Military medicine
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Historical Article
Antidepressant Effect of the VA Weight Management Program (MOVE) Among Veterans With Severe Obesity.
Obesity is prevalent among users of Veteran's Health Administration services, where it is comorbid with depression, post-traumatic stress disorder, type 2 diabetes, cardiovascular disease, colon, and breast cancer. Among obese subjects, severe obesity represents a subpopulation with the highest risk of depression. We investigate the antidepressant effect of a local VA weight management program (Managing Overweight Veterans Everywhere - MOVE) among depressed veterans with severe obesity. ⋯ Depressed veterans with severe obesity improved their depressive symptoms by participating in the MOVE program. Veterans in the IMP had greater but short-term antidepressant effect as compared to educational intervention for obesity. Future studies with larger sample size may elucidate the underlying mechanisms of weight reduction to improve depression and, more importantly, sustain response among veterans with severe obesity.
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The American Society of Anesthesiologists' Physical Status (ASA-PS) Classification System was established to grade a patient's physical status prior to surgery. The literature shows inconsistencies in the application of the ASA-PS classification among providers. The many uses of the ASA-PS class require reliable ASA-PS class designations between providers. While much literature illustrates the inconsistency, there is limited research on how to improve inter-rater agreement. ⋯ While there was improvement in agreement following an education intervention, the agreement seen was not statistically significant. More research needs to be done to determine how to improve inter-rater reliability of the ASA-PS classification system with a focus on non-anesthesia providers.
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Comparative Study
Quantifying Training Load During Physically Demanding Tasks in U.S. Army Soldiers: A Comparison of Physiological and Psychological Measurements.
There are many ways to quantify the training loads required to perform soldiering tasks. Although indirect calorimetry may provide the most accurate measures, the equipment can be burdensome and expensive. Simpler measures may provide sufficient data, while being more practical for measuring soldiers in the field. The purpose of this study was to examine the relationship between total relative oxygen uptake (TotalRelVO2) measured by indirect calorimetry during three soldiering tasks, with two field-expedient measures of training load: summated heart rate zone (sumHR) and session rate of perceived exertion (sRPE). ⋯ SumHR and sRPE are acceptable alternatives to TotalRelVO2 when attempting to quantify and/or monitor training load during soldiering tasks.
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The goal of this study is to update the incidence of hyphema in Operation Iraqi (OIF) and Enduring Freedom (OEF). We wanted to assess associated ocular injuries and final visual acuity (VA) in open-globe versus closed-globe injuries with a hyphema. ⋯ Close follow-up in patients with hyphema is important due to the associated development of traumatic cataract and retinal detachment and poor final visual outcome.
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Occult HBV infection (OBI) is defined as the presence of detectable hepatitis B virus (HBV) DNA in HBV surface antigen (HBsAg) negative individuals. Rarely, OBI is attributed to mutant HBV that cannot be detected by commercial assays, but most cases occur in the setting of chronic hepatitis B, particularly infection with wild-type viruses associated with strong HBV suppression. OBI is a high-risk diagnosis as it is associated with multiple complications: HBV reactivation in immunocompromised states, transmission of HBV, progression of liver disease, and hepatocellular carcinoma. ⋯ This case series illustrates the clinical significance of OBI and the importance of screening for OBI in HBsAg negative patients with signs of chronic or severe hepatic inflammation. It also prompts an intriguing question regarding the prevalence of both HBV and OBI in the United States military and whether or not routine screening for HBV should be implemented in this population. Further study is warranted to determine if adding HBV core antibody to a universally employed screening regimen would be beneficial.