Military medicine
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The evolution of military helmet devices has increased the amount of head-supported mass (HSM) worn by warfighters. HSM has important implications for spine biomechanics, and yet, there is a paucity of studies that investigated the effects of differing HSM and accelerative profiles on spine biomechanics. The aim of this study is to investigate the segmental motions in the subaxial cervical spine with different sizes of HSM under Gx accelerative loading. ⋯ The subaxial cervical spine experiences motion increases at all levels at both velocity profiles with increasing HSM. Larger helmet and greater impact velocity increased motion at all levels, with C5-C6 demonstrating the largest range of motion. HSM should be minimized to reduce the risk of cervical spine injury to the warfighter.
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A Clinical Decision Support System that provides just-in-time medical guidance at the point of injury is being developed. To develop a user interface, a user-centered design approach was taken. ⋯ Through multiple different evaluations, design recommendations for a clinical decision support system were implemented in an iterative process. More iterations and more formalized user testing are planned to maximize the usability of the system.
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Percutaneous dilatational tracheostomy is a commonly performed procedure in intensive care units. Unrecognized tracheal ring fracture has been suggested as a possible factor for tracheal stenosis. The degree of tracheal compression relates to the amount of force required to cannulate the trachea. The objective of this study was to determine the force required to insert two types of tracheostomy tubes with different cuff designs. ⋯ This model suggests that less force is required to insert the Shiley flexible tracheostomy tube, which could result in less tracheal compression. This may be because of the smaller taper-shaped cuff that, when deflated, occupies less volume compared to the barrel-shaped cuff. As a result, less tracheal injury may occur when using the Shiley flexible tracheostomy tube during percutaneous tracheostomy procedures.
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Military flight surgeons evaluating aviators for flight fitness based on the cervical spine range of motion (CROM) have no operationally relevant reference with which to make a reliable determination. The published physiological limits for the general population do not necessarily apply to military aviators. CROM requirements for rotary-wing aviators would ideally be defined by measurements taken directly within their operational environment. ⋯ The flight simulator could be a useful platform for flight surgeons determining CROM-related flight fitness if methods to increase the frequency of neck twist rotation movements during flight were implemented. The published maximum CROM values for the general population are not an appropriate reference for flight surgeons making flight fitness determinations related to CROM.
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Rhabdomyolysis-induced acute kidney injury (RIAKI) can interrupt physical training and increase mortality in injured warfighters. The legal performance-enhancing drugs caffeine and ibuprofen, which can cause renal injury, are widely used by service members. Whether caffeine or ibuprofen affects RIAKI is unknown. Cilastatin treatment was recently identified as an experimental treatment to prevent RIAKI at injury. To determine potential interacting factors in RIAKI treatment, we test the hypothesis that caffeine and ibuprofen worsen RIAKI and interfere with treatment. ⋯ Caffeine does not worsen RIAKI. The widely used performance-enhancing drug ibuprofen greatly worsens RIAKI in mice. Standard or experimental treatment of RIAKI including the addition of cilastatin to standard resuscitation is ineffective in mice with RIAKI exacerbated by ibuprofen. These findings may have clinical implications for the current therapy of RIAKI and for translational studies of novel treatment.