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Hood, Charles Hardin. "The United States Army Medical Department in Low-Intensity Conflict." Military Medicine 156, no. 2 (February 1, 1991): 64–67. http://dx.doi.org/10.1093/milmed/156.2.64.
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Kiley, Kevin C. "The United States Army Medical Department Center and School: Supporting Soldiers into the 21st Century." Military Medicine 168, suppl_1 (September 1, 2003): 33–36. http://dx.doi.org/10.1093/milmed/168.suppl_1.33.
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Molloy, Joseph M., Timothy L. Pendergrass, Ian E. Lee, Michelle C. Chervak, Keith G. Hauret, and Daniel I. Rhon. "Musculoskeletal Injuries and United States Army Readiness Part I: Overview of Injuries and their Strategic Impact." Military Medicine 185, no. 9-10 (March 16, 2020): e1461-e1471. http://dx.doi.org/10.1093/milmed/usaa027.
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Abstract Introduction Noncombat injuries (“injuries”) greatly impact soldier health and United States (U.S.) Army readiness; they are the leading cause of outpatient medical encounters (more than two million annually) among active component (AC) soldiers. Noncombat musculoskeletal injuries (“MSKIs”) may account for nearly 60% of soldiers’ limited duty days and 65% of soldiers who cannot deploy for medical reasons. Injuries primarily affect readiness through increased limited duty days, decreased deployability rates, and increased medical separation rates. MSKIs are also responsible for exorbitant medical costs to the U.S. government, including service-connected disability compensation. A significant subset of soldiers develops chronic pain or long-term disability after injury; this may increase their risk for chronic disease or secondary health deficits potentially associated with MSKIs. The authors will review trends in U.S. Army MSKI rates, summarize MSKI readiness-related impacts, and highlight the importance of standardizing surveillance approaches, including injury definitions used in injury surveillance. Materials/Methods This review summarizes current reports and U.S. Department of Defense internal policy documents. MSKIs are defined as musculoskeletal disorders resulting from mechanical energy transfer, including traumatic and overuse injuries, which may cause pain and/or limit function. This review focuses on various U.S. Army populations, based on setting, sex, and age; the review excludes combat or battle injuries. Results More than half of all AC soldiers sustained at least one injury (MSKI or non-MSKI) in 2017. Overuse injuries comprise at least 70% of all injuries among AC soldiers. Female soldiers are at greater risk for MSKI than men. Female soldiers’ aerobic and muscular fitness performances are typically lower than men’s performances, which could account for their higher injury rates. Older soldiers are at greater injury risk than younger soldiers. Soldiers in noncombat arms units tend to have higher incidences of reported MSKIs, more limited duty days, and higher rates of limited duty days for chronic MSKIs than soldiers in combat arms units. MSKIs account for 65% of medically nondeployable AC soldiers. At any time, 4% of AC soldiers cannot deploy because of MSKIs. Once deployed, nonbattle injuries accounted for approximately 30% of all medical evacuations, and were the largest category of soldier evacuations from both recent major combat theaters (Iraq and Afghanistan). More than 85% of service members medically evacuated for MSKIs failed to return to the theater. MSKIs factored into (1) nearly 70% of medical disability discharges across the Army from 2011 through 2016 and (2) more than 90% of disability discharges within enlisted soldiers’ first year of service from 2010 to 2015. MSKI-related, service-connected (SC) disabilities account for 44% of all SC disabilities (more than any other body system) among compensated U.S. Global War on Terrorism veterans. Conclusions MSKIs significantly impact soldier health and U.S. Army readiness. MSKIs also figure prominently in medical disability discharges and long-term, service-connected disability costs. MSKI patterns and trends vary between trainees and soldiers in operational units and among military occupations and types of operational units. Coordinated injury surveillance efforts are needed to provide standardized metrics and accurately measure temporal changes in injury rates.
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Moussavian, Parvaneh A., Dominic A. Solimando, and J. Aubrey Waddell. "Ifosfamide, Carboplatin, and Etoposide (ICE) for Metastatic Soft Tissue Sarcoma." Hospital Pharmacy 43, no. 11 (November 2008): 878–82. http://dx.doi.org/10.1310/hpj4311-878.
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The complexity of cancer chemotherapy requires that pharmacists be familiar with the complicated regimens and highly toxic agents used. This column reviews various issues related to preparation, dispensing, and administration of antineoplastic therapy and the agents, both commercially available and investigational, used to treat malignant diseases. The views expressed in this article are those of the author(s) and do not reflect the official policy of the Department of the Army, the Department of Defense, or the United States Government.
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Kessler, Remi A., Ansh Bhammar, Nikita Lakomkin, Raj K. Shrivastava, Jonathan J. Rasouli, Jeremy Steinberger, Joshua Bederson, Constantinos G. Hadjipanayis, and Deborah L. Benzil. "Spinal cord injury in the United States Army Special Forces." Journal of Neurosurgery: Spine 34, no. 1 (January 2021): 110–16. http://dx.doi.org/10.3171/2020.7.spine20804.
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OBJECTIVESpinal cord injury (SCI) is an area of key interest in military medicine but has not been studied among the US Army Special Forces (SF), the most elite group of US soldiers. SF soldiers make up a disproportionate 60% of all Special Operations casualties. The objective of this study was to better understand SCI incidence in the SF, its mechanisms of acquisition, and potential areas for intervention by addressing key issues pertaining to protective equipment and body armor use.METHODSAn electronic survey questionnaire was formulated with the close collaboration of US board-certified neurosurgeons from the Mount Sinai Hospital and Cleveland Clinic Departments of Neurosurgery, retired military personnel of the SF, and operational staff of the Green Beret Foundation. The survey was sent to approximately 6000 SF soldiers to understand SCI diagnosis and its associations with various health and military variables.RESULTSThe response rate was 8.2%. Among the 492 respondents, 94 (19.1%) self-reported an SCI diagnosis. An airborne operation was the most commonly attributed cause (54.8%). Moreover, 87.1% of SF soldiers reported wearing headgear at the time of injury, but only 36.6% reported wearing body armor, even though body armor use has significantly increased in post-9/11 SF soldiers compared with that in their pre-9/11 counterparts. SCI was significantly associated with traumatic brain injury, arthritis, low sperm count, low testosterone, erectile dysfunction, tinnitus, hyperacusis, sleep apnea, posttraumatic stress disorder, major depressive disorder, and generalized anxiety disorder. Only 16.5% of SF soldiers diagnosed with SCI had been rescued via medical evacuation (medevac) for treatment.CONCLUSIONSA high number of SF soldiers self-reported an SCI diagnosis. Airborne operations landings were the leading cause of SCI, which coincided with warfare tactics employed during the Persian Gulf War, Operation Iraqi Freedom, and other conflicts. A majority of SCIs occurred while wearing headgear and no body armor, suggesting the need for improvements in protective equipment use and design. The low rate of medevac rescue for these injuries may suggest that medical rescue was not attainable at the time or that certain SCIs were deemed minor at the time of injury.
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McDonald, Kenneth, Tyler McLees, Shane Connolly, James McNulty, Leah Wasserman, and LTC Robert Prins. "Modeling Megacity Medical System Response to a CBRNE Event." Industrial and Systems Engineering Review 4, no. 2 (November 12, 2016): 131–48. http://dx.doi.org/10.37266/iser.2016v4i2.pp131-148.
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The collaborative effectiveness of the public health system (PHS) and the Army Medical Department (AMEDD) is limited in the case of a 10-kiloton (kt) nuclear event on a megacity due to an overall lack of knowledge and understanding among agencies. This study details an exhaustive analysis of the current medical response system using New York City as a case study. Through the problem definition phase of the Systems Decision Process (SDP), this report identifies operational gaps existing at different levels within the system. Identified operational gaps existed at the local, state, and federal levels in the areas of resources, communication, and planning within the following agencies: Sloan Kettering Memorial Hospital, the Office of Emergency Management (OEM), the Federal Emergency Management Agency (FEMA), Health and Human Services (HHS), and the United States Department of Veteran Affairs (VA). Evaluation of the operational gaps illustrated the areas which were most vulnerable. The current analysis suggests that the system in place requires adjustments of the identified gaps so that maximum efficiency can be achieved.
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Mantua, J., W. J. Sowden, C. Mickelson, J. J. Choynowski, A. F. Bessey, T. M. Burke, V. F. Capaldi, and A. B. McKeon. "0199 Sleep and Risk Taking Behavior in United States Army Soldiers: A Four Study Mega-Analysis." Sleep 43, Supplement_1 (April 2020): A78. http://dx.doi.org/10.1093/sleep/zsaa056.197.
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Abstract Introduction In military service members, high risk-taking behavior (RTB; e.g., looking to start a fight, reckless driving) leads to injury, judicial reprimand, and removal from military service. Consequently, reducing RTB has become a priority of the United States (U.S.) Army, and identifying modifiable antecedents of RTB has become critical. In non-military populations, in-lab studies have shown sleep restriction/deprivation leads to risky decision-making. We assessed whether sleep duration/quality and RTB are related in U.S. Army soldiers in operationally-relevant settings. Methods Sleep and RTB questionnaire data were collected in 4 unique samples: U.S. Army soldiers from an Armored Brigade Combat Team, Reserve Officer Training Corps (ROTC) Cadets, Special Operations infantrymen, and elite mountain warfare instructors. We aggregated data to conduct a mega-analysis, which is a combined analysis of original raw data. We assessed whether RTB (assessed with an in-house measure of soldier-specific RTB) was correlated with nightly sleep hours (n=2175), Insomnia Severity Index (n=1076), and Pittsburgh Sleep Quality Index scores (n=503). Next, using a linear regression, we assessed whether sleep duration was a predictor of RTB while controlling for relevant demographic factors (age, gender, marital status, combat experience, years of education, rank, years of service; n=1198). Results Higher RTB was correlated with lower sleep duration (r=-.23,p<.001), more insomnia symptoms (r=.29,p<.001), and poorer sleep quality (r=.20,p<.001). In the full model, lower age (B=-.02,p=.03) and higher combat experience (B=.05,p=.006) predicted higher RTB. Sleep duration remained a significant (and the strongest) predictor of RTB (B=-.18,p<.001). Conclusion Military leaders should work to build in more sleep opportunities and remove environmental sleep disruptors during training and deployment operations. Leaders should also monitor soldier behavior after military operations that require sleep loss in order to reduce RTB, and, consequently, increase the readiness of the force. Support This work was supported by the Military Operational Medicine Research Program (MOMRP). The opinions and assertions contained herein are the private views of the authors and are not to be construed as official or as reflecting the views of the US Army or of the US Department of Defense. This abstract has been approved for public release with unlimited distribution.
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Opalak, Charles F., Rafael A. Vega, Jodi L. Koste, R. Scott Graham, and Alex B. Valadka. "One hundred years of neurosurgery at the Medical College of Virginia/Virginia Commonwealth University (1919–2019)." Journal of Neurosurgery 133, no. 6 (December 2020): 1873–79. http://dx.doi.org/10.3171/2019.8.jns183464.
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The Department of Neurosurgery at the Medical College of Virginia/Virginia Commonwealth University (VCU) celebrates its 100th anniversary in 2019. It was founded by C. C. Coleman, who directed the US Army School of Brain Surgery during World War I and was one of the original members of the Society of Neurological Surgeons. Coleman began a residency program that was among the first four such programs in the United States and that produced such prominent graduates as Frank Mayfield, Gayle Crutchfield, and John Meredith. Neurosurgery at VCU later became a division under the medical school’s surgery department. Division chairs included William Collins and Donald Becker. It was during the Becker years that VCU became a leading National Institutes of Health–funded neurotrauma research center. Harold Young oversaw the transition from division to department and expanded the practice base of the program. In 2015, Alex Valadka assumed leadership and established international collaborations for research and education. In its first 100 years, VCU Neurosurgery has distinguished itself as an innovator in clinical research and an incubator of compassionate and service-oriented physicians.
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Rodin, Miriam. "Practicing Medicine and Practicing Anthropology Can be Complementary: A Physician-Anthropologist in Academic Geriatric Practice." Practicing Anthropology 20, no. 2 (April 1, 1998): 21–25. http://dx.doi.org/10.17730/praa.20.2.m64402j2618wl65w.
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First I was an urban anthropologist, then I was a medical anthropologist on the faculty of a university medical center. Then I went to medical school, completing undergraduate, graduate and fellowship training in internal medicine and geriatrics. At first I thought of myself as an anthropologist in medical school, a privileged participant-observer of the making of doctors in the United States. Ten years out of medical training I think of myself as a physician. I am responsible for the outpatient and inpatient care of elderly patients. I am also the medical director of a nursing home. I am teaching faculty for medical students and medical residents at Northwestern University Medical School in Chicago where I give both lecture and bedside instruction in the finer points of geriatric differential diagnosis and medical management. Occasionally I volunteer for teaching duties in ethics and humanities. Yet my funded research is more recognizably applied anthropology. With funding from the Illinois Department of Public Health and from the United States Army Breast Cancer Research Fund, I direct a research and intervention project to increase use of early cancer detection among older immigrant women in Chicago. In this article I will describe the research, but my principal focus will be on the role of anthropology in my practice as an academic geriatrician.
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Pandolf, Kent B., Ralph Francesconi, Michael N. Sawka, Allen Cymerman, Reed W. Hoyt, Andrew J. Young, and Edward J. Zambraski. "United States Army Research Institute of Environmental Medicine: Warfighter research focusing on the past 25 years." Advances in Physiology Education 35, no. 4 (December 2011): 353–60. http://dx.doi.org/10.1152/advan.00049.2011.
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The United States Army Research Institute of Environmental Medicine (USARIEM) celebrated its 50th anniversary on July 1, 2011. This article reviews its history, evolution, and transition of its research programs as well as its scientific and military accomplishments, emphasizing the past 25 yr. During the 1990s, USARIEM published a series of pocket guides providing guidance for sustaining Warfighter health and performance in Southwest Asia, Somalia, the former Republic of Yugoslavia, Rwanda, and Haiti. Issues identified during Operation Desert Storm elicited research that improved nutritional guidelines for protracted desert operations; safer use of nuclear, chemical, and biological protective clothing; equipment, development, and fielding of efficient microclimate cooling systems; and effective evaluation of pharmaceuticals to protect soldiers from chemical and biological threats. During the first decade of the 21st century, USARIEM and the Department of the Army published official medical/performance doctrines for operations in the heat and cold and at high altitude. The current Global War on Terrorism focused research to improve doctrines for hot, cold, and high-altitude operations, reduce musculoskeletal training injuries, provide improved field nutrition, more efficient planning for operational water requirements, and improve both military clothing and materiel. This article also describes the critically important interactions and communications between USARIEM and deployed units and the benefits to Warfighters from this association. This report presents USARIEM's unique and world-class facilities, organizational changes, scientific and support personnel, and major research accomplishments, including the publication of 2,200 scientific papers over the past 25 yr.
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Garges, Eric, June Early, Sandra Waggoner, Nazia Rahman, Dana Golden, Brian Agan, and Ann Jerse. "Biomedical Response to Neisseria gonorrhoeae and Other Sexually Transmitted Infections in the US Military." Military Medicine 184, Supplement_2 (November 1, 2019): 51–58. http://dx.doi.org/10.1093/milmed/usy431.
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ABSTRACT Introduction Sexually transmitted infections (STIs) continue to plague militaries and defense forces. While the historical recognition of the impact of STIs on operations is evident, contemporary surveillance and research activities are limited. As Neisseria gonorrhoeae and other sexually transmitted pathogens become increasingly resistant to antibiotics, the role of the Department of Defense (DoD) in disease surveillance and clinical research is essential to military Force Health Protection. Methods The Infectious Disease Clinical Research Program (IDCRP) of the Uniformed Services University of the Health Sciences partnered with the DoD Global Emerging Infections Surveillance (GEIS) program to monitor the distribution of gonorrhea antimicrobial resistance (AMR) both domestically and abroad. The DoD gonococcal reference laboratory and repository was established in 2011 as a resource for confirmatory testing and advanced characterization of isolates collected from sites across the continental United States (CONUS) and GEIS-funded sites outside the continental United States (OCONUS). The IDCRP is currently implementing surveillance efforts at CONUS military clinics, including Madigan Army Medical Center, Naval Medical Center Camp Lejeune, Naval Medical Center Portsmouth, Naval Medical Center San Diego, and San Antonio Military Medical Center (efforts were also previously at Womack Army Medical Center). The reference laboratory and repository receives specimens from OCONUS collaborators, including Armed Forces Research Institute of Medical Sciences (AFRIMS; Bangkok, Thailand), Naval Medical Research Unit No. 3 (NAMRU-3), Ghana Detachment (Accra, Ghana), Naval Medical Research Unit No. 6 (NAMRU-6; Lima, Peru), U.S. Army Medical Research Unit – Georgia (USAMRD-G; Tbilisi, Republic of Georgia), and U.S. Army Medical Research Directorate – Kenya (USAMRD-K; Nairobi, Kenya). The gonococcal surveillance program, to include findings, as well as associated clinical research efforts are described. Results Among N. gonorrhoeae isolates tested within the United States, 8% were resistant to tetracycline, 2% were resistant to penicillin, and 30% were resistant to ciprofloxacin. To date, only one of the 61 isolates has demonstrated some resistance (MIC=1 μg/ml) to azithromycin. No resistance to cephalosporins has been detected; however, reduced susceptibility (MIC=0.06–0.125 μg/ml) has been observed in 13% of isolates. Resistance is commonly observed in N. gonorrhoeae isolates submitted from OCONUS clinical sites, particularly with respect to tetracycline, penicillin, and ciprofloxacin. While no azithromycin-resistant isolates have been identified from OCONUS sites, reduced susceptibility (MIC=0.125–0.5 μg/ml) to azithromycin was observed in 23% of isolates. Conclusion Continued monitoring of circulating resistance patterns on a global scale is critical for ensuring appropriate treatments are prescribed for service members that may be infected in the U.S. or while deployed. Domestic surveillance for gonococcal AMR within the Military Health System has indicated that resistance patterns, while variable, are not dramatically different from what is seen in U.S. civilian data. Global patterns of gonococcal AMR have been described through the establishment of a central DoD gonococcal reference laboratory and repository. This repository of global isolates provides a platform for further research and development into biomedical countermeasures against gonococcal infections.
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Sokolov, Barbara Berglund, and John Bertland. "Letterman General Hospital during World War I." California History 97, no. 3 (August 1, 2020): 86–121. http://dx.doi.org/10.1525/ch.2020.97.3.86.
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When the United States entered World War I on April 6, 1917, the Army Medical Department operated only four general hospitals and was in many ways unprepared for the scale and nature of the conflict ahead. This article examines the war's impact on Letterman General Hospital in San Francisco, which was the largest of the four hospitals before the war. In addition to tripling in capacity, Letterman incorporated many of the Medical Department's new services, the most significant concerning orthopedics and physical rehabilitation. The army's embrace of the ethic of rehabilitation was part of a major change in how the government managed care and compensation for those wounded in war—a change that marked a shift, continuing to this day, in how both state and society understand the relationship between disability and citizenship. After the war, Letterman incorporated new requirements for treating veterans in support of the country's evolving veterans’ health care system, which at times was unable to provide the full level of care the government had pledged and that many veterans had come to expect.
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Beekley, Alec C., and David M. Watts. "Combat trauma experience with the United States Army 102nd Forward Surgical Team in Afghanistan††This is an original work by the authors. The opinions expressed are the authors' alone. They do not necessarily reflect the opinion of the United States government, the Department of Defense, the United States Army, or Madigan Army Medical Center." American Journal of Surgery 187, no. 5 (May 2004): 652–54. http://dx.doi.org/10.1016/j.amjsurg.2004.02.001.
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Sanchez, Emily, Amy R. Gelfand, Michael D. Perkins, Maia C. Tarnas, Ryan B. Simpson, Jarrod A. McGee, and Elena N. Naumova. "Providing Food and Nutrition Services during the COVID-19 Surge at the Javits New York Medical Station." International Journal of Environmental Research and Public Health 18, no. 14 (July 12, 2021): 7430. http://dx.doi.org/10.3390/ijerph18147430.
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Military field hospitals typically provide essential medical care in combat zones. In recent years, the United States (US) Army has deployed these facilities to assist domestic humanitarian emergency and natural disaster response efforts. As part of the nation’s whole-of-government approach to the coronavirus disease (COVID-19) pandemic, directed by the Federal Emergency Management Agency and the Department of Health and Human Services, during New York City’s (NYC) initial surge of COVID-19, from 26 March to 1 May 2020, the US Army erected the Javits New York Medical Station (JNYMS) field hospital to support the city’s overwhelmed healthcare system. The JNYMS tasked a nutrition operations team (NuOp) to provide patient meals and clinical nutrition evaluations to convalescent COVID-19 patients. However, few guidelines were available for conducting emergency nutrition and dietary response efforts prior to the field hospital’s opening. In this case study, we summarize the experiences of the NuOp at the JNYMS field hospital, to disseminate the best practices for future field hospital deployments. We then explain the challenges in service performance, due to information, personnel, supply, and equipment shortages. We conclude by describing the nutrition service protocols that have been implemented to overcome these challenges, including creating a standardized recordkeeping system for patient nutrition information, developing a meal tracking system to forecast meal requirements with food service contractors, and establishing a training and staffing model for military-to-civilian command transition. We highlight the need for a standardized humanitarian emergency nutrition service response framework and propose a Nutrition Response Toolkit for Humanitarian Crises, which offers low-cost, easily adaptable operational protocols for implementation in future field hospital deployments.
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Harrison, Mark. "Book Review: The Army Medical Department, 1917—1941. By Mary C. Gillett. Washington, DC: Center of Military History, United States Army. 2009. xx + 644 pp. US$54. ISBN 978 0 16 083970 2." War in History 18, no. 2 (April 2011): 268–70. http://dx.doi.org/10.1177/09683445110180020705.
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Slater, James M. "Developing and Understanding a Hospital-Based Proton Facility: Bringing Physics into Medicine." Technology in Cancer Research & Treatment 6, no. 4_suppl (August 2007): 1–7. http://dx.doi.org/10.1177/15330346070060s401.
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From October 18 to 20, 2006, a symposium, Developing and Understanding a Hospital-based Proton Facility: Bringing Physics Into Medicine, was held at the Renaissance Esmeralda Resort and Spa, Indian Wells, California. The event was offered by the Department of Radiation Medicine at Loma Linda University (LLU), supported by the Telemedicine and Advanced Technology Research Center (TATRC) and the United States Army Medical Research and Materiel Command (USAMRMC). The meeting was intended to discuss factors involved in planning, developing, and operating a hospital-based proton treatment center. It brought together some of the most distinguished physicists, radiation biologists, and radiation oncologists in the world, and more than 100 individuals participated in the three-day educational offering. This overview reports on the event and introduces several papers written by many of the speakers from their presentations, for publication in this issue of Technology in Cancer Research and Treatment. Both the symposium and the papers are appropriate for this journal: exploitation of technology was one of the underlying themes of the symposium.
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Mantua, Janna, Grace Overman, Kathleen Huang, Hannah Eldringhood, and Sidhartha Chaudhury. "0229 Concerns about the future linked with poor sleep quality in U.S. Army Soldiers withdrawing from Afghanistan." Sleep 45, Supplement_1 (May 25, 2022): A104. http://dx.doi.org/10.1093/sleep/zsac079.227.
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Abstract Introduction A special operations unit of U.S. Soldiers rotated through Afghanistan from October, 2001 to the U.S. drawdown in 2020-2021. For these Soldiers, the drawdown has led to uncertainties about the future of the unit and their careers. Psychological stress resulting from these uncertainties could lead to sleep disturbances. This study assessed the relationship between attitudes about the Afghanistan drawdown and sleep. Methods A survey was broadly distributed in July-August 2021. To assess attitudes about the drawdown, participants were asked whether they felt changes in their personal readiness had occurred since the drawdown began. They were asked how they believed the unit should support Afghanistan in the future (remain in Afghanistan, support only through airstrikes, or no further support). Lastly, Soldiers were asked whether the drawdown made them more likely to switch to another unit, get out of the Army, or no change. Subjective sleep quality and duration from the month prior was assessed. Due to the abrupt fall of Kabul, the survey was discontinued earlier than planned, resulting in 35 participants. Results Soldiers were 32.80±5.99 years old. They had been in the unit for 8.89±5.71 years and had deployed to Afghanistan 5.14±3.14 times. The average sleep duration was 6.66±0.79 hours, and the average sleep quality was 63.39%±21.63%. There were no relationships between attitudes and sleep duration. However, regression analyses showed those who reported increased stress (B=18.16, p=.01), decreased morale (B=2.97, p=.006), and decreased motivation (B=2.69, p=.01) since the drawdown began had poorer sleep quality. ANOVA tests showed Soldiers who believed the unit should remain in Afghanistan had poorer sleep quality than those endorsing only air support or no involvement (F(2,29)=6.39, p=.005). Further, those who endorsed being more likely to make a career change had poorer sleep quality than those with no changes in career plans (F(2,29)=3.53, p=.04). Conclusion These results indicate that psychological distress resulting from the drawdown may be impacting sleep quality in this unit. Continuous monitoring of sleep quality may prove to be a sensitive indicator of elevated stress at the unit level. Support (If Any) Support for this study came from the Military Operational Medicine Research Program (MOMRP) of the United States Army Medical Research and Development Command (USAMRDC). Material has been reviewed by the Walter Reed Army Institute of Research. There is no objection to its presentation and/or publication. The opinions or assertions contained herein are the private views of the authors, and are not to be construed as official, or as reflecting true views of the Department of the Army or the Department of Defense. The investigators have adhered to the policies for protection of human subjects as prescribed in AR 70–25. The authors have no conflicts of interest to disclose.
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Summers, Shane M., Christopher J. Nagy, Michael D. April, Brandon W. Kuiper, Rechell G. Rodriguez, and Woodson S. Jones. "The Prevalence of Faculty Physician Burnout in Military Graduate Medical Education Training Programs: A Cross-Sectional Study of Academic Physicians in the United States Department of Defense." Military Medicine 184, no. 9-10 (April 3, 2019): e522-e530. http://dx.doi.org/10.1093/milmed/usz055.
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Abstract Introduction In military populations, physician burnout has potential to adversely affect medical readiness to deploy in support of joint operations. Burnout among Graduate Medical Education (GME) faculty may further threaten the welfare of the medical force given the central role these officers have in training and developing junior physicians. The primary aim of this investigation was to estimate the prevalence of burnout among faculty physicians in United States (US) Army, Navy, and Air Force GME programs. Materials and Methods We conducted a cross-sectional study of faculty physicians at US military GME training programs between January 2018 and July 2018. Through direct coordination with Designated Institutional Officials, we administered the Maslach Burnout Inventory Health Services Survey (MBI-HSS) via online web link to faculty physicians listed in Accreditation Data System at each sponsoring institution. In addition to the MBI-HSS, we collected demographic data and queried physicians about common occupational stressors in order to assist institutional leaders with identifying at-risk physicians and developing future interventions to address burnout. Results Sixteen of 21 institutions that currently sponsor military GME programs agreed to distribute the MBI-HSS survey to core faculty. We received completed assessments from 622 of the 1,769 (35.1%) reported physician core faculty at these institutions. Of the 622 physician respondents, 162 demonstrated high levels of emotional exhaustion and depersonalization for an estimated 26% prevalence of burnout. We identified only one independent risk factor for burnout: increasing numbers of deployments (OR 1.38, 95% CI 1.07–1.77). Physicians in our cohort who reported a desire to stay beyond their initial active duty service obligation were less likely to be classified with burnout (OR 0.45, 95% CI 0.26–0.77). The most common drivers of occupational distress were cumbersome bureaucratic tasks, insufficient administrative support, and overemphasis on productivity metrics. Conclusions We estimate that 26% of physician faculty in military GME programs are experiencing burnout. No specialty, branch of service, or specific demographic was immune to burnout in our sample. Institutional leaders in the MHS should take action to address physician burnout and consider using our prevalence estimate to assess effectiveness of future interventions.
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McManus, John, Jose Salinas, Melinda Morton, Charles Lappan, and Ron Poropatich. "Teleconsultation Program for Deployed Soldiers and Healthcare Professionals in Remote and Austere Environments." Prehospital and Disaster Medicine 23, no. 3 (June 2008): 210–16. http://dx.doi.org/10.1017/s1049023x0006489x.
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AbstractBackground: In April 2004, the US Army Medical Department approved the use of the Army Knowledge Online (AKO) electronic e-mail system as a teleconsultation service for remote teledermatology consultations from healthcare providers in Iraq, Kuwait, and Afghanistan to medical subspecialists in the United States. The success of the system has resulted in expansion of the telemedicine program to include 11 additional clinical specialty services: (1) burn-trauma; (2) cardiology; (3) dermatology; (4) infectious disease; (5) nephrology; (6) ophthalmology; (7) pediatric intensive care; (8) preventive and occupational medicine; (9) neurology; (10) rheumatology; and (11) toxicology. The goal of the program is to provide a mechanism for enhanced diagnosis of remote cases resulting in a better evacuation system (i.e., only evacuation of appropriate cases). The service provides a standard practice for managing acute and emergent care requests between remote medical providers in austere environments and rear-based specialists in a timely and consistent manner.Methods: Consults are generated using the AKO e-mail system routed through a contact group composed of volunteer, on-call consults. The project manager receives and monitors all teleconsultations to ensure Health Insurance Portability and Accountability Act compliance and consultant's recommendations are transmitted within a 24-hour mandated time period. A subspecialty “clinical champion” is responsible for recruiting consultants to answer teleconsultations and developing a call schedule for each specialty. Subspecialties may have individual consultants on call for specific days (e.g., dermatology and toxicology) or place entire groups on-call for a designated period of time (e.g., ophthalmology).Results: As of May 2007, 2,337 consults were performed during 36 months, with an average reply time of five hours from receipt of the teleconsultation until a recommendation was sent to the referring physician. Most consultations have been for dermatology (66%), followed by infectious disease (10%). A total of 51 known evacuations were prevented from use of the program, while 63 known evacuations have resulted following receipt of the consultants' recommendation. A total of 313 teleconsultations also have been performed for non-US patients.Conclusions: The teleconsultation program has proven to be a valuable resource for physicians deployed in austere and remote locations. Furthermore, use of such a system for physicians in austere environments may prevent unnecessary evacuations or result in appropriate evacuations for patients who initially may have been “underdiagnosed.”
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Alger, Sara, Clare Bennett, Neanne Bennett, Matthew Huebner, Jennifer Lee, Heather McCuiag Edge, Amos Simms, and Amy Adler. "0212 Insufficient Sleep and Behavioral Health in the Military: A 5-Nation Perspective." SLEEP 46, Supplement_1 (May 1, 2023): A94. http://dx.doi.org/10.1093/sleep/zsad077.0212.
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Abstract Introduction Insufficient sleep (< 7 hours per night) degrades both health and performance and constitutes a risk to military mission success. Accordingly, militaries across the globe are increasingly focusing on sleep management, including the role that leaders play in fostering and promoting a healthy sleep culture. In the present study, we assessed survey data from the militaries of five nations on: 1) sleep behavior, 2) the relationship between sleep behavior and mental health, and 3) the role leaders play in improving service member sleep. The goal was to determine the extent to which insufficient sleep, its link to behavioral health, and the role of leaders were relevant in militaries across allied English-speaking nations. Methods Data from five nations: Australia, Canada, New Zealand, the United Kingdom, and the United States were assessed. Each nation administered a survey to a military sample, including questions on sleep problems (e.g., Insomnia Severity Index) and mental health. In addition, some countries assessed how first-line leaders addressed sleep in their units using items from the sleep leadership scale. Each data collection differed in terms of scope, setting, and objective. Results Insufficient sleep (< 7 hours per night) was reported by 34.9%, 67.2% and 95.4% of survey respondents from the New Zealand Defence Force, Canadian Armed Forces, and the US Army, respectively. Those reporting shorter mean sleep durations also reported fewer sleep difficulties, likely reflecting higher sleep pressure from chronic sleep loss. Across all five nations, sleep problems (e.g., difficulty falling asleep) were positively correlated with behavioral health symptoms (e.g., depression and anxiety symptoms). Importantly, leader engagement in promoting healthy sleep was positively correlated with sleep duration and negatively correlated with sleep problems and behavioral health symptoms. Conclusion Insufficient sleep is pervasive in the militaries of the nations included in the present study – a finding that has serious implications for the behavioral health and resilience of service members, and more broadly for the overall effectiveness of these military forces. Across nations, militaries should attend to these risks and examine ways that first-line leaders can promote healthy sleep in their service members. Support (if any) Department of Defense Military Operational Medicine Research Program
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Berryman, Claire, Susan Cheung, Erika Collette, Stefan Pasiakos, Harris Lieberman, and Victor Fulgoni. "Amino Acid Intake and Conformance with the Dietary Reference Intakes in the United States: Analysis of the National Health and Nutrition Examination Survey, 2001–2018." Current Developments in Nutrition 6, Supplement_1 (June 2022): 886. http://dx.doi.org/10.1093/cdn/nzac067.006.
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Abstract Objectives The lack of complete amino acid composition data in food composition databases has made determining population-wide amino acid intake difficult. This cross-sectional study characterizes habitual intakes of each amino acid and adherence to dietary requirements for each essential amino acid (EAA) by age, gender, and race/ethnicity in the US population. Methods Food and Nutrient Database for Dietary Studies ingredient codes with missing amino acid composition data were matched to similar ingredients with available data, so that amino acid composition could be determined for virtually 100% of foods reported in What We Eat in America, the dietary intake assessment component of NHANES. Amino acid intakes during 2-y cycles of NHANES 2001–2018 (n = 84,629; ≥ 2 y) were calculated as relative [mg/kg of ideal body weight (IBW)/d] and absolute (g/d) intakes. Data from NHANES 2011–2018 were used to determine the percentage of the population consuming less than the Dietary Reference Intakes for each EAA by age, sex, and race/ethnicity. Results Relative intakes of EAAs were greatest in those 2–3 y (females: 1552 ± 9 and males: 1659 ± 9 mg/kg IBW/d) and lowest in those ≥80 y (females: 446 ± 2 and males: 461 ± 3 mg/kg IBW/d). Absolute intakes of EAAs were greatest in those 31–50 y (females: 31.4 ± 0.1 and males: 45.5 ± 0.1 g/d) and lowest in those 2–3 y (females: 22.4 ± 0.1 and males: 26.0 ± 0.1 g/d). In individuals 2–18 y and ≥19 y, relative intakes of EAAs were lowest in the NHB population (860 ± 16 and 505 ± 5 mg/kg IBW/d, respectively) and highest in the Asian population (994 ± 35 and 580 ± 7 mg/kg IBW/d, respectively). Less than 1% of individuals ≥19 y were not meeting the Estimated Average Requirements for each EAA. Conclusions Individual amino acid intakes in the US population exceed recommended minimum population requirements. Future studies can use the method described here to quantify habitual amino acid intake and examine relationships with health and disease. Funding Sources Institute for the Advancement of Food and Nutrition Sciences (IAFNS) Protein Committee, US Army Medical Research and Development Command, and the Department of Defense Center Alliance for Nutrition and Dietary Supplements Research.
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Trombetta, Leroy, Tommy Brown, Kathy Moore, Mary Joe Dehart, Robert Sawin, and Kenneth Azarow. "A quantitative assay for telomerase enzyme activity predicts severity of disease in neuroblastoma 1 1All financial support for this research has been provided by the Department of Clinical Investigations, Madigan Army Medical Center, United States Army. The opinions or assertions contained herein are the private views of the authors and are not to be construed as official or reflecting the views of the Department of the Army or the Department of Defense." Current Surgery 56, no. 7-8 (September 1999): 413–16. http://dx.doi.org/10.1016/s0149-7944(99)00155-5.
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Man, R. Y. K., and D. Bose. "A tribute to Peter E. Dresel, Ph.D.: (February 27, 1925 – November 15, 1987)." Canadian Journal of Physiology and Pharmacology 67, no. 7 (July 1, 1989): 691. http://dx.doi.org/10.1139/y89-111.
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Dr. Peter E. Dresel was a highly respected pharmacologist who played a significant role in the development of this discipline in Canada. Peter immigrated to the United States of America from Germany at a very young age. After graduating from high school and serving meritoriously in the U.S. Army during World War II, he obtained his doctorate in pharmacology from the University of Rochester in 1952. After serving in several positions in the university and in the pharmaceutical industry, Peter was recruited in 1956 by Mark Nickerson to join the fledgling Department of Pharmacology at the University of Manitoba. Nickerson's wish to develop Peter into a neuropharmacologist was never fulfilled. Instead, Peter went on to become an outstanding cardiac pharmacologist who trained a number of students, many of whom hold prestigious positions in their field of research. Having helped shape the "Nickerson Era" in Manitoba and having established a name in the cardiovascular pharmacology scene in North America, Peter became the Head of the Department of Pharmacology at Dalhousie University in Halifax in 1976. For the next 12 years Peter showed his superb academic and administrative abilities in shaping a vigorous and productive department.Peter served The Pharmacological Society of Canada in many capacities. He was a Councillor (1966–1969), Secretary (1969–1972), Vice President (1974–1975), and ultimately President (1975–1977). In addition to serving on the editorial boards of several international journals and scientific review committees, Peter was very active in university affairs, serving in the Senate at both the University of Manitoba and Dalhousie. He was also elected President of the Associate of Academic Staff at the University of Manitoba.Peter will be remembered for his unique flair. Despite his flamboyance, he had the unique ability to make his students feel at ease. His wealth of life experiences enabled him to teach his students and colleagues more than just science. He was eclectic and provocative, loyal and compassionate. Peter was never afraid of facing a challenge, nor was he too big to admit mistakes. Above all, he was extraordinarily generous in speaking of the accomplishments of his students and colleagues. Peter Dresel lived his life to the fullest, and helped those who crossed his path to do the same. His attributes will be judged not only through his contributions to science, but also by the enrichment of all who were touched by his influence.It is only befitting to honor Peter Dresel with a Memorial Issue in this Journal, which he served so well as an Associate Editor. The response of former students and colleagues has been overwhelming, and we wish to thank them all for their contributions.
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Speer, John K. "Doherty v. U.S. Department of Justice." American Journal of International Law 85, no. 2 (April 1991): 345–48. http://dx.doi.org/10.2307/2203070.
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This case is the latest in a series of actions brought in the United States since 1984 that have resulted in court and administrative decisions on the claim of asylum by, and attempt at extradition of, the plaintiff, Joseph Patrick Doherty, a native of Northern Ireland and subject of the United Kingdom and its Colonies. He was admittedly a member of the Provisional Irish Republican Army and was convicted in absentia, in Northern Ireland, of murder of a British Army officer there in 1980. In the instant case, the plaintiff sought review by the United States Court of Appeals for the Second Circuit of two administrative decisions by successive Attorneys General of the United States (one by Edwin Meese in June 1988, and the other by Richard Thornburgh in July 1989).
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Bauer, Elizabeth M., and Thanh Duc Hoang. "Complete Androgen Insensitivity and Decreased Bone Mineral Density." Journal of the Endocrine Society 5, Supplement_1 (May 1, 2021): A778—A779. http://dx.doi.org/10.1210/jendso/bvab048.1584.
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Abstract Background: Complete androgen insensitivity syndrome (CAIS) is a rare disorder of sex development and primary amenorrhea results in an XY karyotype but female phenotype. Patients with this syndrome have lower bone mineral density (BMD) when compared to age matched controls. Clinical Case: A 44-year-old phenotypic woman with a history of complete androgen insensitivity syndrome presented for follow-up. She was previously on hormone replacement therapy (HRT) at various doses from the age of 12 until her early 30s when her therapy became sporadic. At age 40, she was prescribed transdermal estrogen therapy but discontinued soon after a dermatologic reaction and had not been on any form of hormone replacement since that time. Past medical history was significant for karyotype 46 XY, osteochondritis dissecans of right ankle and bilateral orchiectomy at age 4. She was single with one adopted child. Physical examination showed a height 75 inches, weight 244 lbs and a normal heart, lung, and abdominal examinations. Laboratory results showed estradiol 12.3pg/mL(7.63-42.6), total testosterone 12.0 ng/dL(7-40), FSH 109.6 mIU/mL(25.8-134.8), LH 42.49 mIU/mL(7.7-58.5), anti-mullerian hormone < 0.015 ng/mL (0.26-5.81), inhibin B <7.0 pg/mL(<17), androstenedione 48 ng/dL(41-262), dihydrotestosterone 2.7 ng/dL(4-22) and dehydroepiandrosterone sulfate 209 ng/dL(31-701). A baseline DXA showed low bone density for age with T-score (Z-score) of -2.0 (-1.6) lumbar-spine; -1.6 (-1.2) femoral neck, -1.1 (-0.8) total hip and -2.5 (-2.0) forearm. Discussion:CAIS is caused by a mutation in the androgen receptor (AR) located on the X-chromosome causing complete unresponsiveness to androgen hormone. Karyotype is XY but feminization occurs due to aromatization of androgen to estrogen. Gonadectomy for testicular malignancy prevention is controversial as testicular tumors in CAIS is generally low and gonadal resection subjects individuals to lifelong hormone replacement. These patients also have lower BMD when compared to female or male age matched controls. This is even more apparent in those with removed gonads. Low BMD is exacerbated by poor compliance, inadequate dose or inappropriate HRT. Whether or not fracture risk is higher has yet to be elucidated. Currently, there is no guideline on how to manage low BMD including osteoporosis in this patient population. It is important to counsel patients with CAIS on BMD loss and to ensure optimization of factors that affect bone health including compliance with HRT, vitamin D/calcium intake and exercise. The views expressed in this article are those of the authors and do not reflect the official policy of the Department of Army/Navy/Air Force, Department of Defense, or the United States Government.
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Selvanesan, Benson, Sheelu Varghese, Justyna Andrys, Ricardo Arriaza, Rahul Prakash, Purushottam Tiwari, Cara Olsen, et al. "Abstract P2-17-04: Pharmacological inhibition of LY6K induced cell cycle arrest and DNA damage by disrupting the LY6K-Histone-Aurora B signaling axis." Cancer Research 83, no. 5_Supplement (March 1, 2023): P2–17–04—P2–17–04. http://dx.doi.org/10.1158/1538-7445.sabcs22-p2-17-04.
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Abstract Pharmacological inhibition of LY6K induced cell cycle arrest and DNA damage by disrupting the LY6K-Histone-Aurora B signaling axis Benson C. Selvanesan1,2, Sheelu Varghese1,2, Justyna Andrys5, Ricardo H. Arriaza6, Rahul Prakash6, Purushottam B Tiwari7, Cara Olsen8, Daniel Hupalo2,4, Yuriy Gusev5, Megha N. Patel6, Sara Contente1, Miloslav Sanda9, Aykut Uren7, Matthew D. Wilkerson3,4, Clifton L. Dalgard3,4, Linda S. Shimizu6, Maksymilian Chruszcz6, Tomasz Borowski5, Geeta Upadhyay 1,3,7. Affiliations 1 Department of Pathology, 2 Henry M. Jackson Foundation, 3 Murtha Cancer Center, 4 Department of Anatomy, Physiology, and Genetics 8 Department of Preventive Medicine and Biostatistics Uniformed Services University of the Health Sciences, Bethesda, MD, USA. 5 Jerzy Haber Institute of Catalysis and Surface Chemistry Polish Academy of Sciences, Cracow, Poland. 6 Department of Chemistry and Biochemistry, University of South Carolina, Columbia, SC, USA. 7 Department of Oncology, Georgetown University Medical Center, Washington, DC, USA. 9 Max Planck Institute for Heart and Lung Research, Ludwigstrasse, 43, 61231 Bad Nauheim, Germany. Correspond Disclaimer The opinions expressed herein are those of the authors and are not necessarily representative of the official policies of the Uniformed Services University of the Health Sciences (USUHS), the Department of Defense (DOD), the United States Army/Navy/Air Force, the U.S. Government, or any other funding agencies Conflict of Interest None Acknowledgments NIH, NCI, R01 CA227694. NIH, NCI, R21CA256424. DOD, USUHS, VPR-NFP-74-9824. Biomedical Instrumentation Center, USUHS. The American Genome Center, USUHS. Antibody Characterization Program, Clinical Proteomics Tumor Analysis Consortium (CPTAC), National Cancer Institute, National Institute of Health. The Polish Grid Infrastructure, Cracow, Poland. NIH P30CA51008 and 1S10OD019982-01 to Biacore Molecular Interaction Shared Resource (BMISR), Georgetown University. ABSTRACT Increased expression of LY6K is significantly associated with poor survival outcomes in many solid cancers, including triple-negative and estrogen receptor-positive breast, ovarian, gastric, head and neck, neuroblastoma, bladder, and lung cancers. Inhibition of LY6K signaling is an ideal therapeutic approach for cancer, since the LY6K protein is not involved in vital organ function. Previously, we identified the small molecule NSC243928 as a binder of LY6K using surface plasmon resonance screening and showed that its activity was dependent on LY6K expression in triple-negative breast cancer cells. Here, we demonstrate the structural basis of the molecular interaction of NSC243928 with LY6K protein and the subsequent inhibition of LY6K function in mitosis and cell division via Aurora B-histone pathway. We observed that LY6K interacts with phosphorylated histones and Aurora B kinases during mitosis and that this interaction was disrupted in the presence of NSC243928. Disruption of LY6K function in mitosis/cytokinesis leads to DNA damage, senescence, and apoptosis of cancer cells. We observed that NSC243928 led to increased binding of LY6K to phosphorylated gammaH2X at S139, which was dependent on NSC243928 interaction with LY6K on phenylalanine 79. Furthermore, we observed increased levels of phosphorylated gammaH2X at S139 and increased caspase-3 activation in the tumor isografts of 4T1 and E0771 mammary tumors treated with NSC243928. These data reveal that LY6K is a novel cell cycle target for therapeutic development in triple-negative breast cancer and other solid cancers with high expression of LY6K, such as bladder cancer, head and neck, and lung cancer. Citation Format: Benson Selvanesan, Sheelu Varghese, Justyna Andrys, Ricardo Arriaza, Rahul Prakash, Purushottam Tiwari, Cara Olsen, Daniel Huplo, yuriy Gusev, Megha Patel, Sara Contente, Miloslav Sanda, Matthew Wilkerson, Clifton Dalgard, Linda S. Shimizu, Maksymilian Chruszcz, Tomasz Borowski, Geeta Upadhyay. Pharmacological inhibition of LY6K induced cell cycle arrest and DNA damage by disrupting the LY6K-Histone-Aurora B signaling axis [abstract]. In: Proceedings of the 2022 San Antonio Breast Cancer Symposium; 2022 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2023;83(5 Suppl):Abstract nr P2-17-04.
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Goob, Thomas C. "Bloodborne Exposures at a United States Army Medical Center." Applied Occupational and Environmental Hygiene 14, no. 1 (January 1999): 20–25. http://dx.doi.org/10.1080/104732299303377.
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Gilman, S. E., E. J. Bromet, K. L. Cox, L. J. Colpe, C. S. Fullerton, M. J. Gruber, S. G. Heeringa, et al. "Sociodemographic and career history predictors of suicide mortality in the United States Army 2004–2009." Psychological Medicine 44, no. 12 (February 19, 2014): 2579–92. http://dx.doi.org/10.1017/s003329171400018x.
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BackgroundThe US Army suicide rate has increased sharply in recent years. Identifying significant predictors of Army suicides in Army and Department of Defense (DoD) administrative records might help focus prevention efforts and guide intervention content. Previous studies of administrative data, although documenting significant predictors, were based on limited samples and models. A career history perspective is used here to develop more textured models.MethodThe analysis was carried out as part of the Historical Administrative Data Study (HADS) of the Army Study to Assess Risk and Resilience in Servicemembers (Army STARRS). De-identified data were combined across numerous Army and DoD administrative data systems for all Regular Army soldiers on active duty in 2004–2009. Multivariate associations of sociodemographics and Army career variables with suicide were examined in subgroups defined by time in service, rank and deployment history.ResultsSeveral novel results were found that could have intervention implications. The most notable of these were significantly elevated suicide rates (69.6–80.0 suicides per 100 000 person-years compared with 18.5 suicides per 100 000 person-years in the total Army) among enlisted soldiers deployed either during their first year of service or with less than expected (based on time in service) junior enlisted rank; a substantially greater rise in suicide among women than men during deployment; and a protective effect of marriage against suicide only during deployment.ConclusionsA career history approach produces several actionable insights missed in less textured analyses of administrative data predictors. Expansion of analyses to a richer set of predictors might help refine understanding of intervention implications.
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Shah, Nirmish, Ralph Boccia, Walter K. Kraft, Brandon M. Hardesty, Jincy Paulose, Dram Laine, Das Purkayastha, Savita Nandal, and Abdullah Kutlar. "A Multicenter Retrospective Noninterventional Follow-up Study in Patients with Sickle Cell Pain Crisis Who Previously Participated in the Sustain Trial in the United States Successor Study." Blood 132, Supplement 1 (November 29, 2018): 4910. http://dx.doi.org/10.1182/blood-2018-99-111332.
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Abstract INTRODUCTION SUSTAIN was a randomized, double-blind, placebo-controlled, phase 2, 52-week study that compared the effect of crizanlizumab, a P-selectin inhibitor, versus placebo on the frequency of sickle cell pain crises (SCPCs, or vaso-occlusive crises [VOCs] leading to a health care visit) in patients with any genotype of sickle cell disease (SCD). Crizanlizumab 5.0 mg/kg significantly reduced the annual frequency of VOCs versus placebo (1.6 vs 3.0, P=0.01) and increased the time to first on-treatment VOC (4.1 vs 1.4 months, P=0.001). The current study, SUCCESSOR (SUSTAIN Chart-review of Crizanlizumab to Evaluate Sickle-cell Study One-year Retrospective), reviewed medical records of patients who completed the SUSTAIN study at US sites to assess additional cases of significant pain crisis events, and to generate real-world data on treatment patterns and health care resource utilization upon completion of treatment with crizanlizumab. METHODS SUCCESSOR is a retrospective cohort study of adult patients (≥18 years old) who participated in the SUSTAIN study in the United States to evaluate outcomes related to SCD up to 52 weeks following their completion of the trial. SUCCESSOR included the per protocol population from SUSTAIN, which included the intent-to-treat patients who received at least 12 of the 14 planned study drug doses, completed a visit at least 14 days after the final dose of study drug, and had no major protocol violations that impacted the efficacy assessments. The overall study period for the retrospective study was from September 2015 to March 2017 and patient data were obtained from medical records. Crizanlizumab was not administered post-SUSTAIN. Patient consent was obtained prior to data collection if required by local and/or central research ethics review. RESULTS In this preliminary analysis, a total of 6 patient data sets were extracted. These patients had been randomized to the following treatment arms in the SUSTAIN study: 1 placebo, 1 crizanlizumab 2.5 mg/kg, and 4 crizanlizumab 5.0 mg/kg. The patient who had received placebo during SUSTAIN was a 27-year-old male with HbS/β0-thalassemia SCD. The patient who had received crizanlizumab 2.5 mg/kg was a 42-year-old female with HbSC SCD. The patients who had received crizanlizumab 5.0 mg/kg were: a 28-year-old male with HbSS SCD; a 32-year-old female with HbSS SCD; a 56-year-old female with HbSC SCD; and a 65-year-old female with HbSS SCD. All patients were Black or African-American. In the 52 weeks following completion of the SUSTAIN study, patients who had received placebo or crizanlizumab 2.5 mg/kg reported 4 and 5 VOC events, respectively, while crizanlizumab 5.0 mg/kg patients reported 0-2 VOC events (Table). Four patients (3 crizanlizumab 5.0 mg/kg, 1 placebo) reported hydroxyurea (HU) usage during and after SUSTAIN. One patient who had received crizanlizumab 5.0 mg/kg and did not report HU usage during SUSTAIN reported HU usage post-SUSTAIN. All patients reported opioid usage after SUSTAIN. Transfusions were not allowed during SUSTAIN; 2 patients, 1 who had received crizanlizumab 5.0 mg/kg and 1 who had received placebo, reported transfusions post-SUSTAIN. Five of the 6 patients reported utilizing health care resources (eg, clinic visits, emergency department visits, or hospitalizations) post-SUSTAIN. One patient who received crizanlizumab 5.0 mg/kg did not report utilizing any health care resources post-SUSTAIN and did not report any VOC events in the 52 weeks after SUSTAIN. CONCLUSIONS We report our initial results from a limited number of patients from SUCCESSOR and therefore summarized post-SUSTAIN outcomes without analysis. In 5 of the 6 patients, the annual frequency of VOC events remained the same or increased in the post-SUSTAIN period compared to that during the SUSTAIN study. Data collection is ongoing in additional eligible patients. Disclosures Shah: Novartis: Consultancy, Research Funding, Speakers Bureau. Boccia:Amgen: Honoraria, Research Funding, Speakers Bureau; Celgene: Research Funding, Speakers Bureau; BMS: Research Funding, Speakers Bureau. Hardesty:Biomarin: Research Funding; Bioverativ: Research Funding; Global Blood Therapeutics: Research Funding; Novo Nordisk: Consultancy, Honoraria, Membership on an entity's Board of Directors or advisory committees, Research Funding; Octapharma: Consultancy, Honoraria, Research Funding; Pfizer: Honoraria, Research Funding; Prometic: Research Funding; Sangamo: Research Funding; Shire: Consultancy, Honoraria, Membership on an entity's Board of Directors or advisory committees, Research Funding, Speakers Bureau. Paulose:Novartis Pharmaceuticals Corporation: Employment, Equity Ownership. Laine:Novartis Pharmaceuticals Corporation: Employment, Equity Ownership. Purkayastha:Novartis Pharmaceuticals Corporation: Employment. Nandal:Novartis Pharmaceuticals Corporation: Employment. Kutlar:Sancilio: Other: DSMB Chair; Bluebird Bio: Other: DSMB Member; Novartis: Consultancy, Honoraria, Other: Personal fees, Research Funding.
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Steele, Scott R., Matthew J. Martin, Philip S. Mullenix, James V. Crawford, Daniel S. Cuadrado, and Charles A. Andersen. "Focused high-risk population screening for carotid arterial stenosis after radiation therapy for head and neck cancer††This is an original work by the above authors. The opinions expressed are the authors' and the authors' alone. They do not necessarily reflect the opinion of the United States government, the Department of Defense, or Madigan Army Medical Center." American Journal of Surgery 187, no. 5 (May 2004): 594–98. http://dx.doi.org/10.1016/j.amjsurg.2004.01.014.
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Masterman, Kelly-Anne, Oscar Haigh, Kirsteen Tullett, Ingrid Leal-Rojas, Carina Walpole, Frances Pearson, Jonathon Cebon, et al. "612 Human CLEC9A antibodies deliver NY-ESO-1 antigen to CD141+ dendritic cells to activate naïve and memory NY-ESO-1-specific CD8+ T cells." Journal for ImmunoTherapy of Cancer 8, Suppl 3 (November 2020): A648. http://dx.doi.org/10.1136/jitc-2020-sitc2020.0612.
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BackgroundDendritic cells (DC) are crucial for the efficacy of cancer vaccines, but current vaccines do not harness the key cDC1 subtype required for effective CD8+ T cell mediated tumor immune responses. Vaccine immunogenicity could be enhanced by specific delivery of immunogenic tumor antigens to CD141+ DC, the human cDC1 equivalent. CD141+ DC exclusively express the C-type-lectin-like receptor CLEC9A, which is important for the regulation of CD8+ T cell responses. This study developed a new vaccine that harnesses a human anti-CLEC9A antibody to specifically deliver the immunogenic tumor antigen, NY-ESO-1 to human CD141+ DC. The ability of the CLEC9A-NY-ESO-1 antibody to activate NY-ESO-1 specific naïve and memory CD8+ T cells was examined and compared to a vaccine comprised of a human DEC-205-NY-ESO-1 antibody that targets all human DC.MethodsHuman anti-CLEC9A, anti-DEC-205 and isotype control IgG4 antibodies were genetically fused to NY-ESO-1 polypeptide. Cross-presentation to NY-ESO-1- epitope specific CD8+ T cells and reactivity of T cell responses in melanoma patients was assessed by IFNγ production following incubation of CD141+ DC and patient peripheral blood mononuclear cells with targeting antibodies. Humanized mice containing human DC subsets and a repertoire of naïve NY-ESO-1-specific CD8+ T cells were used to investigate naïve T cell priming. T cell effector function was measured by expression of IFNγ, MIP-1β, TNF and CD107a and by lysis of target tumor cells.ResultsCLEC9A-NY-ESO-1 Ab were effective at mediating delivery and cross-presentation of multiple NY-ESO-1 epitopes by CD141+ DC for activation of NY-ESO-1-specific CD8+ T cells. When benchmarked to NY-ESO-1 conjugated to an untargeted control antibody or to anti-human DEC-205, CLEC9A-NY-ESO-1 was superior at ex vivo reactivation of NY-ESO-1-specific T cell responses in melanoma patients. Moreover, CLEC9A-NY-ESO-1 induced priming of naïve NY-ESO-1-specific CD8+ T cells with polyclonal effector function and potent tumor killing capacity in vitro.ConclusionsThese data advocate human CLEC9A-NY-ESO-1 antibody as an attractive strategy for specific targeting of CD141+ DC to enhance tumour immunogenicity in NY-ESO-1-expressing malignancies.Ethics ApprovalWritten informed consent was obtained for human sample acquisition in line with standards established by the Declaration of Helsinki. Study approval was granted by the Mater Human Research Ethics Committee (HREC13/MHS/83 and HREC13/MHS/86) and The U.S. Army Medical Research and Materiel Command (USAMRMC) Office of Research Protections, Human Research Protection Office (HRPO; A-18738.1, A-18738.2, A-18738.3). All animal experiments were approved by the University of Queensland Animal Ethics Committee and conducted in accordance with the Australian Code for the Care and Use of Animals for Scientific Purposes in addition to the laws of the United States and regulations of the Department of Agriculture.
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Niihara, Yutaka, Rafael Razon, Suvankar Majumdar, Brian Claggett, Onyinye C. Onyekwere, Alan Ikeda, Tammuella Singleton, et al. "Phase 3 Study of L-Glutamine in Sickle Cell Disease: Analyses of Time to First and Second Crisis and Average Cumulative Recurrent Events." Blood 130, Suppl_1 (December 7, 2017): 685. http://dx.doi.org/10.1182/blood.v130.suppl_1.685.685.
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Abstract Background A Phase 3, double-blind, randomized, placebo-controlled trial of L-glutamine in 230 patients (ages 5-58) over 48 weeks was conducted at 31 centers in the United States. Twice daily oral administration of L-glutamine or placebo was based on body weight approximating 0.3 g/kg/dose. The primary endpoint was the number of sickle cell crises (SCCs) during 48 weeks of follow-up. The treatment effect measured was the difference of two median numbers of SCCs between two arms by week 48. The SCCs required treatment with I.V. narcotics/ketorolac at an emergency department or during hospitalization in patients with a history of ≥ 2 crisis from the previous year. Splenic sequestration, acute chest syndrome and priapism were also considered to be SCCs. Patients stabilized on hydroxyurea (HU) treatment for at least 3 months prior to study screening (66% in both arms of the study) remained on HU for the duration of the study. The primary analysis via a Cochran-Mantel-Haenszel (CMH) test statistic showed a highly significant treatment effect (p=0.005). There was a median of 3 crises for the L-glutamine treatment arm and 4 for the placebo arm (25% difference). There were no concerning adverse events from the treatment compared with the placebo arm. In this abstract, we reported the results from additional analyses of times to first and second crisis as well as cumulative recurrent events, which further demonstrated the clinically meaningful treatment effect of L-glutamine. Methods The Kaplan-Meier estimates are constructed with the data from the times to the first and second SCC for both arms. The corresponding estimates of the hazard ratios with confidence intervals and p-values are obtained to evaluate the relative merit of two groups. The 50% quartile (median) of the curve and the 95% confidence interval were reported by treatment. Furthermore, recurrent event time analysis was also performed using the Andersen-Gill procedure as well as the robust method by Lin, Wei, Yang and Ying to estimate the intensity rates. Results L-glutamine therapy significantly prolonged the time to first and the time to second SCCs. The median time to first crisis was delayed by 30 days (84 days vs. placebo 54 days; p=0.0152) and the median time to second crisis was delayed by 79 days (212 days vs. placebo 133 days; p=0.0260). Hazard ratios for the time to first and second crisis were similar (0.69 and 0.68 respectively), suggesting an approximately 30% hazard reduction from the treatment (Figures 1 and 2). Both cumulative recurrent event analyses models for SCCs yielded an intensity rate ratio of 0.75 with 95% confidence intervals based on the Andersen-Gill of (0.62, 0.90) and Lin, Wei, Yang and Ying of (0.55, 1.01), respectively (Figure 3). This suggested that the average cumulative crisis count was reduced by approximately 25% over the entire 48-week period. Cumulative event curve separation was clear by day 30 of treatment and was maintained over the 48-week study period. Conclusion The results of the primary endpoint using time to event analytical methods substantiated the original CMH test result that L-glutamine treatment provided clinical benefit in reducing crises, and other acute complications of sickle cell disease, in patients 5 years of age and older irrespective of hydroxyurea use. EndariTM (L-glutamine oral powder) is now FDA-approved to reduce the acute complications of sickle cell disease in adult and pediatric patients 5 years of age and older. Disclosures Niihara: Emmaus Medical, Inc: Employment, Equity Ownership. Razon: Emmaus Medical, Inc: Employment. Wood: Emmaus Medical, Inc: Employment, Equity Ownership. Singh: Emmaus Medical, Inc: Employment. Tran: Emmaus Medical, Inc: Employment, Equity Ownership. Stark: Emmaus Medical, Inc: Employment, Equity Ownership.
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Gilligan, Peter H. "The Invisible Army." Journal of Clinical Microbiology 55, no. 9 (June 28, 2017): 2583–89. http://dx.doi.org/10.1128/jcm.00658-17.
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ABSTRACT The “invisible army” of clinical microbiologists is facing major changes and challenges. The rate of change in both the science and technology is accelerating with no end in sight, putting pressure on our army to learn and adapt as never before. Health care funding in the United States is undergoing dramatic change which will require a new set of assumptions about how clinical microbiology is practiced here. A major challenge facing the discipline is the replacement of a generation of clinical microbiologists. In my opinion, it is incumbent on us in the invisible army to continue to work with the American Society for Microbiology (ASM) in meeting the future challenges faced by our discipline. In this commentary, I will first discuss some recent history of clinical microbiology within ASM and then some current challenges we face.
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Newmark, Jonathan. "Military Bands as a Population for Studying Musicians' Health." Medical Problems of Performing Artists 24, no. 1 (March 1, 2009): 50. http://dx.doi.org/10.21091/mppa.2009.1011.
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The largest employer of full-time musicians in the United States is the Department of Defense. There are, within the Department, four separate full-time band programs (Army, Air Force, Marines, and Navy), of which the Army is by far the largest. Not only are these musicians employed full-time, but they have completely free health care and a uniform, electronic, world-wide health record that follows them for the length of their careers. They also have to adhere to the physical fitness standards of their services, including both height and weight standards and biannual physical fitness tests; in the Army, the latter includes pushups, sit-ups, and 2-mile runs every 6 months. It has always occurred to me that this population is uniquely suited to the sort of study that the Editorial in the September 2009 issue describes.
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Swedler, David I., Joseph J. Knapik, Kelly W. Williams, Tyson L. Grier, and Bruce H. Jones. "Risk Factors for Medical Discharge From United States Army Basic Combat Training." Military Medicine 176, no. 10 (October 2011): 1104–10. http://dx.doi.org/10.7205/milmed-d-10-00451.
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Hand, Roger, Stanley Wiener, and Jay P. Sanford. "Medical Readiness Education and Training Exercises by United States Army Medical Personnel in Kenya." Military Medicine 154, no. 8 (August 1, 1989): 417–21. http://dx.doi.org/10.1093/milmed/154.8.417.
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La Rosa, CPT Rene De. "Reflections on Suffering and Culture in Iraq: An Army Nurse Perspective." International Journal of Human Caring 11, no. 2 (March 2007): 53–58. http://dx.doi.org/10.20467/1091-5710.11.2.53.
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The United States Army (U.S. Army) has a fine tradition of providing healthcare on the battlefield. In March 2003, the United States military (U.S. military) entered the Iraqi theater of operations. Included in the military package were medical “assets” dedicated to sustain the health of the military fighting men and women, as well as the health of Iraqi detainees. Detainee medical care was a completely new setting where American nurses had not practiced before but where they were vitally needed. The purpose of this article is to describe the broad themes of suffering and healing at Abu Ghraib Internment Facility in Iraq and the mutual culture shock experienced by both sides of the war effort.
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Jarvela, Stephen, Kevin Boyd, and Robert Gadinski. "TRANGUCH GASOLINE SITE CASE HISTORY." International Oil Spill Conference Proceedings 2003, no. 1 (April 1, 2003): 637–42. http://dx.doi.org/10.7901/2169-3358-2003-1-637.
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ABSTRACT A team, consisting of the United States Environmental Protection Agency; Pennsylvania Department of Environmental Protection; Pennsylvania Department of Health; Agency for Toxic Substances and Disease Registry; United States Coast Guard and United States Army Corps of Engineers, has completed major steps to provide a safe and healthy environment for the residents of Laurel Gardens, Hazleton, PA. What started as a simple underground gasoline leak took on more serious dimensions when gasoline vapors were found in nearby homes. The investigation and mitigation expanded to include over 400 properties. The remediation consists of a ground water treatment system and a soil vapor extraction system. This paper and its presenters look at the critical aspects of this case as the investigation went from subsurface soil and ground water contamination impacting surface water to the contamination of indoor air. It examines the impact of preferential pathways that include sanitary and storm sewers as well as a 19th century abandoned coal mine. In addition to the technical aspects, this examination looks at the public health and community issues that have surrounded this case.
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FREEMON, FRANK R. "Administration of the Medical Department of the Confederate States Army, 1861 to 1865." Southern Medical Journal 80, no. 5 (May 1987): 630–37. http://dx.doi.org/10.1097/00007611-198705000-00019.
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Boyko, Ihor. "LIFE PATH, SCIENTIFIC-PEDAGOGICAL AND PUBLIC ACTIVITY OF VOLODYMYR SOKURENKO (TO THE 100TH ANNIVERSARY OF HIS BIRTH)." Visnyk of the Lviv University. Series Law 72, no. 72 (June 20, 2021): 158–66. http://dx.doi.org/10.30970/vla.2021.72.158.
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The life path, scientific-pedagogical and public activity of Volodymyr Sokurenko – a prominent Ukrainian jurist, doctor of law, professor, talented teacher of the Lviv Law School of Franko University are analyzed. It is found out that after graduating from a seven-year school in Zaporizhia, V. Sokurenko entered the Zaporizhia Aviation Technical School, where he studied two courses until 1937. 1/10/1937 he was enrolled as a cadet of the 2nd school of aircraft technicians named after All-Union Lenin Komsomol. In 1938, this school was renamed the Volga Military Aviation School, which he graduated on September 4, 1939 with the military rank of military technician of the 2nd category. As a junior aircraft technician, V. Sokurenko was sent to the military unit no. 8690 in Baku, and later to Maradnyany for further military service in the USSR Air Force. From September 4, 1939 to March 16, 1940, he was a junior aircraft technician of the 50th Fighter Regiment, 60th Air Brigade of the ZAK VO in Baku. The certificate issued by the Railway District Commissariat of Lviv on January 4, 1954 no. 3132 states that V. Sokurenko actually served in the staff of the Soviet Army from October 1937 to May 1946. The same certificate states that from 10/12/1941 to 20/09/1942 and from 12/07/1943 to 08/03/1945, he took part in the Soviet-German war, in particular in the second fighter aviation corps of the Reserve of the Supreme Command of the Soviet Army. In 1943 he joined the CPSU. He was awarded the Order of the Patriotic War of the 1st degree and the Order of the Red Star (1943) as well as 9 medals «For Merit in Battle» during the Soviet-German war. With the start of the Soviet-German war, the Sokurenko family, like many other families, was evacuated to the town of Kamensk-Uralsky in the Sverdlovsk region, where their father worked at a metallurgical plant. After the war, the Sokurenko family moved to Lviv. In 1946, V. Sokurenko entered the Faculty of Law of the Ivan Franko Lviv State University, graduating with honors in 1950, and entered the graduate school of the Lviv State University at the Department of Theory and History of State and Law. V. Sokurenko successfully passed the candidate examinations and on December 25, 1953 in Moscow at the Institute of Law of the USSR he defended his thesis on the topic: «Socialist legal consciousness and its relationship with Soviet law». The supervisor of V. Sokurenko's candidate's thesis was N. Karieva. The Higher Attestation Commission of the Ministry of Culture of the USSR, by its decision of March 31, 1954, awarded V. Sokurenko the degree of Candidate of Law. In addition, it is necessary to explain the place of defense of the candidate's thesis by V. Sokurenko. As it is known, the Institute of State and Law of the USSR has its history since 1925, when, in accordance with the resolution of the Presidium of the Central Executive Committee of March 25, 1925, the Institute of Soviet Construction was established at the Communist Academy. In 1936, the Institute became part of the USSR Academy of Sciences, and in 1938 it was reorganized into the Institute of Law of the USSR Academy of Sciences. In 1941–1943 it was evacuated to Tashkent. In 1960-1991 it was called the Institute of State and Law of the USSR Academy of Sciences. In Ukraine, there is the Institute of State and Law named after V. Koretsky of the NAS of Ukraine – a leading research institution in Ukraine of legal profile, founded in 1949. It is noted that, as a graduate student, V. Sokurenko read a course on the history of political doctrines, conducted special seminars on the theory of state and law. After graduating from graduate school and defending his thesis, from October 1, 1953 he was enrolled as a senior lecturer and then associate professor at the Department of Theory and History of State and Law at the Faculty of Law of the Lviv State University named after Ivan Franko. By the decision of the Higher Attestation Commission of the Ministry of Higher Education of the USSR of December 18, 1957, V. Sokurenko was awarded the academic title of associate professor of the «Department of Theory and History of State and Law». V. Sokurenko took an active part in public life. During 1947-1951 he was a member of the party bureau of the party organization of LSU, worked as a chairman of the trade union committee of the university, from 1955 to 1957 he was a secretary of the party committee of the university. He delivered lectures for the population of Lviv region. Particularly, he lectured in Turka, Chervonohrad, and Yavoriv. He made reports to the party leaders, Soviet workers as well as business leaders. He led a philosophical seminar at the Faculty of Law. He was a deputy of the Lviv City Council of People's Deputies in 1955-1957 and 1975-1978. In December 1967, he defended his doctoral thesis on the topic: «Development of progressive political thought in Ukraine (until the early twentieth century)». The defense of the doctoral thesis was approved by the Higher Attestation Commission on June 14, 1968. During 1960-1990 he headed the Department of Theory and History of State and Law; in 1962-68 and 1972-77 he was the dean of the Law Faculty of the Ivan Franko Lviv State University. In connection with the criticism of the published literature, on September 10, 1977, V. Sokurenko wrote a statement requesting his dismissal from the post of Dean of the Faculty of Law due to deteriorating health. During 1955-1965 he was on research trips to Poland, Czechoslovakia, Romania, Austria, and Bulgaria. From August 1966 to March 1967, in particular, he spent seven months in the United States, England and Canada as a UN Fellow in the Department of Human Rights. From April to May 1968, he was a member of the government delegation to the International Conference on Human Rights in Iran for one month. He spoke, in addition to Ukrainian, English, Polish and Russian. V. Sokurenko played an important role in initiating the study of an important discipline at the Faculty of Law of the Lviv University – History of Political and Legal Studies, which has been studying the history of the emergence and development of theoretical knowledge about politics, state, law, ie the process of cognition by people of the phenomena of politics, state and law at different stages of history in different nations, from early statehood and modernity. Professor V. Sokurenko actively researched the problems of the theory of state and law, the history of Ukrainian legal and political thought. He was one of the first legal scholars in the USSR to begin research on the basics of legal deontology. V. Sokurenko conducted extensive research on the development of basic requirements for the professional and legal responsibilities of a lawyer, similar to the requirements for a doctor. In further research, the scholar analyzed the legal responsibilities, prospects for the development of the basics of professional deontology. In addition, he considered medical deontology from the standpoint of a lawyer, law and morality, focusing on internal (spiritual) processes, calling them «the spirit of law.» The main direction of V. Sokurenko's research was the problems of the theory of state and law, the history of legal and political studies. The main scientific works of professor V. Sokurenko include: «The main directions in the development of progressive state and legal thought in Ukraine: 16th – 19th centuries» (1958) (Russian), «Democratic doctrines about the state and law in Ukraine in the second half of the 19th century (M. Drahomanov, S. Podolynskyi, A. Terletskyi)» (1966), «Law. Freedom. Equality» (1981, co-authored) (in Russian), «State and legal views of Ivan Franko» (1966), «Socio-political views of Taras Shevchenko (to the 170th anniversary of his birth)» (1984); «Political and legal views of Ivan Franko (to the 130th anniversary of his birth)» (1986) (in Russian) and others. V. Sokurenko died on November 22, 1994 and was buried in Holoskivskyi Cemetery in Lviv. Volodymyr Sokurenko left a bright memory in the hearts of a wide range of scholars, colleagues and grateful students. The 100th anniversary of the Scholar is a splendid opportunity to once again draw attention to the rich scientific heritage of the lawyer, which is an integral part of the golden fund of Ukrainian legal science and education. It needs to be studied, taken into account and further developed.
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Knapik, Joseph J., Emily K. Farina, Christian B. Ramirez, Stefan M. Pasiakos, James P. McClung, and Harris R. Lieberman. "Medical Encounters During the United States Army Special Forces Assessment and Selection Course." Military Medicine 184, no. 7-8 (April 3, 2019): e337-e343. http://dx.doi.org/10.1093/milmed/usz056.
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Abstract Introduction The Special Forces Assessment and Selection (SFAS) is an extremely physically and mentally demanding 19- to 20-day course designed to determine whether Soldiers are qualified to enter the Special Forces Qualification Course. As a first step to understand medical problems during SFAS, this study examined injuries, illnesses, and activities associated with injuries during the course. Materials and Methods Medical events during the SFAS course were compiled from Sick Call Trackers (a log of medical encounters maintained by medical personnel in the field) and Chronology of Medical Care (Standard Form 600). Descriptive statistics were calculated for each injury and illness and injuries were compiled by the activities performed when the injuries occurred. Results Of the 800 Soldiers who volunteered for the study, 38% (n = 307/800) and 12% (n = 97/800) experienced one or more injuries and/or illnesses, respectively. The most common injuries were blisters and abrasions/lacerations with incidences of 20% (n = 158/800) and 13% (104/800), respectively. The most common illnesses were respiratory infections, other infections, contact dermatitis, and allergies with incidences of 7% (n = 57/800), 2% (n = 14/800), 2% (n = 14/800), and 2% (n = 13/800), respectively. Among all injuries recorded (n = 573), the most common were blisters (46%), abrasions/lacerations (24%), pain (not otherwise specified) (19%), tendonitis (3%), and sprains (3%). Among all illnesses recorded (n = 133), the most common were respiratory infections (56%), allergies (11%), contact dermatitis (11%), and other infections (11%). Most injuries were experienced during land navigation (44%), team events (20%), and foot marching (11%), running (6%), and the obstacle course (5%), but when the estimated time involved for each event was considered, activities with the highest injury rates were the obstacle course (65 injuries/hr), running (27 injuries/hr), the Combat Readiness Assessment (activity involving combat-related tasks) (20 injuries/hr), and foot marching (16 injuries/hr). Conclusion The major limitations of this investigation were: 1) the low specificity with regard to many of the diagnoses/complaints; and 2) the fact that the medical problems reported here are only those seen by medical care providers and are likely an underestimate of the total morbidity in the SFAS course. Soldiers often self-treat and some may be reluctant to see medical personnel because of how it might affect their rating in the course. Nonetheless, this investigation alerts medical personnel to the injuries and illnesses to expect, and public health workers and leadership with activities to target for injury prevention measures during SFAS.
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Santose, Rachel A. "An Engaging Remembrance: A Review of the American Battle Monuments Commission Website." DttP: Documents to the People 44, no. 1 (September 7, 2016): 22. http://dx.doi.org/10.5860/dttp.v44i1.6062.
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Over 100,000 US military personnel died during World War I, with many of these deaths occurring directly on foreign battlefields. Public Law 389, enacted by the 66th Congress, as well as Public Law 360, enacted by the 80th Congress, allowed for a family’s repatriation of soldier remains to the United States for burial in a national or private cemetery. In 1919, however, the US War Department decided to establish permanent American military cemeteries in Europe and offered this option as an alternative to repatriation. To persuade family members to consent, the War Department needed to ensure these cemeteries were impressive and significant symbols of the American sacrifice on foreign soil; therefore, the War Department detailed a group of Army officers to serve as the Battle Monuments Board in 1921. Two years later, on March 4, 1923, Congress passed the Act for the Creation of an American Battle Monuments Commission (ABMC), which established one authoritative organization under Title 36 of the United States Code to control the construction of monuments and memorials to the American military in foreign countries.
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Kurtzke, JF. "Some contributions of the Department of Veterans Affairs to the epidemiology of multiple sclerosis." Multiple Sclerosis Journal 14, no. 8 (July 16, 2008): 1007–12. http://dx.doi.org/10.1177/1352458508096005.
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The first class 1 treatment trial ever conducted in multiple sclerosis (MS) was a Veterans Administration Cooperative Study. This led us to explore MS in the military–veteran populations of the United States in three main series: Army men hospitalized with final diagnoses of MS in World War II, all veterans of World War II and the Korean Conflict, and veterans of later service up to 1994. In each series, all cases had been matched with pre-illness military peers. These series provide major information on its clinical features, course and prognosis, including survival, by sex and race (white men and women; black men), as well as risk factors for occurrence, course, and survival. They comprise the only available nationwide morbidity distributions of MS in the United States. Veterans who are service-connected for MS by the Department of Veterans Affairs and matched with their military peers remain a unique and currently available resource for further clinical and epidemiological study of this disease.
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Brenner, Lisa A., Jeri E. Forster, Colin G. Walsh, Kelly A. Stearns-Yoder, Mary Jo Larson, Trisha A. Hostetter, Claire A. Hoffmire, Jaimie L. Gradus, and Rachel Sayko Adams. "Trends in suicide rates by race and ethnicity among members of the United States Army." PLOS ONE 18, no. 1 (January 17, 2023): e0280217. http://dx.doi.org/10.1371/journal.pone.0280217.
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Efforts were focused on identifying differences in suicide rates and time-dependent hazard rate trends, overall and within age groups, by race and ethnicity among United States Army members who returned from an index deployment (October 2007 to September 2014). This retrospective cohort study was conducted using an existing longitudinal database, the Substance Use and Psychological Injury Combat Study (SUPIC). Demographic (e.g., race and ethnicity) and military data from the Department of Defense compiled within SUPIC, as well as Department of Veterans Affairs data were linked with National Death Index records (through 2018) to identify deaths by suicide including those that occurred after military service. The cohort included 860,930 Army Service members (Active Duty, National Guard, and Reserve). Age-adjusted (using the direct standardization method) and age-specific suicide rates per 100,000 person years were calculated and rate ratios (RR) were used for comparisons. Trends were evaluated using hazard rates over time since the end of individuals’ index deployments. Among those aged 18–29 at the end of their index deployment, the suicide rate for American Indian/Alaskan Native (AI/AN) individuals was 1.51 times higher (95% confidence interval [CI]: 1.03, 2.14) compared to White non-Hispanic individuals (WNH), and lower for Hispanic and Black non-Hispanic (BNH) than for WNH individuals (RR = 0.65 [95% CI: 0.55, 0.77] and RR = 0.71 [95% CI: 0.61, 0.82], respectively). However, analyses revealed increasing trends in hazard rates post-deployment (≤ 6.5 years) within groups of Hispanic and BNH individuals (Average Annual Percent Change [APC]: 12.1% [95% CI: 1.3%, 24.1%] and 11.4% [95% CI: 6.9%, 16.0%], respectively) with a smaller, increase for WNH individuals (APC: 3.1%; 95% CI: 0.1%, 6.1%). Findings highlight key subgroups at risk for post-deployment suicide (i.e., WNH, AI/AN and younger individuals), as well as heterogeneous trends overtime, with rates and trends varying within race and ethnic groups by age groups. Post-deployment suicide prevention efforts that address culturally relevant factors and social determinants of health associated with health inequities are needed.
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Gandy, Roy E., Raven M. Christopher, and Charles B. Rodning. "The Statesmanship of William Crawford Gorgas, M.D., Surgeon General, Medical Corps, United States Army." American Surgeon 83, no. 3 (March 2017): 221–32. http://dx.doi.org/10.1177/000313481708300316.
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If statesmanship can be characterized as a bed rock of principles, a strong moral compass, a vision, and an ability to articulate and effect that vision, then the fortitude, tenacity, imperturbability, and resilience of William Crawford Gorgas cannot be overestimated. As Chief Sanitary Officer in Cuba and as Chief Medical Officer in Panama, he actualized strategies to eradicate the vectors of yellow fever and malaria. His superiors initially pigeonholed his requisitions, refused to provide him with any authority, and clamored for his dismissal. Nevertheless, with dogged persistence he created a coalition of the willing, who eventually implemented those reforms. As Surgeon General in the United States Army, he organized and expanded the Active Duty and Medical Reserve Corps in anticipation of World War I. Skilled university affiliated surgeons and personnel from throughout North America, manned base hospitals in Europe. Those lessons impacted upon subsequent military and civilian surgical care—organizationally, logistically, and clinically. He was universally recognized for his bonhomie, savoir-faire, modesty, discretion, decorum, courtesy, and graciousness. To those attributes must be added his devotion to duty, discipline, integrity, and authenticity, which characterized his leadership and statesmanship. Those attributes are most worthy of emulation and perpetuation by clinicians, academicians, educators, and investigators.
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Mullenix, Philip S., Daniel G. Cuadrado, Scott R. Steele, Matthew J. Martin, Craig S. See, Alan L. Beitler, and Preston L. Carter. "Secondary operations are frequently required to complete the surgical phase of therapy in the era of breast conservation and sentinel lymph node biopsy††This is an original work by the above authors. The opinions expressed in this original work are those of the authors alone. They do not necessarily reflect the opinion of the United States government, the Department of Defense, or Madigan Army Medical Center." American Journal of Surgery 187, no. 5 (May 2004): 643–46. http://dx.doi.org/10.1016/j.amjsurg.2004.01.003.
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Cole, George F., and I. Ridgway Davis. "Fred Kort." PS: Political Science & Politics 37, no. 4 (October 2004): 891. http://dx.doi.org/10.1017/s1049096504045354.
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Fred Kort, professor emeritus at the University of Connecticut, passed away at the age of 85 on July 17, 2004, after a long battle with cancer. Born in Vienna, Fred witnessed the rise of the Nazis and was a student of law at the University of Vienna until 1938 when Jewish students were expelled. As a result, Fred emigrated to the United States in 1939. In 1942 he volunteered for the U.S. Army and returned to Europe with the 11th Armored Division, fought in the Battle of the Bulge and other engagements, and eventually was stationed in Vienna. Upon his return to the United States, Fred enrolled at Northwestern University in 1946, earning his B.A., M.A., and Ph.D. in four years. He joined the department of political science at the University of Connecticut in 1950 and taught for 40 years, retiring in 1990.
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Niihara, Yutaka, Charles William Stark, Rafael Razon, Lan T. Tran, Joseph M. Becerra, Eduard H. Panosyan, and Joseph Louis Lasky. "Consistent Benefit of L-Glutamine Observed across Patients with Low, Medium, and High Number of Crises Reported in the Year Prior to Screening -- Analysis from the Phase 3 Study of L-Glutamine in Sickle Cell Anemia." Blood 132, Supplement 1 (November 29, 2018): 1065. http://dx.doi.org/10.1182/blood-2018-99-119720.
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Abstract Background: A Phase 3, double-blind, randomized, placebo-controlled trial of L-glutamine in 230 patients (ages 5-58) over 48 weeks was conducted at 31 centers in the United States. Twice daily oral L-glutamine or placebo was administered, based on body weight approximating 0.3 g/kg/dose. The primary endpoint was the number of sickle cell crises pain (SCCs) during 48 weeks of treatment. The treatment effect measured was the difference of the median number of SCCs between two arms at week 48. To qualify as an SCC, the patient had to have received treatment with I.V. narcotics/ketorolac at an emergency department or during hospitalization in patients with a history of ≥2 crisis from the previous year. Splenic sequestration, acute chest syndrome and priapism were also considered to be SCCs. Patients stabilized on hydroxyurea (HU) treatment for at least 3 months prior to study screening (66% in both arms of the study) remained on HU for the duration of the study. The primary analysis via a Cochran-Mantel-Haenszel (CMH) test statistic showed a highly significant treatment effect (p=0.005). There was a median of 3 crises for the L-glutamine treatment arm and 4 for the placebo arm (25% difference). There were no concerning adverse events from the treatment compared with the placebo arm. In this abstract, we reported the results from additional analyses of times to first and second crisis as well as cumulative recurrent events, which further demonstrated the clinically meaningful treatment effect of L-glutamine. Although not pre-specified as part of the study nor the drug approval process, external and internal reviewers of the data were interested in examining any differential effects of L-glutamine on patients that had either low, moderate or high frequencies of SCCs prior to study screening. Methods: An evaluation of the data was performed based on patients by three categories of crises; 2 crises (low), 3 - 5 (moderate) and ≥6 crises (high) as collected from their medical records at entry into the phase 3 study. The negative binomial regression (NBR) model was used to ascertain the rate ratios (rate of crises of L-glutamine assignment arm divided by the rate of crises on placebo). The NBR model was utilized to generate an estimate of treatment effect and treatment by subgroup interactions for the three subgroups. A rate ratio < 1.0 favored L-glutamine treatment effect. A significant interaction could be seen if the treatment arm is better than placebo for one category but worse than placebo for another. Subgroups with corresponding sample sizes were as follows: 2 SCCs in year prior: L-glutamine (n = 53) and placebo (n = 26). 3-5 SCCs in year prior: L-glutamine (n = 76) and placebo (n = 36). ≥6 SCCs in year prior: L-glutamine (n = 22) and placebo (n = 16). Results: Rate ratios (bolded) as shown in Table 1 were similar between all categories (2 crises, 3 to 5 crises, and ≥ 6 crises; 0.87, 0.74, and 0.82, respectively). There was no difference in treatment effect among the categories. These findings are confirmed by the lack of treatment by the prior year SCCs interaction; p = 0.8397. Numerically and graphically (Figure 1), there is an apparent lower rate ratio in those that had 3 to 5 SCCs in the year prior to screening. Discussion: The number of crises in the year prior to study screening is viewed as an indicator of disease severity, although this may not always be true due to the intra-patient variability in disease presentation. The apparent lower rate ratio in those that had 3 to 5 SCCs in the year prior to screening may be due to having the largest sample size of the three categories., The analysis indicates that the benefit of L-glutamine treatment observed in the phase 3 trial is consistent regardless of the history (one year) of SCCs prior to the initiation of L-glutamine therapy. Reference:A Phase 3 Trial of l-Glutamine in Sickle Cell Disease | NEJM. New England Journal of Medicine. https://www.nejm.org/doi/full/10.1056/NEJMoa1715971. Published 2018. Accessed July 24, 2018. Disclosures Niihara: Emmaus Medical, Inc: Employment, Equity Ownership. Stark:Emmaus Medical, Inc: Employment, Equity Ownership. Razon:Emmaus Medical, Inc: Employment, Equity Ownership. Tran:Emmaus Medical, Inc: Employment, Equity Ownership. Becerra:Emmaus Medical, Inc: Employment.
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Willy, Mary, Judith P. Kelly, Parivash Nourjah, David W. Kaufman, Daniel S. Budnitz, and Judy Staffa. "Emergency department visits attributed to selected analgesics, United States, 2004-2005." Pharmacoepidemiology and Drug Safety 18, no. 3 (December 30, 2008): 188–95. http://dx.doi.org/10.1002/pds.1691.
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