Effect of Sodium Lauryl Sulfate (SLS) on Primary Human Gingival Fibroblasts in an In Vitro Wound Healing Model.
CONCLUSION: Our results showed a dose- and time-dependent inhibition on HGFs wound fill by SLS; however, future in vivo studies are needed to validate if our in vitro findings using SLS-free dentifrices to avoid the potential delay of wound healing. PMID: 30901402 [PubMed - in process] (Source: Military Medicine)
Source: Military Medicine - March 23, 2019 Category: International Medicine & Public Health Tags: Mil Med Source Type: research

Formative Assessment of Performance in Diagnostic Ultrasound Using Simulation and Quantitative and Objective Metrics.
Authors: Sheehan FH, McConnaughey S, Freeman R, Zierler RE Abstract BACKGROUND: We developed simulator-based tools for assessing provider competence in transthoracic echocardiography (TTE) and vascular duplex scanning. METHODS: Psychomotor (technical) skill in TTE image acquisition was calculated from the deviation angle of an acquired image from the anatomically correct view. We applied this metric for formative assessment to give feedback to learners and evaluate curricula.Psychomotor skill in vascular ultrasound was measured in terms of dexterity and image plane location; cognitive skill was assessed from me...
Source: Military Medicine - March 23, 2019 Category: International Medicine & Public Health Tags: Mil Med Source Type: research

Correlates of Depression in U.S. Military Service Members With a History of Mild Traumatic Brain Injury.
CONCLUSIONS: Results confirm chronically elevated the rates of depressive disorders and PTSD comorbidity among service members with a history of mTBI. Depression screening and treatment within the Military Health System should remain a priority for service members reporting a remote history of mTBI. Individuals with chronic PTSD, women, service members undergoing MEB and those who served in greater than three combat deployments are at particular risk. PMID: 30901404 [PubMed - in process] (Source: Military Medicine)
Source: Military Medicine - March 23, 2019 Category: International Medicine & Public Health Tags: Mil Med Source Type: research

3D Tibia Reconstruction Using 2D Computed Tomography Images.
CONCLUSIONS: Subject-specific tibia models can provide even great insights into the mechanisms of stress fracture injury, which are common in military and athletic settings. Rapid development of 3D tibia models allows for the future work of determining peak stress-related injury correlates to stress fracture outcomes. PMID: 30901405 [PubMed - in process] (Source: Military Medicine)
Source: Military Medicine - March 23, 2019 Category: International Medicine & Public Health Tags: Mil Med Source Type: research

Biomechanics of Blast TBI With Time-Resolved Consecutive Primary, Secondary, and Tertiary Loads.
Authors: Przekwas A, Garimella HT, Tan XG, Chen ZJ, Miao Y, Harrand V, Kraft RH, Gupta RK Abstract Blast-induced traumatic brain injury (bTBI) has become a signature casualty of recent military operations. In spite of significant clinical and preclinical TBI research, current understanding of injury mechanisms and short- and long-term outcomes is limited. Mathematical models of bTBI biomechanics may help in better understanding of injury mechanisms and in the development of improved neuroprotective strategies. Until present, bTBI has been analyzed as a single event of a blast pressure wave propagating through the b...
Source: Military Medicine - March 23, 2019 Category: International Medicine & Public Health Tags: Mil Med Source Type: research

Fast Fourier Transformation of Peripheral Venous Pressure Changes More Than Vital Signs with Hemorrhage.
Authors: Bonasso PC, Dassinger MS, McLaughlin B, Burford JM, Sexton KW Abstract Vital signs are included in the determination of shock secondary to hemorrhage; however, more granular predictors are needed. We hypothesized that fast Fourier transformation (FFT) would have a greater percent change after hemorrhage than heart rate (HR) or systolic blood pressure (SBP). Using a porcine model, nine 17 kg pigs were hemorrhaged 10% of their calculated blood volume. Peripheral venous pressure waveforms, HR and SBP were collected at baseline and after 10% blood loss. FFT was performed on the peripheral venous pressure wavef...
Source: Military Medicine - March 23, 2019 Category: International Medicine & Public Health Tags: Mil Med Source Type: research

Differential Effects of Caffeine on Motor and Cognitive Outcomes of Penetrating Ballistic-Like Brain Injury.
This study assessed the effect of caffeine on neurobehavioral recovery in the WRAIR penetrating ballistic-like brain injury (PBBI) model. Unilateral frontal PBBI was produced in the right hemisphere of anesthetized rats at moderate (7%-PBBI) or severe (10%-PBBI) injury levels. Animals were randomly assigned to pretreatment groups: acute caffeine (25 mg/kg CAF gavage, 1 h prior to PBBI), or chronic caffeine (0.25 g/L CAF drinking water, 30 days prior to PBBI). Motor function was evaluated on the rotarod at fixed-speed increments of 10, 15, and 20 RPM. Cognitive performance was evaluated on the Morris water maze. Acute caffe...
Source: Military Medicine - March 23, 2019 Category: International Medicine & Public Health Tags: Mil Med Source Type: research

A Novel Arterial Line Simulation Model.
We describe, to our knowledge, the first arterial line insertion and transducing model utilizing only items found in the deployed environment. This model can be easily made and utilized to train medical personnel of all skill levels to augment the capabilities of medical units in areas where mass casualty events are likely. PMID: 30901409 [PubMed - in process] (Source: Military Medicine)
Source: Military Medicine - March 23, 2019 Category: International Medicine & Public Health Tags: Mil Med Source Type: research

Utilizing Plasma Composition Data to Help Determine Procoagulant Dynamics in Patients with Thermal Injury: A Computational Assessment.
In this study, we use a computational model to study the FXa dynamics underlying tissue factor-initiated thrombin generation in a small cohort of burn patients. MATERIALS AND METHODS: Plasma samples were collected upon admission (Hour 0) from nine subjects (five non-survivors) with major burn injuries and then at 48 hours. Coagulation factor concentrations (II, V, VII, VIII, IX, X, TFPI, antithrombin (AT), protein C (PC)) were measured and used in a computational model to generate time course profiles for thrombin (IIa), FXa, extrinsic tenase, intrinsic tenase and prothrombinase complexes upon a 5 pM tissue factor stim...
Source: Military Medicine - March 23, 2019 Category: International Medicine & Public Health Tags: Mil Med Source Type: research

The Impact of Affective States on Postconcussive Symptoms in a TBI Population.
Authors: Garcia K, Moore B, Kim G, Dsurney J, Chan L Abstract The occurrence of persistent postconcussive symptoms (PCS) associated with traumatic brain injury (TBI) is an increasing cause of disability and lost productivity. The reasons for these persistent symptoms in a percentage of even mild TBI are poorly understood. The existence of comorbid conditions such as post-traumatic stress disorder or other traumatic injuries may be factors that impact the presence of PCS. We expect that greater levels of affective symptoms will be associated with increases in PCS assessed on the Neurobehavioral Symptom Inventory (NS...
Source: Military Medicine - March 23, 2019 Category: International Medicine & Public Health Tags: Mil Med Source Type: research

Prominent Injury Types in Vehicle Underbody Blast.
CONCLUSION: Skeletal fractures are the most frequent AIS 2+ injury resulting from UBB events. Visceral torso injuries are infrequent in individuals that survive and they generally occur in conjunction with skeletal injuries. PMID: 30901412 [PubMed - in process] (Source: Military Medicine)
Source: Military Medicine - March 23, 2019 Category: International Medicine & Public Health Tags: Mil Med Source Type: research

Comparison of a Novel Trainer to a Traditional Swine Model for Training Providers in Lateral Canthotomy and Cantholysis.
Authors: Herder PAP, Lu MM, LaPorta AJ, Ross DW, Calvano CJ, Enzenauer RW Abstract RESEARCH OBJECTIVE: Military personnel are at greater risks of head and facial traumas and permanent blindness from orbital compartment syndrome in modern warfare. Rapid treatment must be implemented with a low-risk surgical remedy: lateral canthotomy and cantholysis (LCC). Traditional training of LCC is primarily performed using an animal tissue trainer (ATT); however, limitations to these types of trainers exist. Therefore, our research objectives were focused on highlighting the effectiveness, benefits, and vision-saving potential...
Source: Military Medicine - March 23, 2019 Category: International Medicine & Public Health Tags: Mil Med Source Type: research

Portable System for Neuro-Optical Diagnostics Using Virtual Reality Display.
Authors: Versek C, Rissmiller A, Tran A, Taya M, Chowdhury K, Bex P, Sridhar S Abstract A new product prototype system for diagnosing vision and neurological disorders, called NeuroDotVR, is described herein: this system utilizes a novel wireless NeuroDot brain sensor [Versek C et al. J Neural Eng. 2018 Aug; 15(4):046027] that quantitatively measures visual evoked potentials and fields resulting from custom visual stimuli displayed on a smartphone housed in a virtual reality headset. The NeuroDot brain sensor is unique in that it can be operated both in regular electroencephalography mode, as well as a new electric...
Source: Military Medicine - March 23, 2019 Category: International Medicine & Public Health Tags: Mil Med Source Type: research

Perceptions and Response to Conservative Treatment of Low Back Pain in Soldiers During Initial Entry Training: A Convergence Mixed Methods Study.
This study's purpose was to (1) describe clinical changes in psychosocial factors of LBP following a self-management intervention and (2) explore the LBP experience of military trainees. Ten participants in Initial Entry Training (IET) were included in this mixed methods study. A self-management intervention of exercises and psychosocial education was provided. Quantitative instruments assessing psychosocial factors were delivered at baseline and 6 weeks. Qualitative data were gathered after treatment and analyzed using a phenomenological approach. Low levels of psychosocial risk factors were reported. Patient satisfaction...
Source: Military Medicine - March 23, 2019 Category: International Medicine & Public Health Tags: Mil Med Source Type: research

Evaluation of the Commercial, Off-the-Shelf (COTS) King-Devick Eye Tracking System.
Authors: Onge PS, Temme LA, McAtee A, O'Brien KJ, Byrd BK Abstract Concussion biomarkers are important guides for diagnosis and return-to-duty decisions. Recent literature describes the King-Devick (KD) test as a sensitive sports-related concussion screener. This test involves timing an individual reading aloud 120 digits printed on three test cards. The test is commonly considered to evaluate the effects of concussion and other factors on reading-related eye movements (EMs). However, the extent to which the KD test reflects EMs remains a matter of conjecture since the test reports only reading speed and number of ...
Source: Military Medicine - March 23, 2019 Category: International Medicine & Public Health Tags: Mil Med Source Type: research

Sources of Stress and Psychological Health Outcomes Among U.S. Air Force Total Force Distributed Common Ground System Operators.
This study re-examines the most frequently reported occupational stressors, as well as the prevalence of occupational burnout (i.e., high-emotional exhaustion and cynicism, and low professional efficacy), and psychological distress within this population. Active duty (n = 1717), ANG (n = 139), and Reserve (n = 173) Intel operators participated in a comprehensive, online, occupational health assessment. Results reveal that occupational stressors contributing to elevated rates of distress, regardless of TF status (i.e., low manning, long work hours, excessive workload, and organizational communication concerns) are consisten...
Source: Military Medicine - March 23, 2019 Category: International Medicine & Public Health Tags: Mil Med Source Type: research

A Mobile Device Dual-Task Paradigm for the Assessment of mTBI.
CONCLUSION: The optimal dual-task paradigm to evaluate cognitive-motor performance with minimal floor and ceiling effects consists of tandem stance with eyes closed while stimuli are presented at a rate of one per second. PMID: 30901418 [PubMed - in process] (Source: Military Medicine)
Source: Military Medicine - March 23, 2019 Category: International Medicine & Public Health Tags: Mil Med Source Type: research

Improving Relative Bioavailability of Oral Imidazolidinedione by Reducing Particle Size Using Homogenization and Ultra-Sonication.
Authors: Zeng Q, Xie L, Zhang J, Vuong C, Potter B, Aylor S, Sousa J, Black C, Li Q Abstract Particle size is an important determinant of gastrointestinal absorption of compounds administrated orally. The present study evaluates the effect of a reduction in particle size assessed by homogenization, sonication, and homogenization plus sonication on the bioavailability of imidazolidinedione (IZ), an antimalarial compound with known causal prophylactic activity and radical cure of relapsing malaria. Formulations were administrated intragastrically to mice, and blood samples were collected for LC-MS/MS analysis. The ho...
Source: Military Medicine - March 23, 2019 Category: International Medicine & Public Health Tags: Mil Med Source Type: research

Crossover Assessment of Intraoral and Cuffed Ventilation by Emergency Responders.
Authors: McCrory B, Lowndes BR, Thompson DL, Wadman MC, Sztajnkrycer MD, Walker R, Lomneth CS, Hallbeck MS Abstract OBJECTIVES: A cuffed bag valve mask (BVM) is the most common device used by emergency medical responders to ventilate patients. The BVM can be difficult for users to seal around the patient's mouth and nose. An intraoral mask (IOM) with snorkel-like design may facilitate quicker and better ventilation particularly under austere conditions. METHODS: Both a BVM and IOM were utilized by 27 trained emergency medical technicians and paramedics to ventilate a lightly embalmed cadaver. Ventilation effica...
Source: Military Medicine - March 23, 2019 Category: International Medicine & Public Health Tags: Mil Med Source Type: research

Self-Reported Sleep, Anxiety, and Cognitive Performance in a Sample of U.S. Military Active Duty and Veterans.
This study examined the relationship between U.S. active duty and veterans' (n = 233) self-reported sleep (Pittsburgh Sleep Quality Index), anxiety (Zung Self-Rating Anxiety Scale), and cognitive performance (Automated Neuropsychological Assessment Metric). Statistical analyses included Pearson product moment correlations and multivariate analysis of variance, with Tukey-b post-hoc tests, with a p
Source: Military Medicine - March 23, 2019 Category: International Medicine & Public Health Tags: Mil Med Source Type: research

Naval Health Research Center Surveillance for Meningococcal Disease.
Authors: Broderick M, Myers C Abstract Historically, meningococcal disease has had a devastating impact on U.S. military personnel, but since the introduction of a vaccine in the 1970s, rates have dropped over 90%.1 Department of Defense instructions mandate a meningococcal vaccine for all service personnel. In the last 5 years, rates of meningococcal disease in the military are similar to the U.S. general population. The active duty incidence was 0.21 cases per 100,000 person-years from 2013-2017. Six cases occurred in the 6 months between September 2016 and February 2017; of these, only one was determined to be a...
Source: Military Medicine - March 23, 2019 Category: International Medicine & Public Health Tags: Mil Med Source Type: research

The 2017 Military Health System Research Symposium Awards.
Authors: Reilly PA PMID: 30901423 [PubMed - in process] (Source: Military Medicine)
Source: Military Medicine - March 23, 2019 Category: International Medicine & Public Health Tags: Mil Med Source Type: research

4-Aminopyridine as a Single Agent Diagnostic and Treatment for Severe Nerve Crush Injury.
CONCLUSION: 4-AP singularly provides both a new potential therapy to promote durable recovery and remyelination in acute peripheral nerve injury and a means of identifying lesions in which this therapy would be most likely to be of value. The ability to distinguish injuries that may respond to extended therapy without intervention can offer benefit to wounded soldiers. PMID: 30901424 [PubMed - in process] (Source: Military Medicine)
Source: Military Medicine - March 23, 2019 Category: International Medicine & Public Health Tags: Mil Med Source Type: research

Modeling Framework Used to Analyze and Describe Junctional Tourniquet Skills.
Authors: Bauchwitz BR, Curley T, Kwan C, Niehaus JM, Pugh CM, Weyhrauch PW Abstract Medical educators have acknowledged the importance of simulation training in developing procedural skills. While simulation training in other disciplines has benefitted from evaluations of users' skill acquisition, the majority of medical training simulators continue to be developed from overly simplified descriptions of procedures, such as techniques prescribed by existing instructional material. Our objective was to use a modeling framework to characterize the skill of various users in applying junctional tourniquets in order to d...
Source: Military Medicine - March 23, 2019 Category: International Medicine & Public Health Tags: Mil Med Source Type: research

Mental Health Care for Service Members and Their Families Across the Globe.
Authors: McGraw K, Adler J, Andersen SB, Bailey S, Bennett C, Blasko K, Blatt AD, Greenberg N, Hodson S, Pittman D, Ruscio AC, Stoltenberg CDG, Tate KE, Kuruganti K Abstract The U.S. Defense Department partnered with the International Initiative for Mental Health Leadership on effective leadership and operational practices for delivery of mental health (MH) as well as addiction services throughout the world for Service Members (SM) and beneficiaries. A Military Issues Work Group (MIWG) was established in 2011 to focus on challenges experienced by military SM and beneficiaries among countries. The MIWG found common ...
Source: Military Medicine - March 23, 2019 Category: International Medicine & Public Health Tags: Mil Med Source Type: research

Reduced Complications of Supraclavicular Approach in Simulated Central Venous Access: Applicability to Military Medicine.
Authors: Sappenfield J, Grek S, Cooper LA, Lizdas DE, Lampotang S Abstract In a study with 76 anesthesia providers on a mixed reality simulator, central venous access via the supraclavicular approach to the subclavian vein, without ultrasonography required less attempts compared to the infraclavicular approach. Participants had shorter times to venous access and larger improvements in confidence. Results from this simulation-based study indicate that the supraclavicular approach may deserve consideration as an alternative approach for central venous access in deployed military environments. The use of ultrasonograp...
Source: Military Medicine - March 23, 2019 Category: International Medicine & Public Health Tags: Mil Med Source Type: research

Comparison of AR, ITS, CBT, and Didactic Training and Evaluation of Retinopathy-Based Diagnosis.
CONCLUSION: Periodic simulator intervention could result in significant knowledge retention over extended periods of time. PMID: 30901428 [PubMed - in process] (Source: Military Medicine)
Source: Military Medicine - March 23, 2019 Category: International Medicine & Public Health Tags: Mil Med Source Type: research

Acellular Fish Skin Grafts for Management of Split Thickness Donor Sites and Partial Thickness Burns: A Case Series.
Authors: Alam K, Jeffery SLA Abstract METHODS: Ten patients having split-thickness skin grafting for burn injury were treated with the fish skin xenografts. RESULTS: There were no adverse reactions noted on the use of the fish skin grafts. No patient had any reaction to the fish skin and there was a zero incidence of infection. The handling of the fish skin was excellent, a robust and pliable xenograft that was easy to apply.The quality of donor site healing was judged to be good in all cases. Both the analgesic effect noted and the relatively short average times until 100% re-epithelialization are promising. W...
Source: Military Medicine - March 23, 2019 Category: International Medicine & Public Health Tags: Mil Med Source Type: research

Females Engaged in Elite Training Previously Only Open to Males: Exploring the Variables of Successful Outcomes.
Authors: Givens ML, Eklund K Abstract To date, there has been no analysis of the skills or attributes predicting success in female trainees who undergo traditionally male elite military training. This retrospective case control study characterized variables specific to females in the Special Operations Combat Medic course. 20/39 males and 15/38 females successfully completed the course. Several objective variables of interest including height and body weight, marital status, dependents, and physical fitness scores revealed trends but marital status and dependents were the only variables that achieved statistical si...
Source: Military Medicine - March 23, 2019 Category: International Medicine & Public Health Tags: Mil Med Source Type: research

Evaluation of Aircrew Low-Intensity Threat Laser Eye Protection.
Authors: Reddix MD, Funke ME, Kinney MJ, Bradley JL, Irvin G, Rea EJ, Kunkle CK, McCann MB, Gomez J Abstract Prototype low-intensity threat laser eye protection (LIT-LEP) spectacles were evaluated for US Coast Guard (USCG) cockpits and night vision goggle compatibility. The impetus for interest in aviation LIT-LEP is driven in part by the fact that easily accessible 0.5-2.0 W high-power laser pointers exceed safety standards for direct on-axis viewing. A repeated-measures experimental design was used to assess LIT-LEP performance relative to a no-LEP control for the following tasks: Near- and far contrast acuity, n...
Source: Military Medicine - March 23, 2019 Category: International Medicine & Public Health Tags: Mil Med Source Type: research

Characteristics of Iraqi Patients Treated During Operation Inherent Resolve by a Forward Surgical Team.
CONCLUSIONS: Given the Role 2 configuration, these results demonstrate FSTs must be capable of managing critically ill patients with markedly limited resources. This management will include general operations in both adult and pediatric patients, resuscitation with a limited blood supply, and patient assessment with minimal to no diagnostic tools. This analysis can inform resident training, pre-deployment training, as well as sustainment training for surgeons after residency. PMID: 30901432 [PubMed - in process] (Source: Military Medicine)
Source: Military Medicine - March 23, 2019 Category: International Medicine & Public Health Tags: Mil Med Source Type: research

Computational Modeling of Primary Blast Lung Injury: Implications for Ventilator Management.
In this study, we developed a computational lung model with mechanical properties consistent with healthy and PBLI conditions. PBLI conditions were simulated with bilateral derecruitment and increased perihilar tissue stiffness. As a result of these tissue abnormalities, airway flow was heterogeneously distributed in the model under PBLI conditions, during both conventional mechanical ventilation (CMV) and high-frequency oscillatory ventilation. PBLI conditions resulted in over three-fold higher parenchymal strains compared to the healthy condition during CMV, with flow distributed according to regional tissue stiffness. D...
Source: Military Medicine - March 23, 2019 Category: International Medicine & Public Health Tags: Mil Med Source Type: research

Impact of Tinnitus on Military Service Members.
CONCLUSIONS: This study has revealed that, for these samples of study participants, tinnitus has an impact on military Service members that is comparable to how it affects Veterans who have completed their military service within the previous 2.5 years. PMID: 30901434 [PubMed - in process] (Source: Military Medicine)
Source: Military Medicine - March 23, 2019 Category: International Medicine & Public Health Tags: Mil Med Source Type: research

Maximizing the Resilience of Healthcare Workers in Multi-hazard Events: Lessons from the 2014-2015 Ebola Response in Africa.
Authors: Schreiber M, Cates DS, Formanski S, King M Abstract There is increasing knowledge that health care workers (HCWs) can experience a variety of emotional impacts when responding to disasters and terrorism events. The Anticipate, Plan and Deter (APD) Responder Risk and Resilience Model was developed to provide a new, evidence-informed method for understanding and managing psychological impacts among HCWs. APD includes pre-deployment development of an individualized resilience plan and an in-theater, real-time self-triage system, which together allow HCWs to assess and manage the full range of psychological ri...
Source: Military Medicine - March 23, 2019 Category: International Medicine & Public Health Tags: Mil Med Source Type: research

Evaluation of the Military Functional Assessment Program for Return-to-Duty Decision Making: A Longitudinal Study.
Authors: Kelley AM, Showers M Abstract Following concussion, return-to-duty decisions are made by medical providers and leaders using informal assessment, review of symptom resolution, and clinical assessments. In an effort to provide military-specific tasks for use in the decision making regarding return-to-duty, a battery developed from the set of basic soldier skills, the Military Functional Assessment Program (MFAP), was evaluated for construct validity using clinical assessment outcomes as well as the relationships between MFAP performance and indicators of long-term performance and satisfaction. A total of 48...
Source: Military Medicine - March 23, 2019 Category: International Medicine & Public Health Tags: Mil Med Source Type: research

An Assessment of Flight Surgeon Confidence to Perform En Route Care.
CONCLUSIONS: Our survey results reveal most FSs are confident in neither their ability to perform ERC nor the ability of their hospital corpsman to provide care during patient movement. PMID: 30901437 [PubMed - in process] (Source: Military Medicine)
Source: Military Medicine - March 23, 2019 Category: International Medicine & Public Health Tags: Mil Med Source Type: research

The Israeli Defense Forces Point of Injury Antimicrobial Treatment Protocol - A New Protocol and Review of the Literature.
CONCLUSION: Point of injury antimicrobial protocol should be used especially when evacuation and definitive surgical treatment are delayed. According to present scientific data and operational needs, Ceftriaxone was chosen for most penetrating injuries, with Metronidazole addition for penetrating abdominal and cranial trauma. PMID: 30901438 [PubMed - in process] (Source: Military Medicine)
Source: Military Medicine - March 23, 2019 Category: International Medicine & Public Health Tags: Mil Med Source Type: research

Section 718 (Telemedicine): Virtual Health Outcomes From Regional Health Command Europe.
CONCLUSION: Regional medical centers conducting synchronous VH will require both internal and external data sources to report Section 718 outcomes required by Congress. As the anticipated demand for direct provider-to-patient telehealth increases, understanding these outcomes may aid initial and ongoing efforts in other military treatment facilities conducting synchronous VH. PMID: 30901439 [PubMed - in process] (Source: Military Medicine)
Source: Military Medicine - March 23, 2019 Category: International Medicine & Public Health Tags: Mil Med Source Type: research

A Prospective Cohort Study of Vitamin D Supplementation in AD Soldiers: Preliminary Findings.
Authors: McCarthy MS, Elshaw EB, Szekely BM, Raju D Abstract PURPOSE: To explore response to vitamin D supplementation in active duty (AD) warfighters and translate findings into evidence-based health policy. BACKGROUND: Soldiers are at risk for musculoskeletal injuries and metabolic dysfunction that impact physical performance and military readiness; the link with low vitamin D status is unclear. METHODS: This prospective trial enrolled 152 soldiers; baseline 25 hydroxyvitamin (OH) D level determined assignment to a no-treatment control (CG) or treatment group (TG) receiving a vitamin D3 supplement for 90 ...
Source: Military Medicine - March 23, 2019 Category: International Medicine & Public Health Tags: Mil Med Source Type: research

Combat-Related Extremity Wounds: Injury Factors Predicting Early Onset Infections.
We examined risk factors for combat-related extremity wound infections (CEWI) among U.S. military patients injured in Iraq and Afghanistan (2009-2012). Patients with ≥1 combat-related, open extremity wound admitted to a participating U.S. hospital (≤7 days postinjury) were retrospectively assessed. The population was classified based upon most severe injury (amputation, open fracture without amputation, or open soft-tissue injury defined as non-fracture/non-amputation wounds). Among 1271 eligible patients, 395 (31%) patients had ≥1 amputation, 457 (36%) had open fractures, and 419 (33%) had open soft-tissue wounds...
Source: Military Medicine - March 23, 2019 Category: International Medicine & Public Health Tags: Mil Med Source Type: research

I'm Wearing My Hearing Protection - Am I Still At Risk for Hearing Loss? Lurking Ototoxins in the Military Environment.
CONCLUSIONS: While evidence in humans is limited, potentially ototoxic substances are worthy of improved surveillance and further research to understand their ototoxic mechanisms, effects, and possible mitigation strategies. A triad approach of monitoring, protecting, and educating is recommended for effective prevention of hearing loss: the Department of Defense Hearing Center of Excellence's Comprehensive Hearing Health Program model employs such an approach. PMID: 30901442 [PubMed - in process] (Source: Military Medicine)
Source: Military Medicine - March 23, 2019 Category: International Medicine & Public Health Tags: Mil Med Source Type: research

Relationships and Evidence-Based Theoretical Perspectives on Persisting Symptoms and Functional Impairment Among Mild Traumatic Brain Injury and Behavioral Health Conditions.
Authors: Herrold AA, Smith B, Aaronson AL, Coleman J, Pape TL Abstract The purpose of this study is to characterize and describe the relationships between symptoms and functional impairment following mild traumatic brain injury (mTBI) and behavioral health conditions (BHCs) in order to inform evidence-based theories on why symptoms and functional impairments persist in some individuals but not others. This is a retrospective, multi-site, cross-sectional study utilizing data collected from a total of 289 Operation Iraqi Freedom/Operation Enduring Freedom Veterans who were classified into diagnostic groups using the ...
Source: Military Medicine - March 23, 2019 Category: International Medicine & Public Health Tags: Mil Med Source Type: research

Issue Overview.
Authors: Reilly PA, Hendrickson Mat TL PMID: 30901444 [PubMed - in process] (Source: Military Medicine)
Source: Military Medicine - March 23, 2019 Category: International Medicine & Public Health Tags: Mil Med Source Type: research

Perceptions of High-Risk Situations for Sexual Assault: Gender Differences in the U.S. Air Force.
This study explored U.S. Air Force service members' perceptions of high-risk situations for sexual assault victimization. Qualitative data were collected from 52 active duty Airmen, including sexual assault survivors and general population officers and enlisted personnel. Participants were recruited through posted flyers, base-wide e-mail messages, and referrals from the Sexual Assault Response Coordinator's office. Content analysis was used to summarize participants' opinions and experiences. High-risk situations for all Airmen included excessive alcohol use, specific physical settings, and situations associated with work...
Source: Military Medicine - March 23, 2019 Category: International Medicine & Public Health Tags: Mil Med Source Type: research

Mechanical and Finite Element Analysis of an Innovative Orthopedic Implant Designed to Increase the Weight Carrying Ability of the Femur and Reduce Frictional Forces on an Amputee's Stump.
This study was designed to test the hypothesis that: "A properly designed implant that harnesses the principle of the incompressibility of fluids can improve the weight carrying ability of an amputee's residual femur and reduce the frictional forces at the stump external socket interface." The hypothesis was tested both mechanically on an Amputee Simulation Device (ASD) and through Finite Element Analysis (FEA) modeling software. With the implant attached to the femur, the FEA and ASD demonstrated that the femur carried 90% and 93% respectively of the force of walking. Without the implant, the FEA model and ASD f...
Source: Military Medicine - March 23, 2019 Category: International Medicine & Public Health Tags: Mil Med Source Type: research

Evaluation of Three Postal Invitational Strategies to Increase Survey Response Rates in a Combat-Injured U.S. Military Population: Findings From the Wounded Warrior Recovery Project.
Authors: Sack DI, Woodruff SI, McCabe CT, Galarneau MR, Han PP Abstract The survival rate of those injured in combat in overseas contingency operations is higher than in previous conflicts. There is a need to assess the long-term psychosocial and quality of life outcomes of those injured in combat, yet surveying this population presents inherent challenges. As part of a large-scale, longitudinal examination of patient-reported outcomes of service members injured on deployment, the present manuscript evaluated the effectiveness of three postal strategies on response rates: (1) mailing a study prenotification postcar...
Source: Military Medicine - March 23, 2019 Category: International Medicine & Public Health Tags: Mil Med Source Type: research

An Exploratory Pilot Study to Describe Shared Decision-Making for PTSD Treatment Planning: The Provider Perspective.
CONCLUSION: These results offer a preliminary understanding of VA MH providers' facilitation of SDM for PTSD care. Findings may provide insights for MH providers who wish to engage patients with PTSD in SDM. PMID: 30901448 [PubMed - in process] (Source: Military Medicine)
Source: Military Medicine - March 23, 2019 Category: International Medicine & Public Health Tags: Mil Med Source Type: research

Pilot Study of a Novel Swine Model for Controlling Junctional Hemorrhage Using the iTClamp in Conjunction With Hemostatic Agents.
Authors: Stuart SM, Zarow G, Walchak A, McLean J, Roszko P Abstract Exsanguinating hemorrhage is a primary cause of battlefield death. The iTClamp is a relatively new device (FDA approval in 2013) that takes a different approach to hemorrhage control by applying mechanism wound closure. However, no previous studies have explored the feasibility of utilizing the iTClamp in conjunction with hemostatic packing. To fill this important gap in the literature, a novel swine model was developed, and a total of 12 trials were performed using QuikClot Combat Gauze or XSTAT sponges in conjunction with the iTClamp to treat art...
Source: Military Medicine - March 23, 2019 Category: International Medicine & Public Health Tags: Mil Med Source Type: research

Development of a Methodology for Simulating Complex Head Impacts With the Advanced Combat Helmet.
Authors: Begonia M, Rooks T, Pintar FA, Yoganandan N Abstract Blunt impact assessment of the Advanced Combat Helmet (ACH) is currently based on the linear head response. The current study presents a methodology for testing the ACH under complex loading that generates linear and rotational head motion. Experiments were performed on a guided, free-fall drop tower using an instrumented National Operating Committee for Standards on Athletic Equipment (NOCSAE) head attached to a Hybrid III (HIII) or EuroSID-2 (ES-2) dummy neck and carriage. Rear and lateral impacts occurred at 3.0 m/s with peak linear accelerations (PLA...
Source: Military Medicine - March 23, 2019 Category: International Medicine & Public Health Tags: Mil Med Source Type: research

A Novel Gradient Echo Plural Contrast Imaging Method Detects Brain Tissue Abnormalities in Patients With TBI Without Evident Anatomical Changes on Clinical MRI: A Pilot Study.
CONCLUSIONS: Our data suggest that GEPCI quantitative R2t* metric has potential to detect abnormalities in GM cellular integrity in individual TBI patients, including abnormalities that are not detectable by a standard clinical MRI. PMID: 30901451 [PubMed - in process] (Source: Military Medicine)
Source: Military Medicine - March 23, 2019 Category: International Medicine & Public Health Tags: Mil Med Source Type: research