100 (6%) patients after the FET procedure for aortic dissection with secondary morphological comparison.

RESULTS

The underlying aortic pathology was acute type B aortic dissection in 33 (44%) patients, subacute or chronic type B aortic dissection in 34 (45%) patients, acute type A aortic dissection in 3 patients and remaining dissection after type A repair in 3 (8%) patients, and acute type B intramural hematoma in 2 (3%) patients. dSINE occurred in 4.4% of patients in the acute setting and in 4.9% of patients in the subacute or chronic setting after TEVAR. After the FET procedure, dSINE occurred in 5.3% of patients in the acute setting and in 6.5% of patients in the chronic setting. The interval between TEVAR or FET and the diagnosis of dSINE was 489 ± 681 days. Follow-up after dSINE was 1340 ± 1151 days, and 4 (5%) patients developed recurrence of dSINE. Morphological analysis between patients after TEVAR with and without dSINE showed a smaller true lumen diameter, a more accentuated oval true lumen morphology, and a higher degree of stent graft oversizing in patients who developed dSINE.

CONCLUSIONS

dSINE after TEVAR or FET is not rare and occurs with similar incidence after acute and chronic aortic dissection (early and late). Avoiding oversizing in the acute and chronic settings as well as carefully selecting patients for TEVAR in postdissection aneurysmal formation will aid in reducing the incidence of dSINE to a minimum.

Dopamine-Induced Dysconnectivity Between Salience Network and Auditory Cortex in Subjects With Psychotic-like Experiences: A Randomized Double-Blind Placebo-Controlled Study

Dopamine is involved in the pathophysiology of schizophrenia. Disrupted salience processing by the salience network (SN) may be a central link between dysregulated dopamine function and psychotic symptoms. However, dopaminergic influence on the SN and its presumed influence on psychotic and subpsychotic symptoms or psychotic-like experiences in healthy individuals remain unclear. Therefore, we investigated dopamine-induced changes in functional connectivity of the right anterior insula (rAI), a central SN hub, and their association with psychotic-like experiences. We enrolled 54 healthy, right-handed male subjects in a randomized, double-blind, cross-sectional placebo-controlled experiment. Psychotic-like experiences were assessed using the revised Exceptional Experiences Questionnaire (PAGE-R). They then received either placebo (n = 32) or 200 mg L-DOPA (n = 33), a dopamine precursor, orally and underwent resting-state functional magnetic resonance imaging. In a seed-to-voxel approach, we analyzed dopamine-induced changes in functional connectivity of the rAI and assessed the relationship between functional connectivity changes and PAGE-R score. L-DOPA reduced functional connectivity between the rAI and the left auditory cortex planum polare. In the placebo group, we found a strong negative correlation between PAGE-R score and rAI to planum polare functional connectivity; in the L-DOPA group, there was a strong positive correlation between PAGE-R score and functional connectivity between rAI and planum polare. The PAGE-R score explained about 30% of the functional connectivity variation between rAI and planum polare in the two groups. Our findings suggest that psychotic-like experiences are associated with dopamine-induced disruption of auditory input to the SN, which may lead to aberrant attribution of salience.

Accuracy of the Multisensory Wristwatch Polar Vantage's Estimation of Energy Expenditure in Various Activities: Instrument Validation Study

Background

Sport watches and fitness trackers provide a feasible way of obtaining energy expenditure (EE) estimations in daily life as well as during exercise. However, today’s popular wrist-worn technologies show only poor-to-moderate EE accuracy. Recently, the invention of optical heart rate measurement and the further development of accelerometers in wrist units have opened up the possibility of measuring EE.

Objective

This study aimed to validate the new multisensory wristwatch Polar Vantage and its EE estimation in healthy individuals during low-to-high-intensity activities against indirect calorimetry.

Methods

Overall, 30 volunteers (15 females; mean age 29.5 [SD 5.1] years; mean height 1.7 [SD 0.8] m; mean weight 67.5 [SD 8.7] kg; mean maximal oxygen uptake 53.4 [SD 6.8] mL/min·kg) performed 7 activities—ranging in intensity from sitting to playing floorball—in a semistructured indoor environment for 10 min each, with 2-min breaks in between. These activities were performed while wearing the Polar Vantage M wristwatch and the MetaMax 3B spirometer.

Results

After EE estimation, a mean (SD) of 69.1 (42.7) kcal and 71.4 (37.8) kcal per 10-min activity were reported for the MetaMax 3B and the Polar Vantage, respectively, with a strong correlation of r=0.892 (P<.001). The systematic bias was 2.3 kcal (3.3%), with 37.8 kcal limits of agreement. The lowest mean absolute percentage errors were reported during the sitting and reading activities (9.1%), and the highest error rates during household chores (31.4%). On average, 59.5% of the mean EE values obtained by the Polar Vantage were within ±20% of accuracy when compared with the MetaMax 3B. The activity intensity quantified by perceived exertion (odds ratio [OR] 2.028; P<.001) and wrist circumference (OR −1.533; P=.03) predicted 29% of the error rates within the Polar Vantage.

Conclusions

The Polar Vantage has a statistically moderate-to-good accuracy in EE estimation that is activity dependent. During sitting and reading activities, the EE estimation is very good, whereas during nonsteady activities that require wrist and arm movement, the EE accuracy is only moderate. However, compared with other available wrist-worn EE monitors, the Polar Vantage can be recommended, as it performs among the best.

Schizotypal Traits are Linked to Dopamine-Induced Striato-Cortical Decoupling: A Randomized Double-Blind Placebo-Controlled Study

The dopamine hypothesis of schizophrenia implies that alterations in the dopamine system cause functional abnormalities in the brain that may converge to aberrant salience attribution and eventually lead to psychosis. Indeed, widespread brain disconnectivity across the psychotic spectrum has been revealed by resting-state functional magnetic resonance imaging (rs-fMRI). However, the dopaminergic involvement in intrinsic functional connectivity (iFC) and its putative relationship to the development of psychotic spectrum disorders remains partly unclear-in particular at the low-end of the psychosis continuum. Therefore, we investigated dopamine-induced changes in striatal iFC and their modulation by psychometrically assessed schizotypy. Our randomized, double-blind placebo-controlled study design included 54 healthy, right-handed male participants. Each participant was assessed with the Schizotypal Personality Questionnaire (SPQ) and underwent 10 minutes of rs-fMRI scanning. Participants then received either a placebo or 200 mg of L-DOPA, a dopamine precursor. We analyzed iFC of 6 striatal seeds that are known to evoke modulation of dopamine-related networks. The main effect of L-DOPA was a significant functional decoupling from the right ventral caudate to both occipital fusiform gyri. This dopamine-induced decoupling emerged primarily in participants with low SPQ scores, while participants with high positive SPQ scores showed decoupling indifferently of the L-DOPA challenge. Taken together, these findings demonstrate that schizotypal traits may be the result of dopamine-induced striato-occipital decoupling.

Development of physical fitness performance in young Swiss men from 2006 to 2015

From 1980 to 2000, physical fitness decreased and body mass index (BMI) increased in the population of many industrialized countries. Little is known about these trends after the year 2000. This study aimed to investigate physical fitness performance, physical activity (PA) behavior, and BMI of young, male Swiss adults between 2006 and 2015. For this purpose, results from the Swiss Armed Forces mandatory recruitment were used. A total of 306 746 male conscripts provided complete fitness test data, mean ± SD (range from 5th to 95th percentile): 20 ± 1 (18‐21) years, 178 ± 7 (168‐189) cm; 74 ± 13 (58‐97) kg, predicted maximal oxygen consumption of 49.9 ± 4.6 (41.8‐56.9) mL/kg/min (Conconi test), 125 ± 58 (43‐232) seconds in trunk muscle strength test (prone bridge), 2.31 ± 0.24 (1.90‐2.66) m in standing long jump, 6.46 ± 0.73 (5.30‐7.70) m in seated shot put (2 kg medical‐ball shot) and 45.6 ± 12.2 (29.9‐66.7) seconds in one‐leg standing test (sum of both legs; eyes closed after 10 seconds and head tilted back after 20 seconds). In the investigated population, 73.8% fulfilled basic PA recommendations, 46.2% were classified as regularly vigorously active. Performances in aerobic endurance and muscle power did not show secular changes over time. However, core stability performance and PA behavior increased, while balance ability decreased over this 10‐year period. Average BMI increased by 2.0% between 2006 and 2010 and did not change thereafter. Male Swiss adults are at least as physically fit as they were a decade ago. The secular trends of decreasing physical performances and increasing BMI have stopped, and self‐reported sport participation and leisure time PA have been increased in the observed population over the last 10 years.

Associations between digit ratio (2D4D), mood, and autonomic stress response in healthy men

The ratio between the length of the second (index) and the fourth (ring) finger (2D4D) is a putative biomarker of prenatal testosterone (T) exposure, with higher exposure leading to a smaller ratio. 2D4D has further been linked to mental and somatic disorders. Healthy male Swiss recruits (N = 245; M_age = 20.30 years) underwent a psychosocial stress test. Mood and salivary alpha-amylase (sAA) were assessed before and after the stress test, while heart rate (HR) and heart rate variability (HRV) were measured continuously. Additionally, 2D4D (right: R2D4D; left: L2D4D) was determined and divided into quartile groups. Correlation analysis showed no associations between R/L2D4D and outcome measures. Comparing calculated quartiles for R2D4D, subjects in the lowest R2D4D quartile expressed trendwise (p < 0.10) lower positive and higher negative affect, significantly elevated sAA activity (p < 0.05), but no HR and HRV differences at baseline as compared to subjects in the upper three quartiles. With regard to acute stress, subjects in the lowest as compared to subjects in the upper three R2D4D quartiles showed a higher increase of negative affect and a stronger cardiac response (p < 0.05), but no alterations in positive affect and sAA activity. Young healthy men in the lowest R2D4D quartile revealed a more negative affect and increased physiological activity at baseline and in response to acute stress. An exposure to high levels of prenatal T might constitute a risk factor potentially increasing vulnerability to stress-related disorders in men.

An evaluation of measurement systems estimating gait speed during a loaded military march over graded terrain

This study aimed to evaluate the accuracy of three measurement systems estimating gait speed during a loaded military march over graded terrain. Systems developed by the Swiss and Netherlands Armed Forces and a commercial wrist-based device were evaluated in comparison to a Global Positioning System. The first part of the paper focuses on the development of the Dutch system, where speed is estimated from a chest worn accelerometer and body measurements. For this validation study 36 subjects were walking or running 13 laps of 200 m at different speeds. Results showed that walking and running speed can be estimated with a R²_adj of 0.968 and 0.740, respectively. In the second part of this paper, data from 64 soldiers performing a 35 km march were used to evaluate the accuracy of three measurement systems in estimating speed. Data showed that estimating gait speed with a single accelerometer can be accurate for military activity, even without prior individual calibration measurements. However, predictions should be corrected for confounders such as body size and shoe type to be accurate. Both, downhill and uphill walking led to changes in gait characteristics and to an overestimation of speed by up to 10%. Correcting for slope or gradient using altimetry in future algorithms/experiments could improve the estimation of gait speed.

Validity of sports watches when estimating energy expenditure during running

Background

The aim of this study was to assess the accuracy of three different sport watches in estimating energy expenditure during aerobic and anaerobic running.

Methods

Twenty trained subjects ran at different intensities while wearing three commercial sport watches (Suunto Ambit2, Garmin Forerunner920XT, and Polar V800). Indirect calorimetry was used as the criterion measure for assessing energy expenditure. Different formulas were applied to compute energy expenditure from the gas exchange values for aerobic and anaerobic running.

Results

The accuracy of the energy expenditure estimations was intensity-dependent for all tested watches. During aerobic running (4–11 km/h), mean absolute percentage error values of −25.16% to +38.09% were observed, with the Polar V800 performing most accurately (stage 1: −12.20%, stage 2: −3.61%, and stage 3: −4.29%). The Garmin Forerunner920XT significantly underestimated energy expenditure during the slowest stage (stage 1: −25.16%), whereas, the Suunto Ambit2 significantly overestimated energy expenditure during the two slowest stages (stage 1: 38.09%, stage 2: 36.29%). During anaerobic running (14–17 km/h), all three watches significantly underestimated energy expenditure by −21.62% to −49.30%. Therefore, the error in estimating energy expenditure systematically increased as the anaerobic running speed increased.

Conclusions

To estimate energy expenditure during aerobic running, the Polar V800 is recommended. By contrast, the other two watches either significantly overestimated or underestimated energy expenditure during most running intensities. The energy expenditure estimations generated during anaerobic exercises revealed large measurement errors in all tested sport watches. Therefore, the algorithms for estimating energy expenditure during intense activities must be improved before they can be used to monitor energy expenditure during high-intensity physical activities.

Physical fitness level affects perception of chronic stress in military trainees

This study investigated whether physical fitness affects the perception of chronic stress in military trainees while controlling for established factors influencing stress perception. The sample consisted of 273 men (20.23 ± 1.12 years, 73.56 ± 10.52 kg, 1.78 ± 0.06 m). Physical fitness was measured by progressive endurance run (maximum oxygen uptake; VO₂ max), standing long jump, seated shot put, trunk muscle strength, and one leg standing test. Perceived stress was measured using the Perceived Stress Questionnaire in Weeks 1 and 11 of basic military training (BMT). VO₂ max and four influencing variables (perceived stress in Week 1, neuroticism, transformational leadership style, and education level) explained 44.44% of the variance of the increase in perceived stress during 10 weeks of BMT (R²  = 0.444, F = 23.334, p < .001). The explained variance of VO₂ max was 4.14% (R²  = 0.041), with a Cohen's f² effect size of 0.045 (assigned as a small effect by Cohen, ). The results indicate a moderating influence of good aerobic fitness on the varied level of perceived stress. We conclude that it is advisable to provide conscripts with a specific endurance training program prior to BMT for stress prevention reasons.

Energy expenditure estimation from respiration variables

The aim of this study was to develop and cross-validate two models to estimate total energy expenditure (TEE) based on respiration variables in healthy subjects during daily physical activities. Ninety-nine male and female subjects systematically varying in age (18-60 years) and body mass index (BMI; 17-36 kg*m-2) completed eleven aerobic activities with a portable spirometer as the criterion measure. Two models were developed using linear regression analyses with the data from 67 randomly selected subjects (50.0% female, 39.9 ± 11.8 years, 25.1 ± 5.2 kg*m-2). The models were cross-validated with the other 32 subjects (49% female, 40.4 ± 10.7 years, 24.7 ± 4.6 kg*m-2) by applying equivalence testing and Bland-and-Altman analyses. Model 1, estimating TEE based solely on respiratory volume, respiratory rate, and age, was significantly equivalent to the measured TEE with a systematic bias of 0.06 kJ*min-1 (0.22%) and limits of agreement of ±6.83 kJ*min-1. Model 1 was as accurate in estimating TEE as Model 2, which incorporated further information on activity categories, heart rate, sex, and BMI. The results demonstrated that respiration variables and age can be used to accurately determine daily TEE for different types of aerobic activities in healthy adults across a broad range of ages and body sizes.

L-dopa Modulates Striatal Functional Connectivity in Adults with Psychotic-like Experiences: A Randomized Double-blind Placebo-controlled Study

Introduction

According to the dopamine hypothesis functional brain abnormalities and neurochemical alterations may converge to cause psychosis through aberrant salience attribution. Indeed, resting-state functional magnetic resonance imaging (rs-fMRI) has revealed widespread brain disconnectivity across the psychotic spectrum.

Objectives

To advance the understanding of the dopaminergic involvement in intrinsic functional connectivity (iFC) and its putative relationship to the development of psychotic disorders we aimed to investigate the link between L-Dopa, a dopamine precursor, and its modulation of striatal iFC in subthreshold psychosis, i.e. non-clinical psychosis.

Methods

We used a randomized, double-blind placebo controlled study design including in our sample 56 healthy, male, right-handed, subjects with no familiar risk factors for psychosis who were assessed with the Schizotypal Personality Questionnaire (SPQ) and underwent 10 minutes of rs-fMRI scanning. All subjects received either 250 mg of Madopar DR®(200 mg L-Dopa plus 50 mg benserazid, dual release form) or a placebo. We analysed resting-state iFC of 6 striatal seeds, known to evoke dopamine related networks.

Results

The main effect of L-Dopa presented itself (FWE-corrected) as a significant decrease in iFC from the right ventral striatum to the cerebellum and the precuneus cortex, and an increase in iFC to the occipital cortex. Subjects with high SPQ positive symptom sub-scores showed a significant increase of L-Dopa induced connectivity.

Conclusion

We identified striatal functional connectivity being modulated by augmented dopamine availability, and in support of the dopamine hypothesis, we found that those iFC patterns are associated to high scores of psychotic like experiences.

Disclosure of interest

The authors have not supplied their declaration of competing interest.

Accuracy of PARTwear Inertial Sensor and Optojump Optical Measurement System for Measuring Ground Contact Time During Running

Ammann, R, Taube, W, and Wyss, T. Accuracy of PARTwear inertial sensor and Optojump optical measurement system for measuring ground contact time during running. J Strength Cond Res 30(7): 2057-2063, 2016-The aim of this study was to validate the detection of ground contact time (GCT) during running in 2 differently working systems: a small inertial measurement sensor, PARTwear (PW), worn on the shoe laces, and the optical measurement system, Optojump (OJ), placed on the track. Twelve well-trained subjects performed 12 runs each on an indoor track at speeds ranging from 3.0 to 9.0 m·s. GCT of one step per run (total 144) was simultaneously obtained by the PW, the OJ, and a high-speed video camera (HSC), whereby the latter served as reference system. The sampling rate was 1,000 Hz for all methods. Compared with the HSC, the PW and the OJ systems underestimated GCT by -1.3 ± 6.1% and -16.5 ± 6.7% (p-values ≤ 0.05), respectively. The intraclass correlation coefficients between PW and HSC and between OJ and HSC were 0.984 and 0.853 (p-values < 0.001), respectively. Despite the constant systematic underestimation of GCT, analyses indicated that PW successfully recorded GCT over a wide range of speeds. However, results showed only moderate validity for the OJ system, with increasing errors when speed decreased. In conclusion, the PW proved to be a highly useful and valid application, and its use can be recommended not only for laboratory settings but also for field applications. In contrast, data on GCT obtained by OJ during running must be treated with caution, specifically when running speed changes or when comparisons are made with GCT data collected by other measurement systems.

Adapted marching distances and physical training decrease recruits' injuries and attrition

There is evidence that progressive loading of physical demands at the beginning of basic military service and specific physical training can reduce injury incidences. Therefore, aim of this study was to measure the effects of a progressive increase in marching distances and an adapted physical training program on injury incidence and attrition rate in a Swiss Army infantry training school. One company reduced the distances covered on foot during the first 4 weeks of basic military training. A second company performed an adapted physical training program for 10 weeks. A third company participated in both interventions combined, and a fourth company served as a control group without any intervention. The injury incidences and attrition rates of 651 male recruits were registered during 21 weeks of military service. Several predictor variables for injury and attrition, such as physical fitness, previous injuries, level of previous physical activity, smoking, motivation, and socioeconomic factors, were assessed as well. The data were analyzed using binary logistic backward regressions. Each intervention separately had a favorable effect on injury prevention. However, combining the 2 interventions resulted in the greatest reduction in injury incidence rate (-33%). Furthermore, the adapted physical training successfully reduced the military service attrition rates (-53%).

Aerobic Fitness Level Affects Cardiovascular and Salivary Alpha Amylase Responses to Acute Psychosocial Stress

Background

Good physical fitness seems to help the individual to buffer the potential harmful impact of psychosocial stress on somatic and mental health. The aim of the present study is to investigate the role of physical fitness levels on the autonomic nervous system (ANS; i.e. heart rate and salivary alpha amylase) responses to acute psychosocial stress, while controlling for established factors influencing individual stress reactions.

Methods

The Trier Social Stress Test for Groups (TSST-G) was executed with 302 male recruits during their first week of Swiss Army basic training. Heart rate was measured continuously, and salivary alpha amylase was measured twice, before and after the stress intervention. In the same week, all volunteers participated in a physical fitness test and they responded to questionnaires on lifestyle factors and personal traits. A multiple linear regression analysis was conducted to determine ANS responses to acute psychosocial stress from physical fitness test performances, controlling for personal traits, behavioural factors, and socioeconomic data.

Results

Multiple linear regression revealed three variables predicting 15 % of the variance in heart rate response (area under the individual heart rate response curve during TSST-G) and four variables predicting 12 % of the variance in salivary alpha amylase response (salivary alpha amylase level immediately after the TSST-G) to acute psychosocial stress. A strong performance at the progressive endurance run (high maximal oxygen consumption) was a significant predictor of ANS response in both models: low area under the heart rate response curve during TSST-G as well as low salivary alpha amylase level after TSST-G. Further, high muscle power, non-smoking, high extraversion, and low agreeableness were predictors of a favourable ANS response in either one of the two dependent variables.

Conclusions

Good physical fitness, especially good aerobic endurance capacity, is an important protective factor against health-threatening reactions to acute psychosocial stress.

The influence of the gait-related arm swing on elevation gain measured by sport watches

The elevation gain is an important contributor to the total workload in endurance sports. The purpose of this study was to evaluate the influence of the arm swing on elevation gain in three sport watches (Garmin® Forerunner 910XT, Polar® RS800CX and Suunto® Ambit2) on a flat 400 m outdoor track. Altogether, a total of 120 repetitions of 1,200 m were performed at self-selected speeds corresponding to strolling, walking, jogging and running. During the assessment two devices of each sport watch, one secured on the hip and one on the wrist, were worn by the participants. A small but significant (effect size = .39; p < .001) influence of the arm swing on elevation was revealed in all sport watches. Elevation indication errors recorded on the wrist were significantly larger than the ones recorded on the hip (4.0-7.4 vs. 1.2-5.7 m per 1,200 m; p < .05). Furthermore, when wearing the devices on the wrist, errors in elevation indication increased when gait speed increased. Users should be aware that wearing the devices on the hip can significantly decrease measurement errors. This might be especially relevant for activities with high dynamics, such as jogging and running.

Training Methods and Training Instructors' Qualification Are Related to Recruits' Fitness Development During Basic Military Training

Adequate physical fitness is essential for successful military service. Military organizations worldwide therefore make continuous efforts to improve their army's physical training (PT) programs. To investigate the effect of the training methods and the qualification of PT instructors on the development of recruits' physical fitness, the present study compared the outcomes of 2 training groups. Both study groups participated in approximately 145 minutes per week of PT. The control group executed the standard army PT prepared and supervised by army PT instructors. Content of the PT in the intervention group was similar to that of the control group, but their training sessions' methods were different. Their training sessions were organized, prepared, and delivered by more and better-qualified supervisors (tertiary-educated physical education teachers). After 10 weeks of training, the participants of the intervention group experienced a significantly greater physical fitness improvement than those of the control group (positive change in endurance 32 and 17%, balance 30 and 21%, and core strength 74 and 45%, respectively). In both groups, the recruits with the lowest initial fitness levels significantly increased their performance. In the intervention group, but not the control, one-third of the recruits with the highest initial fitness levels were able to further improve their general fitness performance. This study demonstrates that the training methods and quality of instruction during PT sessions are relevant for recruits' fitness development in basic military training.

[Health Status of Young Men in Switzerland: Monitoring Results from Conscription]

Due to their representativeness and consistent measurement standards the medical und sports data of the Swiss conscripts provide a valuable basis for a continuous health monitoring of young Swiss men. During three to four years, the prevalence of overweight and obesity seems to stabilise on a high level. After a longer period of decreasing performance at the endurance test between the 1980s and 2002, the level of physical performance in the fitness test does no longer decrease since 2006. However, health and health behaviour show significant regional and socioeconomic inequalities among young Swiss men. Besides economic resources and education, major driving factors behind these inequalities can be identified in health knowledge, values, and attitudes.

Trunk muscle strength tests to predict injuries, attrition and military ability in soldiers

AIM

Physical fitness is related to injuries, attrition and military ability in military organisations. Therefore, all military organizations of the North Atlantic Treaty Organizations (NATO) test their employees' physical fitness at least once a year. The sit-up test is part of most of the fitness test batteries used. A possible alternative to the sit-up test is the global trunk muscle strength test (TMS). The aim of the present study was to compare the predictability of injuries, attrition and military ability between TMS and sit-up test performances.

METHODS

A total of 230 male recruits in a Swiss Army fusilier company completed TMS and sit-up tests in week 1 of military training school. During the following 13 weeks, injuries, attrition and military ability data were collected. Statistical analysis included backward binary regression and receiver operating characteristic (ROC) curve analysis to compare the discriminative power of TMS and the sit-up test to predict injuries, attrition and military ability.

RESULTS

ROC analysis revealed larger areas under the curve for total injuries, attrition and military ability for the TMS (areatotal injuries=0.58; areaattrition=0.60; areamilitary ability=0.59) than for the sit-up test (areatotal injuries=0.53; areaattrition=0.50; areamilitary ability=0.56). Binary logistic regression analysis revealed low body mass index, low TMS performance and cigarette smoking to be potential risk factors for injuries; while sit-up performance was extracted from the model.

CONCLUSION

The TMS seems to be a valid alternative to the sit-up test in a military setting due to its appropriate results in predicting injuries in the present study.

Help-seeking in people with exceptional experiences: results from a general population sample

BACKGROUND

Exceptional experiences (EE) are experiences that deviate from ordinary experiences, for example precognition, supernatural appearances, or déjà vues. In spite of the high frequency of EE in the general population, little is known about their effect on mental health and about the way people cope with EE. This study aimed to assess the quality and quantity of EE in persons from the Swiss general population, to identify the predictors of their help-seeking, and to determine how many of them approach the mental health system.

METHODS

An on-line survey was used to evaluate a quota sample of 1580 persons representing the Swiss general population with respect to gender, age, and level of education. Multinomial logistic regression was applied to integrate help-seeking, self-reported mental disorder, and other variables in a statistical model designed to identify predictors of help-seeking in persons with EE.

RESULTS

Almost all participants (91%) experienced at least one EE. Generally, help-seeking was more frequent when the EE were of negative valence. Help-seeking because of EE was less frequent in persons without a self-reported mental disorder (8.6%) than in persons with a disorder (35.1%) (OR = 5.7). Even when frequency and attributes of EE were controlled for, people without a disorder sought four times less often help because of EE than expected. Persons with a self-reported diagnosis of mental disorder preferred seeing a mental health professional. Multinomial regression revealed a preference for healers in women with less education, who described themselves as believing and also having had more impressive EE.

CONCLUSION

Persons with EE who do not indicate a mental disorder less often sought help because of EE than persons who indicated a mental disorder. We attribute this imbalance to a high inhibition threshold to seek professional help. Moreover, especially less educated women did not approach the mental health care system as often as other persons with EE, but preferred seeing a healer.

Mood and autonomic responses to repeated exposure to the Trier Social Stress Test for Groups (TSST-G)

INTRODUCTION

A group version of the Trier Social Stress Test (TSST-G) was introduced as a standardized, economic and efficient tool to induce a psychobiological stress response simultaneously in a group of subjects. The aim of the present study was to examine the efficacy of the TSST-G to repeatedly induce an affective and autonomic stress response while comparing two alternative protocols for the second examination.

METHODS AND MATERIALS

Healthy young male recruits participated twice in the TSST-G 10 weeks apart. In the first examination, the TSST-G consisted of a combination of mental arithmetic and a fake job interview (TSST-G-1st; n=294). For the second examination, mental arithmetic was combined with either (a) a defensive speech in response to a false shoplifting accusation (TSST-G-2nd-defence; n=105), or (b) a speech on a more neutral topic selected by the investigators (TSST-G-2nd-presentation; n=100). Affect ratings and salivary alpha-amylase (sAA) were determined immediately before and after the stress test, while heart rate (HR) and heart rate variability (HRV) were measured continuously.

RESULTS

TSST-G-1st resulted in a significant increase of negative affect, HR, and sAA, and a significant decrease in positive affect and HRV. TSST-G-2nd, overall, resulted in a significant increase of HR and sAA (the latter only in response to TSST-G-2nd-defence) and a decrease in HRV, while no significant affect alterations were found. When comparing both, TSST-G-2nd-defence and -2nd-presentation, the former resulted in a stronger stress response with regard to HR and HRV.

DISCUSSION

The findings reveal that the TSST-G is a useful protocol to repeatedly evoke an affective and autonomic stress response, while repetition leads to affective but not necessarily autonomic habituation. When interested in examining repeated psychosocial stress reactivity, a task that requires an ego-involving effort, such as a defensive speech, seems to be significantly superior to a task using an impersonal speech.

Glucose Measurement by Affinity Sensor and Pulsed Measurements of Fluidic Resistances: Proof of Principle

Affinity sensors for glucose are based on a different measuring principle than the commercially available amperometric needle type sensors: reversible affinity interaction of glucose with specific receptors is the primary recognition mechanism instead of an enzymatic glucose oxidation. A novel pulsed-flow micro-fluidic system was used to characterize first the viscosity of a sensitive liquid containing the glucose receptor Concanavalin A and dextran and in a second approach to characterize the geometry of a fluidic resistance. In the viscometric sensor, glucose of the sensitive liquid is equilibrated, while passing through a dialysis chamber, with the surrounding medium. With the membrane flow sensor, the viscosity of the liquid remains constant but the pores of the flow-resisting membrane contain a swellable hydrogel affecting the width of the pores. Two types of hydrogel were tested with the membrane flow sensor; one is highly sensitive to pH and salt concentration, the other contains receptors of phenyl boronic acids to obtain sensitivity to glucose. The viscometric affinity sensor (first approach) showed a linear response over 0 to 30 mmol/L glucose concentration range. The disturbing effect of air bubbles could be compensated for. The sensing proof of principle of the second approach could be demonstrated by its linear response to different saline concentrations; however, the glucose-sensitive membrane developed showed only a small response to glucose. Glucose monitoring based on this pulsed flow measuring principle offers interesting alternatives for the development of CGM systems with different options for the glucose sensing part.

A comparative study of exceptional experiences of clients seeking advice and of subjects in an ordinary population

Exceptional experiences (EE) occur frequently within the populations of many countries and across various socio-cultural contexts. Although some EE show similarities with mental disorders, it would be a mistake to identify them in general as disorders. In fact, the vast number of individuals reporting EE includes subclinical and completely healthy subjects. We conducted a comparative empirical study of several characteristics of EE for two samples - one from ordinary population and the other from clients seeking advice. We found surprisingly similar phenomenological patterns of EE in both samples, but the frequency and intensity of EE for clients seeking advice significantly exceeded those for the ordinary population. Our results support the hypothesis of a continuous spectrum between mental health and mental disorder for the types of experiences analyzed.

The Swiss Army physical fitness test battery predicts risk of overuse injuries among recruits

AIM

The aim of this study was to quantify the discriminative power of physical performance tests to recognize conscripts with enhanced risk of acute and overuse injuries in specific, physically demanding occupational specialties of the Swiss Army. The five performance tests investigated represent the Swiss Army Physical Fitness Test Battery.

METHODS

Physical fitness performances were assessed during recruitment procedures prior to military service, and injury occurrences were assessed during 18 weeks of boot camp. Complete fitness and injury data of 459 volunteers from four military occupational specialties were collected. Discriminative power of volunteers' aerobic endurance capacity, trunk muscle fitness, muscle power of upper and lower extremities, and balance for predicting risk of acute injuries and for predicting risk of overuse injuries was calculated using receiver operating characteristic curve analysis.

RESULTS

The presented fitness tests had no discriminative power for predicting the risk of acute injuries. However, the trunk muscle fitness test was discriminative in predicting overuse injuries in all four military occupational specialties, progressive endurance run in three, balance test in two, and standing long jump in one. Only the seated shot put had no significant power for predicting overuse injuries in all four study groups. However, for different occupational specialties, different fitness parameters were discriminative to predict overuse injuries.

CONCLUSION

It is possible to conclude that the fitness tests used allow detection of conscripts with enhanced overuse injury risk in physically demanding occupational specialties and therefore provide an indicator to select suitable personnel for physically demanding jobs in a military organization.