Military medicine
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Osseointegrated implants for direct skeletal attachment of transtibial prosthesis carry risks that are yet to be fully resolved, such as early loosening, mechanical failure of percutaneous and medullar parts of implant, periprosthetic issues, and infections. Underloading could lead to early loosening and infection. Overloading might compromise the bone-implant interface. Therefore, Goldilocks loading regimen applied by transtibial bone-anchored prostheses is critical for safe and efficient development of osseointegration around the implant during rehabilitation and beyond. We hypothesized that Goldilocks loading could be achieved when ambulating with a so-called anthropomorphic prosthetic ankle showing moment-angle relationship similar to a sound ankle. ⋯ Indexes of anthropomorphicity, while of different magnitude, were positive in control able-bodied group and in the amputee group wearing Free-Flow Foot, which was qualitatively associated with concave shape of their moment-angle curves. The 3 usual feet worn by the participants were classified as nonanthropomorphic as their individual moment-angle curves were convex and the corresponding IAs were negative. Furthermore, this study showed that a foot with anthropomorphic characteristics tends to decrease maximal loads at the bone-implant interface as compared to the nonanthropomorphic feet and possibly may minimize the risks to compromise the integrity of this interface.
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Tele-critical care (TCC) has improved outcomes in civilian hospitals and military treatment facilities (MTFs). Tele-critical care has the potential to concurrently support MTFs and operational environments and could increase capacity and capability during mass casualty events. TCC services distributed across multiple hub sites may flexibly adapt to rapid changes in patient volume and complexity to fully optimize resources. Given the highly variable census in MTF intensive care units (ICU), the proposed TCC solution offers system resiliency and redundancy for garrison, operational, and mass casualty needs, while also maximizing return on investment for the Defense Health Agency. ⋯ Tele-critical care can extend critical care services to anywhere at any time in support of garrison medicine, operational medicine, and mass casualty settings. An interoperable, flexibly staffed, and rapidly expandable TCC network must be further developed given the potential for large casualty volumes to overwhelm a single TCC provider with multiple duties. Lessons learned from development of this capability should have applicability for managing military and civilian mass casualty events.
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This article describes the evolution of first aid in the British Army from the Crimean War to the present day in order to interpret the processes of innovation, implementation, and diffusion of ideas to improve the clinical outcomes for military casualties. ⋯ The current generation of soldiers are at the highest ever standard of first aid training and equipment. This must be maintained through gathering of evidence in effectiveness and outcomes in prehospital emergency care in both military and civilian settings.
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The Security Force Assistance Brigades (SFABs) are specialized units designed to strengthen allied and partnered nations through advising, supporting, liaising, and assessing in support of U.S. national security interests and combatant commanders' war fighting objectives. As the 1st SFAB was the pioneer unit, descriptive analysis of the musculoskeletal injures and body regions occurring before, during, and after deployment was previously unavailable, limiting the ability of embedded holistic health and fitness teams to proactively address the unit's musculoskeletal needs and medical readiness. ⋯ Musculoskeletal injuries are a concern that may limit medical readiness in the SFABs in the time of before, during, and after deployment. Low back pain is the primary musculoskeletal injury of the 1st SFAB throughout the entire deployment cycle. Based on these findings, recommendations include embedding injury prevention programs to address low back pain to improve medical readiness. More research is required to assess the effectiveness of these programs in reducing incidents of musculoskeletal injuries before, during, and after deployment cycles.
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Terumo BCT is developing a system to produce a freeze-dried plasma product, Terumo's freeze-dried plasma (TFDP), that is stored in a rugged, light-weight plastic package suitable for field use, which retains a stable level of specific coagulation factors and proteins within clinical range, when stored for up to 2 years at room temperature and 4°C. ⋯ The TFDP process had no negative impact on coagulation factor activity. Input plasma and anticoagulant type did not affect TFDP quality. Pooling FFP normalized factor variability in TFDP and did not negatively impact product quality. The TFDP is stable for up to 24 months at room and refrigerated temperatures. Terumo's freeze-dried plasma is comparable to PF24/FFP. It does not require complex logistics or time-consuming thawing. Terumo's freeze-dried plasma may be suitable for rapid treatment of coagulopathies with logistical advantages over PF24/FFP.