Military medicine
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To support soldier readiness and mitigate the mental health consequences of deployments, Army regulation mandates soldiers to receive Deployment Cycle Resilience Training (DCRT) throughout their deployment cycle. A recent evaluation revealed several issues with the existing version that threatened the relevancy and usefulness of the training. The present article details the systematic approach taken by the Research Transition Office at the Walter Reed Army Institute of Research to revise the DCRT curriculum and presents the revision updates that are now included in DCRT version 3. ⋯ The revisions outlined in this article enhance the training quality and potential effectiveness of DCRT, which can positively influence soldier and family readiness and mission success. Furthermore, the deliberate and iterative curriculum revision process can serve as a guide to other curriculum development projects, specifically within the military context. Implementation considerations and potential limitations are provided, and future directions are discussed to include the ongoing evaluation.
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Hypoxia and hyperoxia (pulse oximetry [SpO2] > 96%) are associated with increased mortality in critically ill patients. However, provider practices regarding oxygenation in traumatic brain injury (TBI) patients are unknown. This study assesses views on oxygenation of critically ill trauma patients with and without TBI and how this varies between Neurological ICU (NeuroICU) and Surgical-Trauma ICU (STICU) providers. ⋯ Critical care providers at UCHealth University of Colorado Hospital approach the oxygenation of critically ill trauma patients with and without TBI differently. Specifically, critical care respondents accepted a different lower oxygen saturation threshold for TBI and non-TBI patients. NeuroICU and STICU respondents differed in their threshold for the down-titration of supplemental oxygen. Targeted education for critical care providers may reduce these discrepancies and optimize oxygen use.
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Augmented reality systems, like the HoloLens 2 (HL2), have the potential to provide accurate assessments of mild traumatic brain injury (mTBI) symptoms in military personnel by simulating complex military scenarios while objectively measuring the user's movements with embedded motion sensors. The aim of this project was to determine if biomechanical measures of marching and squatting, derived from the HL2 motion sensors, were statistically equivalent, within 5%, to metrics derived from the gold-standard three-dimensional motion capture (MoCap) system. ⋯ Biomechanical outcomes characterizing performance during two common military movements, squatting and marching, were equivalent between the HL2 and MoCap systems in healthy adults. Squatting and marching are two military-relevant tasks that require strength, motor coordination, and balance to perform, all of which are known to be affected by mTBI. Taken together, the data provide support for using the HL2 platform to deliver military-specific assessment scenarios and accurately measure performance during these activities. Utilizing objective and quantitative measures of motor function may enhance the management of military mTBI and reduce unnecessary risk to service members.
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Foot and ankle fractures are the most common military health problem. Automated diagnosis can save time and personnel. It is crucial to distinguish fractures not only from normal healthy cases, but also robust against the presence of other orthopedic pathologies. Artificial intelligence (AI) deep learning has been shown to be promising. Previously, we have developed HAMIL-Net to automatically detect orthopedic injuries for upper extremity injuries. In this research, we investigated the performance of HAMIL-Net for detecting foot and ankle fractures in the presence of other abnormalities. ⋯ Automated fracture detection is promising but to be deployed in clinical use, presence of other abnormalities must be considered to deliver its full benefit. Our results with HAMIL-Net showed that considering other abnormalities improved fracture detection and allowed for incidental findings of other musculoskeletal abnormalities pertinent or superimposed on fractures.
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Although existing auditory injury prevention standards benefit warfighters, the Department of Defense could do more to understand and address auditory injuries (e.g., hearing loss, tinnitus, and central processing deficits) among service members. The Blast Injury Prevention Standards Recommendation (BIPSR) Process is designed to address the needs of all the Military Services for biomedically valid Military Health System (MHS) Blast Injury Prevention Standards. ⋯ The BIPSR Process illuminated important characteristics, capabilities, and limitations of candidate standards and existing datasets (e.g., limited human exposure data to evaluate the validity of injury prediction) for auditory blast injury prevention. The evaluation resulted in the recommendation to use the 8-hour Equivalent Level (LAeq8hr) as the interim MHS Auditory Blast Injury Prevention Standard while the community performs additional research to fill critical knowledge gaps.