Military medicine
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A substantial proportion of adults in the U.S. criminal justice system are military veterans. Justice-involved veterans are of particular public concern given their service to the country and the high rates of health and social problems in the general veteran population. This article describes the development of a national research agenda for justice-involved veterans. ⋯ The intent of sharing this research agenda is to spur stakeholders to conduct, collaborate, and support further study in these areas.
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Combined pulmonary fibrosis and emphysema (CPFE) is a clinical syndrome of upper-zone-predominant emphysema on high-resolution CT and a peripheral and basal-predominant diffuse pulmonary fibrosis. Multiple occupational and inhalational exposures have been associated with CPFE. ⋯ S. veteran, who developed CPFE after a prolonged, intense exposure to trichloroethylene as an aircraft maintenance worker. We believe that this may be another example of occupational-associated CPFE.
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Obstructive sleep apnea (OSA) is a chronic condition that could lead to debilitating and sometimes life-threatening consequences. Oral appliance therapy (OAT) is effective in providing a conservative, nonsurgical treatment option for patients diagnosed with mild-to-moderate OSA. The primary goal of this study is to describe a symptom-based titration protocol and determine if the patients can be effectively managed with oral appliances (OAs). ⋯ Oral appliance therapy (OAT) can be a reliable treatment modality to treat OSA, and performing a separate overnight posttreatment titration study further ensures its effectiveness. Furthermore, OAT can be an effective treatment modality even for moderate-to-severe OSA with posttreatment titration.
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Shock states that occur during, for example, profound hemorrhage can cause global tissue hypoperfusion leading to organ failure. There is an unmet need for a reliable marker of tissue perfusion during hemorrhage that can be followed longitudinally. Herein, we investigated whether longitudinal POMCO2 tracks changes in hemodynamics in a swine model of coagulopathic uncontrolled junctional hemorrhage. ⋯ Despite the logical appeal of measuring noninvasive tissue CO2 measurement as a surrogate for gastrointestinal perfusion, prior studies have only reported snapshots of this readout. The present investigation shows real-time longitudinal measurement of POMCO2 to confirm that MAP inversely correlates to POMCO2 in the face of coagulopathy. The simplicity of measuring POMCO2 in real time can provide an additional practical option for military or civilian medics to monitor trends in hypoperfusion during hemorrhagic shock.
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Diagnostic radiology in the deployed military environment (in-theater diagnostic radiology) was greatly improved in the early 1990s with the addition of CT systems installed in military-grade one-sided expandable ISO-shelters. These shelters were provided with limited radiation shielding by several flexible lead curtains covering only a small portion of the shelter walls, necessitating placement of deployed CT systems at substantial distances from the field medical facility to limit exposures to personnel from secondary radiation. The newest generation deployable CT system is housed in a two-sided ISO-shelter with radiation shielding applied to the shelter walls. To ensure compliance with military and national standards for protection against ionizing radiation, we developed a simple method to calculate safe distances based on workload, frequencies of the various CT exams performed, and occupancy of controlled and uncontrolled areas. ⋯ The shielding in the new deployable CT ISO-shelter substantially reduces the distance between it and the surgical shelters of the field medical unit necessary to ensure radiation safety. Safe distances depend on several factors including workload, types and frequencies of CT exams, occupancy factors, and classification of the area around the ISO-shelter, i.e., controlled and uncontrolled.