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Pediatric Thoracic Trauma in Iraq and Afghanistan.
Conclusion: Penetrating injuries predominated and these children commonly required a transfusion. Mortality was inversely related to age. Children with a hemothorax or a concomitant head injury had significant increases in mortality. Children with thoracic injury as the result of a burn suffered the highest mortality. PMID: 29659947 [PubMed - as supplied by publisher] (Source: Military Medicine)
Source: Military Medicine - April 18, 2018 Category: International Medicine & Public Health Tags: Mil Med Source Type: research

Management of Bullet Emboli to the Heart and Great Vessels.
Conclusion: Bullet emboli can prove to be a clinical challenge. Adjuncts such as X-ray, computed tomography, transthoracic, and/or transesophageal echocardiography help establish the emboli location. While observation in the asymptomatic patient is reasonable in some circumstances, most patients undergo removal. Removal of bullet cardiac emboli is safe with the availability of modern techniques. PMID: 29659980 [PubMed - as supplied by publisher] (Source: Military Medicine)
Source: Military Medicine - April 18, 2018 Category: International Medicine & Public Health Tags: Mil Med Source Type: research

Resident and Staff Satisfaction of Pediatric Graduate Medical Education Training on Transition to Adult Care of Medically Complex Patients.
Conclusions: The findings show the disparity between the presence of and perceived need for a formal curriculum on transitioning complex pediatric patients to adult care. This study also highlighted the knowledge gap of the transition process for novice and experienced pediatricians alike. PMID: 29659994 [PubMed - as supplied by publisher] (Source: Military Medicine)
Source: Military Medicine - April 18, 2018 Category: International Medicine & Public Health Tags: Mil Med Source Type: research

Critical Care in the Military Health System: A 24-h Point Prevalence Study.
This study highlights the need for the establishment of a system that allows for the continuous collection of high priority information about clinical care in the MHS in order to facilitate implementation of standardized protocols and process improvements. PMID: 29660009 [PubMed - as supplied by publisher] (Source: Military Medicine)
Source: Military Medicine - April 18, 2018 Category: International Medicine & Public Health Tags: Mil Med Source Type: research

Costs for Breast Cancer Care in the Military Health System: An Analysis by Benefit Type and Care Source.
Conclusions: Per capita costs to the MHS for breast cancer care were similar by benefit type and lower for direct care compared with purchased care. Further research is needed in breast and other tumor sites to determine patterns and determinants of cancer care costs between benefit types and care sources within the MHS. PMID: 29660010 [PubMed - as supplied by publisher] (Source: Military Medicine)
Source: Military Medicine - April 18, 2018 Category: International Medicine & Public Health Tags: Mil Med Source Type: research

An Interview with Major General (Retired) Melissa Rank: The Evolution of Air Force Nurse Corps Leaders.
Authors: Hughes RV PMID: 29660016 [PubMed - as supplied by publisher] (Source: Military Medicine)
Source: Military Medicine - April 18, 2018 Category: International Medicine & Public Health Tags: Mil Med Source Type: research

Sexual Assault and Disabling PTSD in Active Duty Service Women.
Conclusions: Active Duty service women with PTSD and a MST index trauma are much more likely to require disability evaluation (IDES) than those with PTSD due to other trauma types. IDES evaluation for conditions such as PTSD may result in early termination of military service and is a potential downstream consequence of MST. Service women requiring greater numbers of mental health visits for PTSD treatment may benefit from a multidisciplinary approach to treating concurrent health conditions, such as chronic pain. Those providing care for service women should evaluate for MST, chronic pain and pre-military trauma, such as ...
Source: Military Medicine - April 18, 2018 Category: International Medicine & Public Health Tags: Mil Med Source Type: research

Morning Cortisol Is Associated With Stress and Sleep in Elite Military Men: A Brief Report.
Authors: Hernández LM, Markwald RR, Kviatkovsky SA, Perry LN, Taylor MK Abstract Introduction: Accumulating evidence suggests that trends in salivary cortisol after awakening may be reliable biological predictors of morbidity and mortality. In a sample of elite military men, our lab recently established summary parameters of morning cortisol as well as their stability across 2 d of repeated sampling. Materials and Methods: In this follow-on study, we evaluated summary parameters and their relationships to theoretically relevant demographic (i.e., age, body mass index) and biobehavioral correlates (i.e., ...
Source: Military Medicine - April 18, 2018 Category: International Medicine & Public Health Tags: Mil Med Source Type: research

Preliminary Efficacy Testing of the Disinfectant MicrobeCare XLP for Potential Use in Military Operational Environments.
Conclusion: In these independent tests, MicrobeCare XLP effectively prevented growth of A. baumannii but had unpredictable results suppressing S. aureus. These results may relate to inherent properties of the bacteria or autoclave exposure, although the manufacturer asserts that the coating withstands such degradation. Additional testing could be performed using a broader range of microorganisms and exposure to varying conditions including other sterilization methods. PMID: 29635286 [PubMed - as supplied by publisher] (Source: Military Medicine)
Source: Military Medicine - April 15, 2018 Category: International Medicine & Public Health Tags: Mil Med Source Type: research

Review of VA Clinical Guidance for the Health Conditions Identified by the Camp Lejeune Legislation.
Authors: PMID: 29635301 [PubMed - as supplied by publisher] (Source: Military Medicine)
Source: Military Medicine - April 15, 2018 Category: International Medicine & Public Health Tags: Mil Med Source Type: research

The Voice of the Consumer: A Survey of Veterans and Other Users of Assistive Technology.
Conclusion: This survey revealed several themes for future research and development. Advanced wheelchair design, smart device applications, human-machine interfaces, and assistive robotics and intelligent systems emerged as priorities. Survey results also demonstrated the importance for researchers to understand the effects of policy and cost on translational research and to be involved in educating both consumers and providers. PMID: 29635318 [PubMed - as supplied by publisher] (Source: Military Medicine)
Source: Military Medicine - April 15, 2018 Category: International Medicine & Public Health Tags: Mil Med Source Type: research

Physical, Physiological, and Dietary Comparisons Between Marine Corps Forces Special Operations Command Critical Skills Operators and Enablers.
Conclusions: MARSOC CSOs demonstrated significantly greater FFMI, AP, AC, VO2max, KF, KE, TE, and TF compared with enablers. Dietary intake was consistent between groups, but fueling concerns were identified for all personnel in the subgroup. These findings suggest the need for future studies to examine what physiological and strength thresholds are necessary to operate effectively as a member of a MSOT and determine the relationship between specific performance deficits and risk of injury. In addition, the integration of nutrition strategies that augment and optimize the performance of both CSOs and enablers may be benefi...
Source: Military Medicine - April 15, 2018 Category: International Medicine & Public Health Tags: Mil Med Source Type: research

Clinical, Empirical, and Theoretical Rationale for Selection of Accelerated Resolution Therapy for Treatment of Post-traumatic Stress Disorder in VA and DoD Facilities.
Authors: Kip KE, Diamond DM Abstract Introduction: Post-traumatic stress disorder (PTSD) is a chronic, disabling psychiatric disorder prevalent among U.S. service members and veterans. First-line treatments for PTSD endorsed in the 2017 Veterans Affairs (VA)/Department of Defense (DoD) Clinical Practice Guideline for PTSD emphasize individual, manualized trauma-focused psychotherapies that have a primary component of exposure and/or cognitive restructuring. These include prolonged exposure (PE) therapy, cognitive processing therapy (CPT), eye movement desensitization and reprocessing (EMDR), and others. Accelerated...
Source: Military Medicine - April 15, 2018 Category: International Medicine & Public Health Tags: Mil Med Source Type: research

Twenty Thousand Needles Under the Sea. Trigger Point Dry Needling Aboard an Israeli Navy Submarine: A Case Report.
Authors: Ronel D, Gabbay O, Esterson A, Brand R, Vulfsons S Abstract Nonspecific lower back pain affects a major part of the population at a certain point of their life. The intensity of pain can be debilitating and it causes a significant burden on society. Trigger point dry needling is a method of alleviating such pain by the introduction of needles into trigger points in muscles. A growing body of evidence supports its use in myofascial pain and specifically lower back pain. Submarine Medicine is a unique field due to the special characteristics and the environment of the submarine. It poses challenges that are ...
Source: Military Medicine - April 15, 2018 Category: International Medicine & Public Health Tags: Mil Med Source Type: research

Contemporary Factors Associated with the Use of Laparoscopy for Inguinal Hernia Repair Among Department of Defense Beneficiaries.
Authors: Madenci AL, Wolf LL, Jiang W, Koehlmoos TP, Learn PA, Haider AH, Smink DS Abstract Introduction: The factors that contribute to variation in utilization of laparoscopic inguinal hernia repair are unknown. We sought to determine the current usage patterns of laparoscopic and open surgery in the elective repair of uncomplicated unilateral inguinal hernia in a large population with universal health care coverage comprised of Department of Defense (DoD) beneficiaries. Materials and methods: The DoD Military Health System Data Repository (MDR) tracks health care delivered to a universally insured population...
Source: Military Medicine - April 15, 2018 Category: International Medicine & Public Health Tags: Mil Med Source Type: research

Early Tympanoplasty Using a Synthetic Biomembrane for Military-Related Blast Induced Large Tympanic Membrane Perforation.
Conclusion: Early myringoplasty using a biomembrane for blast injury-induced large tympanic perforation is a fast and minimally invasive method to achieve earlier tympanic closure and a higher closure rate for safe recovery of activity. It can be performed under general anesthesia concurrently with surgery for additional body-wide trauma. The deployment of ENT surgeons on the battlefield in the French Army has enabled early management of these patients. PMID: 29635523 [PubMed - as supplied by publisher] (Source: Military Medicine)
Source: Military Medicine - April 15, 2018 Category: International Medicine & Public Health Tags: Mil Med Source Type: research

Effect of Military Deployment on Diabetes Mellitus in Air Force Personnel.
Authors: Folaron I, True MW, Wardian JL, Sauerwein TJ, Sim A, Tate JM, Rittel AG, Zarzabal LA, Graybill SD Abstract Introduction: Military deployments relocate service members to austere locations with limited medical capabilities, raising uncertainties whether members with diabetes can participate safely. Military regulations require a medical clearance for service members with diabetes prior to deployment, but there is a dearth of data that can guide the provider in this decision. To alleviate the lack of evidence in this area, we analyzed the change in glycated hemoglobin (HbA1c) and body mass index (BMI) before...
Source: Military Medicine - April 15, 2018 Category: International Medicine & Public Health Tags: Mil Med Source Type: research

The Initial Impact of Tele-Critical Care on the Surgical Services of a Community Military Hospital.
Conclusion: Implementation of TCC was associated with an increase in the scope and complexity of surgical admissions with no adverse outcomes. Surgeons were able to safely expand the surgical services offered requiring perioperative ICU care to patients who previously may have been transferred. Caring for these types of patients not only maintains the operational readiness of deployable caregivers but patient experience is also enhanced by minimizing transfers away from family. Further exploration of TCC on surgical case volume and complexity is warranted. PMID: 29635539 [PubMed - as supplied by publisher] (Source: Military Medicine)
Source: Military Medicine - April 15, 2018 Category: International Medicine & Public Health Tags: Mil Med Source Type: research

Jumpstarting Monitoring and Evaluation for Global Health Engagement.
Authors: Burkett EK PMID: 29635541 [PubMed - as supplied by publisher] (Source: Military Medicine)
Source: Military Medicine - April 15, 2018 Category: International Medicine & Public Health Tags: Mil Med Source Type: research

Continuous Veno-Venous Hemofiltration During Intercontinental Aeromedical Evacuation.
Authors: Driscoll IR, Wallace A, Rosario FA, Hensley S, Cline KD, Chung KK Abstract Overseas contingency operations which occur in areas lacking medical infrastructure pose challenges to the stabilization and transportation of critically ill patients. In particular, metabolic derangements resulting from acute kidney injury (AKI) make long-distance aeromedical evacuation risky. Here, we report the first modern use of in-flight continuous veno-venous hemofiltration (CVVH) for intercontinental aeromedical evacuation. Hospital and transport records were reviewed for a 31-yr-old male active duty service member who susta...
Source: Military Medicine - April 15, 2018 Category: International Medicine & Public Health Tags: Mil Med Source Type: research

A Novel Peptide-Based Antimicrobial Wound Treatment is Effective Against Biofilms of Multi-Drug Resistant Wound Pathogens.
In this study, we present the in vitro efficacy of two de novo designed cationic, antimicrobial peptides and related topical formulations against single species and polymicrobial biofilms of MDR bacteria. Minimum biofilm eradication concentrations for peptides ranged from 0.7 μM for Staphylococcus aureus to 13.2 μM for Pseudomonas aeruginosa. Varying pH did not adversely impact peptide activity, however, in the presence of albumin, minimum biofilm eradication concentrations generally increased. When formulated into gels or dressings, both peptides eradicated mono- and polymicrobial biofilms of MDR pathogens. The bioc...
Source: Military Medicine - April 15, 2018 Category: International Medicine & Public Health Tags: Mil Med Source Type: research

Perceptions of Simulator- and Live Tissue-Based Combat Casualty Care Training of Senior Special Operations Medics.
Authors: Bukoski A, Uhlich R, Bowling F, Shapiro M, Kerby JD, Llerena L, Armstrong JH, Strayhorn C, Barnes SL, University of Missouri Combat Casualty Training Consortium Abstract The relative effectiveness of live tissue (LT)- and inanimate simulation (SIM)-based training of combat medics is the subject of intense debate. A structured interview was utilized to determine the training modality preferences and the perceived value of LT- and SIM-based combat casualty care training of 25 senior special operations medics. Participant demographics and training experience, Likert scale-based assessment of trainin...
Source: Military Medicine - April 15, 2018 Category: International Medicine & Public Health Tags: Mil Med Source Type: research

Utilizing Propensity Score Analyses in Prehospital Blood Product Transfusion Studies: Lessons Learned and Moving Toward Best Practice.
This study conducts a systematic review of literature from military and civilian populations to assess current practice of PS methodology in PHT analyses. The decision-making process from the multicenter Prehospital Resuscitation on Helicopter Study (PROHS) is discussed and used as a motivating example. Results show that researchers often omit or incorrectly assess variable balance between treatment groups and include inappropriate variables in the propensity model. When used correctly, PS methodology is an effective statistical technique to show that aggressive en route resuscitation strategies, including PHT, can reduce ...
Source: Military Medicine - April 15, 2018 Category: International Medicine & Public Health Tags: Mil Med Source Type: research

Virtual Reality Training System for Anytime/Anywhere Acquisition of Surgical Skills: A Pilot Study.
This article presents a hardware/software simulation environment suitable for anytime/anywhere surgical skills training. It blends the advantages of physical hardware and task analogs with the flexibility of virtual environments. This is further enhanced by a web-based implementation of training feedback accessible to both trainees and trainers. Our training system provides a self-paced and interactive means to attain proficiency in basic tasks that could potentially be applied across a spectrum of trainees from first responder field medical personnel to physicians. This results in a powerful training tool for surgical ski...
Source: Military Medicine - April 15, 2018 Category: International Medicine & Public Health Tags: Mil Med Source Type: research

Modeling and Comparing Nurse and Physician Trauma Assessment Skills.
This article describes the Methodology for Annotated Skill Trees (MAST), a skill-modeling framework that facilitates the creation of descriptive and rule-based content that supports skill acquisition. This framework is used to generate models of trauma assessment skills from two existing curricula: Advanced Trauma Life Support (ATLS) and the Trauma Nurse Core Course (TNCC). Key differences between these curricula's teaching methods for the same procedure and skill are highlighted through the use of the model framework. The framework comparison provides insight into the underlying teaching approach and highlights the fact t...
Source: Military Medicine - April 15, 2018 Category: International Medicine & Public Health Tags: Mil Med Source Type: research

Simulation Training for Operational Medicine Providers (STOMP): Design and Implementation of a Novel Comprehensive Skills-Based Curriculum for Military General Medical Officers.
Conclusion: The Simulation Training for Operational Medicine Providers curriculum for future General Medical Officers is an effective tool for primary care skill training and credentialing. Plans for export to other Graduate Medical Education sites are underway and further evaluation of skills retention is warranted. PMID: 29635553 [PubMed - in process] (Source: Military Medicine)
Source: Military Medicine - April 15, 2018 Category: International Medicine & Public Health Tags: Mil Med Source Type: research

Videoconferenced Telebehavioral Health Referral Process Adherence.
Authors: Tebbs J Abstract Background: In 2015, the Army mandated 100% digital storage of telehealth consent forms (DA4700) in the Health Artifact and Image Management Solution (HAIMS) system, and a telebehavioral health (TBH) hub clinic set an aim to accomplish this by improving adherence to referral procedures essential to expanding patient access to videoconferenced (VC) behavioral health care. Methods: The Knowledge-to-Action (KTA) planned action framework underpinned development of a two-phase, PDSA (Plan-Do-Study-Act) quality improvement project to increase the rates of TBH new intake consent form complete...
Source: Military Medicine - April 15, 2018 Category: International Medicine & Public Health Tags: Mil Med Source Type: research

Using 3D Printing (Additive Manufacturing) to Produce Low-Cost Simulation Models for Medical Training.
Conclusions: 3D printing has been integral to the production of limited-quantity, low-cost simulation models across a variety of medical specialties. In general, production cost is a small fraction of a commercial, generic simulation model, if available. These simulation and training models are customized to the educational need and serve an integral role in the education of our military health professionals. PMID: 29635555 [PubMed - in process] (Source: Military Medicine)
Source: Military Medicine - April 15, 2018 Category: International Medicine & Public Health Tags: Mil Med Source Type: research

HIV PrEP in the Military: Experience at a Tertiary Care Military Medical Center.
Conclusions: In this first description of PrEP utilization in a U.S. military health care system, a significant number of patients were non-Hispanic Whites, well-educated, were older, or were otherwise at low risk for HIV acquisition. Further effort is needed to enhance PrEP use among the higher risk young African-American MSM population, and further studies are needed to determine the cost-effectiveness of PrEP in individuals who are not categorized as high risk. PMID: 29635556 [PubMed - in process] (Source: Military Medicine)
Source: Military Medicine - April 15, 2018 Category: International Medicine & Public Health Tags: Mil Med Source Type: research

Antibiotic Treatment - What Can Be Learned from Point of Injury Experience?
This study evaluated how well-advanced life saver (ALS) providers complied with Israeli Defense Force (IDF) CPG. Materials and Methods: A retrospective review of all trauma patients between November 2011 and January 2015 was conducted. All casualties who suffered from penetrating injuries with evacuation times greater than 60 min were examined. Casualties who should have received antibiotic treatment in accordance with the IDF CPG were further divided into those who received antibiotics (i.e., "Antibiotic" group) and those who did not receive antibiotic treatment (i.e., "No Antibiotics" group). ...
Source: Military Medicine - April 15, 2018 Category: International Medicine & Public Health Tags: Mil Med Source Type: research

Autofluorescence Imaging for Evaluating Debridement in Military and Trauma Wounds.
Conclusions: The MolecuLight i:X shows promise for debridement evaluation. The use of the MolecuLight i:X may reduce the likelihood of infection, thus having positive implications for military and trauma wounds. PMID: 29635558 [PubMed - in process] (Source: Military Medicine)
Source: Military Medicine - April 15, 2018 Category: International Medicine & Public Health Tags: Mil Med Source Type: research

Risk Factors for Training-Related Injuries During U.S. Army Basic Combat Training.
Conclusions: This Army-wide analysis reveals higher BCT-related injury rates for both men and women than prior studies and identifies risk factors for injuries during BCT. The large data set allows adjustment for many covariates, but because statistical analysis may yield significant findings for small differences, results must be interpreted based on minimally important differences determined by military and medical professionals. Results provide information that may be used to adapt training or medical screening and examination procedures for basic trainees. PMID: 29635559 [PubMed - in process] (Source: Military Medicine)
Source: Military Medicine - April 15, 2018 Category: International Medicine & Public Health Tags: Mil Med Source Type: research

Chronic Neurological Morbidities and Elevated Hippocampal Calcium Levels in a DFP-Based Rat Model of Gulf War Illness.
Authors: Phillips KF, Deshpande LS Abstract Over 20 yr have elapsed since the end of the First Gulf War, yet approximately one-third of the veterans exhibit Gulf War Illness (GWI) symptoms, particularly depression and memory impairments. Exposure to organophosphate (OP) compounds is implicated for GWI development. The role of calcium (Ca2+) signaling in learning, memory, and mood is well established and disruptions in Ca2+ homeostasis are observed in many neurological disorders. However, the status of Ca2+ homeostasis in the development of GWI behavioral impairments is not known. Male Sprague-Dawley rats were expos...
Source: Military Medicine - April 15, 2018 Category: International Medicine & Public Health Tags: Mil Med Source Type: research

Biomechanical Measurement and Modeling of Human Eardrum Injury in Relation to Blast Wave Direction.
Authors: Gan RZ, Leckness K, Nakmali D, Ji XD Abstract Rupture of the eardrum or tympanic membrane (TM) is one of the most frequent injuries of the ear after blast exposure. To understand how the TM damage is related to blast wave direction, human cadaver ears were exposed to blast waves along three directions: vertical, horizontal, and front with respect to the head. Blast overpressure waveforms were recorded at the ear canal entrance (P0), near the TM (P1), and inside the middle ear (P2). Thirteen to fourteen cadaver ears were tested in each wave direction and the TM rupture thresholds were identified. Results sh...
Source: Military Medicine - April 15, 2018 Category: International Medicine & Public Health Tags: Mil Med Source Type: research

Assessment of Anatomical Knowledge and Core Trauma Competency Vascular Skills.
This study reports residents' self-confidence evaluated before and after Advanced Surgical Skills for Exposure in Trauma (ASSET) cadaver-based training, and 12-18 mo later. We hypothesize that residents will better judge their own skill after ASSET than before when compared with evaluator ratings. Methods: Forty PGY2-7 surgical residents performed four procedures: axillary artery (AA), brachial artery (BA), femoral artery exposure and control (FA), and lower extremity fasciotomy (FAS) at the three evaluations. Using 5-point Likert scales, surgeons self-assessed their confidence in anatomical understanding and procedure...
Source: Military Medicine - April 15, 2018 Category: International Medicine & Public Health Tags: Mil Med Source Type: research

TRR's Warrior Camp: An Intensive Treatment Program for Combat Trauma in Active Military and Veterans of All Eras.
Authors: Steele E, Wood DS, J Usadi E, Applegarth DM Abstract Effective treatments for combat trauma in military service members exist, but barriers to care abound, including poor access, stigma, and dropout. Although the effects of post-traumatic stress disorder (PTSD) can be severe, recovery is possible when proper treatment is implemented. Trauma and Resiliency Resources, Inc.'s Warrior Camp (WC) program is designed to address the effects of combat trauma in military service members and veterans. This intensive, 7-d treatment incorporates eye movement desensitization and reprocessing therapy, equine-assisted psy...
Source: Military Medicine - April 15, 2018 Category: International Medicine & Public Health Tags: Mil Med Source Type: research

Physiological Effects of Wearing Athletic Mouth Pieces While Performing Various Exercises.
Authors: Zupan MF, Bullinger DL, Buffington B, Koch C, Parker S, Fragleasso S, Fogg T, Rasmussen-Woerner S Abstract The purpose of this study is to evaluate physiological responses associated with exercise using two different mouthpieces compared with not using a mouthpiece. Improved performance while using the PX3 Bite Regulator (PX3) may significantly reduce the risk of concussions by allowing an athlete to better prepare, react, absorb, and/or avoid impact completely compared with the restricted breathing or mandibular instability that occurs when using mouthguards. Twenty-three subjects completed a battery of f...
Source: Military Medicine - April 15, 2018 Category: International Medicine & Public Health Tags: Mil Med Source Type: research

A Family's Affair: Caring for Veterans with Penetrating Traumatic Brain Injury.
Authors: Delgado RE, Peacock K, Elizondo B, Wells M, Grafman JH, Pugh MJ Abstract Approximately 1.1 million family members are primary caregivers to post 9/11 veterans. These military caregivers assume a role that requires a long-term commitment that may affect their own health status; however, the impact on health among military caregivers is underestimated and underrepresented. As part of a larger retrospective cohort study that aimed to assess the health-related outcomes of post 9/11 veterans with penetrating traumatic brain injury (pTBI), we examined the health impact of caregiving on caregivers. Caregivers (n ...
Source: Military Medicine - April 15, 2018 Category: International Medicine & Public Health Tags: Mil Med Source Type: research

PHIT for Duty, a Mobile Application for Stress Reduction, Sleep Improvement, and Alcohol Moderation.
Authors: Kizakevich PN, Eckhoff R, Brown J, Tueller SJ, Weimer B, Bell S, Weeks A, Hourani LL, Spira JL, King LA Abstract Post-traumatic stress and other problems often occur after combat, deployment, and other military operations. Because techniques such as mindfulness meditation show efficacy in improving mental health, our team developed a mobile application (app) for individuals in the armed forces with subclinical psychological problems as secondary prevention of more significant disease. Based on the Personal Health Intervention Toolkit (PHIT), a mobile app framework for personalized health intervention studi...
Source: Military Medicine - April 15, 2018 Category: International Medicine & Public Health Tags: Mil Med Source Type: research

Effects on Neurons and Hippocampal Slices by Single and Multiple Primary Blast Pressure Waves From Detonating Spherical Cyclotrimethylenetrinitramine (RDX) Explosive Charges.
Authors: Piehler T, Zander N, Banton R, Smith M, Romine H, Benjamin R, Byrnes K, Duckworth J, Bahr BA Abstract Threshold shock-impulse levels required to induce cellular injury and cumulative effects upon single and/or multiple exposures are not well characterized. Currently, there are few in vitro experimental models with blast pressure waves generated by using real explosives in the laboratory for investigating the effects of primary blast-induced traumatic brain injury. An in vitro indoor experimental platform is developed using real military explosive charges to accurately represent battlefield blast exposure a...
Source: Military Medicine - April 15, 2018 Category: International Medicine & Public Health Tags: Mil Med Source Type: research

A Cluster of Exertional Rhabdomyolysis Cases in a ROTC Program Engaged in an Extreme Exercise Program.
This study examined an ER cluster among Reserve Officer Training Corps cadets who participated in a mandatory, timed, extreme conditioning program (ECP) workout. Forty-four cadets participated in this ECP; 11 were subsequently hospitalized with ER. Thirty-five cadets, including all who developed ER, completed a questionnaire to assess ECP times, prior fitness scores, and other ER risk factors. Cadets completed the ECP workout as individuals or in teams. Nine of 29 (31%) individual and two of 15 (13%) team participants were hospitalized with ER. Among the cadets, no associations were noted between hospitalization for ER and...
Source: Military Medicine - April 15, 2018 Category: International Medicine & Public Health Tags: Mil Med Source Type: research

Case Report of Extracorporeal Membrane Oxygenation and Aeromedical Evacuation at a Deployed Military Hospital.
Authors: Hamm MS, Sams VG, DellaVolpe MJD, Lantry JH, Mason PE Abstract The U.S. Military no longer maintains overseas extracorporeal membrane oxygenation (ECMO) capability for patients with severe lung injury including acute respiratory distress syndrome (ARDS). The authors present a case of severe ARDS at a military hospital in Afghanistan with limited capability for rescue therapies to include presentation, treatment, transport, and use of ECMO in the deployed military environment at one Role 3 medical facility. Lack of ECMO in the overseas environment is a significant gap in U.S. Military medical capability. Th...
Source: Military Medicine - April 15, 2018 Category: International Medicine & Public Health Tags: Mil Med Source Type: research

Non-invasive Dual-Channel Broadband Diffuse Optical Spectroscopy of Massive Hemorrhage and Resuscitative Endovascular Balloon Occlusion of the Aorta (REBOA) in Swine.
Conclusions: Dual-channel regional tissue DOS measurements can be used to non-invasively track the formation of hemodynamically distinct tissue compartments during hemorrhage and REBOA. Conventional systemic measures MAP, HR, and SV are uncorrelated with tissue status in inferior (downstream) sites. Multi-compartment DOS may provide a more complete picture of the efficacy of REBOA and similar resuscitation procedures. PMID: 29635570 [PubMed - in process] (Source: Military Medicine)
Source: Military Medicine - April 15, 2018 Category: International Medicine & Public Health Tags: Mil Med Source Type: research

The Uniformed Services University's Surgical Critical Care Initiative (SC2i): Bringing Precision Medicine to the Critically Ill.
We present the SC2i experience as a generalizable template for the national integration of federal and non-federal research databanks to foster critical and surgical care precision medicine. PMID: 29635571 [PubMed - in process] (Source: Military Medicine)
Source: Military Medicine - April 15, 2018 Category: International Medicine & Public Health Tags: Mil Med Source Type: research

Validation of Visual Objective Biomarkers for Acute Concussion.
This study aims to validate visual functions as potential biomarkers for mTBI. Methods: This case-control correlational design utilizes military personnel diagnosed with acute (≤72 h post-injury) mTBI (n = 100) and age-matched controls (n = 100) to examine the relative effectiveness of the pupillary light reflex (PLR), near point of convergence (NPC) break, King-Devick (KD) test time, and Convergence Insufficiency Symptom Survey (CISS) score to discriminate between participants with mTBI. Results: Three of the eight PLR parameters (i.e., average constriction velocity (ACV), average dilation velocity (ADV), and 7...
Source: Military Medicine - April 15, 2018 Category: International Medicine & Public Health Tags: Mil Med Source Type: research

Evaluation of a Novel Wireless Transmission System for Trauma Ultrasound Examinations From Moving Ambulances.
Conclusion: Although there is a slight tendency for the average rating across all subjects and raters to be slightly higher in the base than in the ambulatory condition, none of these differences are statistically significant. These results suggest that the quality of the ambulatory images was viewed as essentially as good as the quality of the base images. PMID: 29635573 [PubMed - in process] (Source: Military Medicine)
Source: Military Medicine - April 15, 2018 Category: International Medicine & Public Health Tags: Mil Med Source Type: research

Splenic Trauma in the Israeli Defense Forces - Do Not Underestimate Minor Trauma.
Authors: Nachman D, Yehoshua L, Benov A, Glassberg E, Padova H Abstract Background: The spleen is the most commonly damaged abdominal organ following blunt abdominal trauma (BAT), usually involving a major injury mechanism. Several cases of splenic rupture caused by minor BAT in the Israeli Defense Forces (IDF) have recently occurred. This led us to explore the demographics and mechanisms of trauma resulting in splenic injury among IDF personnel. Methods: All cases of splenic injury between 2007 and 2015 were pulled from the computerized patient records of the IDF. Data regarding patient demographics, injury me...
Source: Military Medicine - April 15, 2018 Category: International Medicine & Public Health Tags: Mil Med Source Type: research

Comparison of Two Tourniquets on a Mid-Thigh Model: The Israeli Silicone Stretch and Wrap Tourniquet vs. The Combat Application Tourniquet.
Authors: Glick CPTY, Furer MAJA, Glassberg COLE, Sharon R, Ankory MAJR Abstract Introduction: Experience from recent conflicts underlines the dramatic impact of effective tourniquet use on combat casualty mortality. Although the Combat Application Tourniquet (CAT) is replacing the silicone band tourniquets (IST; "Israeli Silicone Tourniquet") in the Israeli Defense Forces, no direct comparison was made between them. The purpose of this study is to compare the performance of the two tourniquets on a mid-thigh model. Methods: Participants were Israeli military recruits who previously had the military fi...
Source: Military Medicine - April 15, 2018 Category: International Medicine & Public Health Tags: Mil Med Source Type: research

Vestibular Test Patterns in the NICoE Intensive Outpatient Program Patient Population.
Authors: King JE, Pape MM, Kodosky PN Abstract The National Intrepid Center of Excellence (NICoE), on the campus of Walter Reed National Military Medical Center, was developed to help improve the lives of active duty service members (SMs) with traumatic brain injury (TBI) and comorbid behavioral health (BH) conditions. During the NICoE intensive outpatient program, SM who have all been identified as having some degree of TBI, undergo extensive interdisciplinary evaluations, including comprehensive vestibular assessment. These SMs sometimes present with vestibular symptoms ranging from lightheadedness to vertigo ass...
Source: Military Medicine - April 15, 2018 Category: International Medicine & Public Health Tags: Mil Med Source Type: research

Clinical Impact of Cabin Altitude Restriction Following Aeromedical Evacuation.
Authors: Butler WP, Steinkraus LW, Burlingame EE, Smith DE, Fouts BL, Serres JL, Burch DS Abstract Combat medical care relies on aeromedical evacuation (AE). Vital to AE is the validating flight surgeon (VFS) who warrants a patient is "fit to fly." To do this, the VFS considers clinical characteristics and inflight physiological stressors, often prescribing specific interventions such as a cabin altitude restriction (CAR). Unfortunately, limited information is available regarding the clinical consequences of a CAR. Consequently, a dual case-control study (CAR patients versus non-CAR patients and non-CAR p...
Source: Military Medicine - April 15, 2018 Category: International Medicine & Public Health Tags: Mil Med Source Type: research