Military medicine
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Chlamydia pneumoniae (Cp) is a bacterium that causes pneumonia and other respiratory diseases. Fever may be present early but absent by time of presentation to clinic. Increases in X-ray-confirmed pneumonia (XCP) and laboratory-confirmed Cp infections were observed in new soldiers in training at Fort Leonard Wood (FLW), Missouri, early in 2014. These findings prompted a site assistance visit from the U.S. Army Public Health Command, Aberdeen Proving Ground, Maryland, with a review of available data and information to describe the outbreak, and inspections of barracks and training facilities and review of training practices to identify opportunities for interventions to reduce the risk of respiratory disease agent transmission. ⋯ The XCP rate and the percentage of specimens positive for Cp increased in early 2014, peaking in May. Only 12% of trainees with laboratory-confirmed Cp were febrile. Historically, acute respiratory disease surveillance at military training centers focused on febrile diseases, particularly those caused by adenoviruses. With introduction of an adenovirus vaccine in late 2011, respiratory disease rates dropped with only sporadic occurrences of adenovirus-associated disease. In 2012, the San Diego surveillance program began providing data on multiple respiratory disease agents, in addition to adenoviruses and influenza viruses. Since then, Cp, rhinoviruses and Mycoplasma pneumoniae have frequently been detected in trainees with acute respiratory disease. Respiratory surveillance programs supporting Army training centers should be re-evaluated in this post-adenovirus vaccine era, to include assessment of the fever criterion for selecting patients for study, the value of chest X-ray surveillance and the value of rapidly providing laboratory results to inform provider decisions regarding antibiotic use.
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Ongoing combat operations in Iraq, Afghanistan, and other theaters have led to an increase in high energy craniomaxillofacial (CMF) wounds. These challenging injuries are typically associated with complex tissue deficiencies, evolving areas of necrosis, and bony comminution with bone and ballistic fragment sequestrum. Restoring form and function in these combat-sustained CMF injuries is challenging, and frequently requires local and distant tissue transfers. War injuries are different than the isolated trauma seen in the civilian sector. Donor sites are limited on patients with blast injuries and they may have preferences or functional reasons for the decisions to choose flaps from the available donor sites. ⋯ While the epidemiology and characteristics of military CMF injuries have been well described, their management remains poorly defined and creates an opportunity for reconstructive principles proven in the civilian sector to be applied in the care of severely wounded service members. The War on Terror marks the first time that microsurgery has been used extensively to reconstruct combat sustained wounds of the CMF region. Our manuscript reviews various options to reconstruct these devastating CMF injuries and emphasizes the need for steady communication between the civilian and military surgical communities to establish the best care for these complex patients.
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Surgical intervention on cetaceans is rarely performed due to challenges including general anesthesia and post-operative wound healing. This report describes the evaluation and treatment of an adult female bottlenose dolphin (Tursiops truncatus) with the US Navy Marine Mammal Program, with a chronic ventral cervical abscess caused by Candida glabrata. Despite aspiration and lavage along with multiple antifungal drugs, the patient developed inspiratory stridor with decreased performance level and surgical treatment was pursued. ⋯ One-year post-op, the dolphin was clinically normal and follow-up imaging showed no significant recurrence of the abscess. This case demonstrates a novel surgical approach of managing abscesses in dolphins, including placement and management of a negative suction drain in a submerged patient. The successful collaboration between veterinary anesthesiology, veterinary medicine, radiology, and general surgery allowed the patient to continue her normal activities as a full-duty service member.
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With the removal in 2016 of restrictions on recruiting women to the combat arms in the all-volunteer Australian Army, a key question has been whether adding women to small combat teams will reduce the sense of cohesion among their members, which entails their subjective bonds with each other, their leader, and wider organization. Despite recent initiatives in Australia and the USA, there are too few women in combat units in any country to answer this question and how these subjective bonds affect a team's ability to stick together under pressure.Men and women recruits in the Australian Army have undertaken basic soldier training in mixed-gender teams since 1995. Recruit training provides the foundation of teamwork and cohesion in all types of units. The present study capitalized on this well-established practice as an avenue for illuminating the development of cohesion in the form of subjective bonds within mixed-gender teams. ⋯ Within the Australian Army, women and men have been trained in mixed-gender sections since 1995 with sustained success, at least anecdotally. The present findings provide the first independent confirmation that all three dimensions of cohesion increase in strength during recruit training much to the same degree in women and men alike. To the extent that felt cohesion translates into effective teamwork, mixed-gender training establishes a sound foundation for integrating women into combat units as well as support units, where they have traditionally served.
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Veterans face several potential difficulties upon leaving active duty. Among these is transition of healthcare to a different setting. The transition from active duty to veteran status is often a challenging time for veterans with diabetes. Changes in healthcare have been shown to decrease diabetes care compliance and diabetes self-management resulting in exacerbation in diabetes symptoms and increased healthcare expenditure. A seamless transition in healthcare management from active duty to veteran status has the potential to maintain or increase diabetes self-management. A gap in the literature exists regarding the transition process between healthcare systems, including the DoD and VA. This paper describes the transition experience of a sample of veterans with diabetes from active duty to veteran status. ⋯ Study participants reported consistent compliance in diabetes self-management. Skills and attitudes obtained during military service led to participant's desire to manage their healthcare with determination to cope with challenges accompanying diabetes. The healthcare transition process would benefit from additional exploration of veteran's needs. Improved processes may facilitate the healthcare management transition of personnel with diabetes from active duty to veteran status.