Military medicine
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The Department of Defense (DoD) operates a large, multi-channeled physician accession pipeline to maintain a professional workforce of over 10,000 active duty physicians. The Uniformed Services University (USU) operates the nation's only federal medical school providing trained doctors to the Army, Navy, Air Force, and Public Health Service. Although the school serves an essential purpose, policymakers question the cost of operating the University's medical school. One challenge is to develop reproducible and transparent costing methods that can be used to evaluate the University's value and efficiency. ⋯ This work provides a foundational framework and approach to estimate the costs of accessioning a physician at USU. This methodology can be replicated for subsequent value analyses of physician accession and retention as budgetary pressures change to match the DoD operating environment. Uniformed Services University's costs should be periodically reassessed against those of alternative accession sources.
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The medical treatment facilities (MTF) represent the equivalent of the healthcare system in the home countries, but they face the limitations of an outpost at the end of the supply chain. The capabilities are limited, and the necessary effort to extend the treatment capacity is tremendous. Algorithms based on scientific evidence or at least profound medical expertise are a tool to facilitate the decision-making process in triage under difficult circumstances. The aim of this article is to present a protocol that regards the specific entities military MTF abroad have to deal with in context of the COVID-19 pandemic. ⋯ The presented triage protocol may be a tool for medical personnel to facilitate the difficult task of triaging. It provides guidance along patient-centered criteria like individual medical, ethical, and legal issues while taking into account the available resources. Future studies are needed to investigate the effectiveness of the SAINT protocol.
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Given the significant number of service members who have incurred mild traumatic brain injury (TBI) over the past two decades, this study was completed to determine the relative contribution of demographic, TBI-related, and psychological factors that predict the readiness of service members with primarily mild TBI. ⋯ In general, those service members who were able to RTD versus those who were classified as disabled (MEB) were of higher IQ and reported less somatic/psychological distress. Of note, traditional indices of TBI severity did not predict the ability of the sample to RTD. The results suggest the importance of treating psychological conditions and identifying possible indicators of resilience (e.g., higher intelligence) to increase the readiness of service members with mild TBI.
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Hydrazines are highly toxic inorganic liquids that are used as propellants in military and aviation industries, such as the U.S. Air Force F-16 Emergency Power Unit and SpaceX SuperDraco Rockets. The most commonly used derivatives include hydrazine, monomethylhydrazine, and 1,1-dimethylhydrazine (unsymmetrical dimethylhydrazine). Industrial workers in close contact with hydrazines during routine maintenance tasks can be exposed to levels well above the National Institute for Occupational Safety and Health relative exposure limits. ⋯ Exposure to small amounts of hydrazine and its derivatives can cause significant soft tissue injury, pulmonary injury, seizures, coma, and death. Neurologic presentations can vary based on exposure compound and dose. Decontamination is critical as treatment is mainly supportive. High-dose intravenous pyridoxine has been suggested as treatment for hydrazine-related neurologic toxicity, but this recommendation is based on limited human data. Despite recent research efforts to generate less toxic alternatives to hydrazine fuel, it will likely continue to have a role in military and aviation industries. Aerospace and military physicians should be aware of the toxicity associated with hydrazine exposure and be prepared to treat hydrazine toxicity in at-risk populations.
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Case Reports
Migration of Broken Dental Needle Through the Internal Jugular Vein in the Parapharyngeal Space.
Accidental broken dental needles during dental blocks have become a rare occurrence but still occur. Although the treatment for such occurrence is controversial, an increasing body of literature demonstrates that migration of such needles is possible. ⋯ This case is unique given the location of migration to the skull base as well as radiologically documented time course. Furthermore, it highlights the need for prompt retrieval of broken dental needles given the high potential of migration and injury to neurovascular structures.