Military medicine
-
Special Weapons and Tactics (SWAT) personnel who practice breaching with blast exposure are at risk for blast-related head trauma. We aimed to investigate the impact of low-level blast exposure on underlying white matter (WM) microstructure based on diffusion tensor imaging (DTI) and neurite orientation and density imaging (NODDI) in SWAT personnel before and after breacher training. Diffusion tensor imaging is an advanced MRI technique sensitive to underlying WM alterations. NODDI is a novel MRI technique emerged recently that acquires diffusion weighted data from multiple shells modeling for different compartments in the microstructural environment in the brain. We also aimed to evaluate the effect of a jugular vein compression collar device in mitigating the alteration of the diffusion properties in the WM as well as its role as a moderator on the association between the diffusion property changes and the blast exposure. ⋯ Our data provided initial evidence of the impact of blast exposure on WM diffusion alteration based on both DTI and NODDI. The mitigating effect of WM diffusivity changes and the moderating effect of collar wearing suggest that the device may serve as a promising solution to protect WM against blast exposure.
-
The role of health problems and programs to address problems in keeping the peace has not been scientifically analyzed. We sought to mitigate this gap in knowledge. ⋯ Without such an association or causal link, the role of health programs in peacekeeping and "stability operations" remains ambiguous. Negative findings do not mean that there is no connection between health programs and peace, and further study should be done. Our results have implications for the value of global health engagement missions.
-
This report examines the etiology of hemiballistic movements that began 24 hours after a 63-year-old male with vascular risk factors received tissue plasminogen activator (tPa) and thrombolysis in cerebral ischemia 3 (TICI3) thrombectomy for a left middle cerebral artery (MCA) ischemic stroke. The clinical course was reviewed from an admission at a large academic institution where assessments included physical exams, head and neck computed tomography angiography (CTA), and head magnetic resonance imaging (MRI) without contrast. The patient's initial physical exam was consistent with a left MCA syndrome and included a National Institute of Health Stroke Scale (NIHSS) of 20. ⋯ No prior cases of hemiballism have been reported as a likely complication of treatment with tPa and thrombectomy. The globus pallidus is the suspected origin of the ballistic movements either from a decreased insular signal or embolic event during treatment. As stroke interventions improve, the susceptibility of certain tissues to brief ischemic events during treatment must be assessed.
-
Frostbite, or the freezing of the tissues by exposure to conditions below the freezing point of water, is an unsettling and potentially dangerous condition that one can develop while living and working in cold environments below 0°C without proper protections. Civilians and military personnel operating in prolonged field conditions in temperatures below freezing rely on advanced fabrics and multiple layers to maintain body heat around the extremities to prevent frostbite. Here, we detail the situation and findings of frostbite in 2 American service members who were exposed to temperatures of approximately -19.5°C for 5 hours while hiking on frozen sea ice. ⋯ The personnel presented with the classic signs and symptoms of second-degree frostbite with blistering and tingling but went on to have no lasting serious sequelae. We find these cases important as it documents the inadequacy of the footgear utilized, despite being operated in weather conditions within the range of the manufacturer's safety recommendations. Sea ice and other very cold, conducting surfaces may require other gear considerations when operating in this unique terrain type.
-
Colorectal cancer is the second leading cause of cancer deaths in the USA, and screening tests are underutilized. The aim of this study was to determine the proportion of individuals at average risk who utilized a recommended initial screening test in a universal healthcare coverage system. ⋯ Universal healthcare coverage does not ensure initial colorectal cancer screening utilization consistent with guidelines no does it eliminate disparities.