Military medicine
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The article presents a clinical case of peculiarities of clinical manifestations, diagnostic and therapeutic approaches of undiagnosed chronic myeloproliferative disease, on the background of which Budd-Chiari syndrome (BCS) developed. The results of clinical course, examination, and treatment of a patient with BCS as a manifestation of the hidden course of primary myelofibrosis with the presence of somatic mutation (V617F) in Janus-tyrosine kinase-2 (JAK2) gene in myeloid cells are presented. Standard clinical and laboratory examinations, and cytomorphologic and histologic examination of bone marrow were used. ⋯ Seven years after the installation of 4 transjugular intrahepatic portosystemic shunts, the patient's condition remains satisfactory. The uniqueness of this clinical case lies in the presence of 2 serious diseases at the same time: myeloproliferative pathology (primary myelofibrosis) JAK2-positive variant and BCS. Timely diagnosis of both hematological diseases and their complication in the form of hepatic vein thrombosis with fulminant cytolytic syndrome allowed timely prescription of adequate treatment with a good clinical response.
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Drill instructors (DIs) are responsible for executing their Services' recruit training programs and for training recruits. DIs assume a variety of roles, including teaching and developing practical skills and knowledge, mentoring, modeling appropriate behavior and attitudes, motivating recruits for success during and after recruit training, applying and instilling discipline, and ensuring the safety and welfare of recruits. This article examines two major research questions at the intersection of gender, gender-integrated training, and the DI role: (1) What differences exist in how DIs experience their role by gender? and (2) how does gender-integrated recruit training affect DIs' approach to training? ⋯ Female DIs face additional challenges in and outside the role compared with their male peers, and some of these challenges are preventable. Staffing and personnel issues plague the female DI population and are a persistent and pervasive challenge to gender integration efforts. Women are a necessary and highly desirable population to fill the DI role, particularly as Services aim to expose recruits to leaders of both genders during their critical first training experience. DIs play an important role in ensuring the successful completion of recruit training, ultimately helping to build the future leaders of the military. The success of gender integration efforts depends on DIs' intentional approach to the process. Future research can build on this work by expanding the scope to other military training environments (beyond recruit training) and examining how DIs' own sociodemographic positions (e.g., gender, race, ethnicity, and sexual orientation) inform their perspective on and approach to equity in the training environment.
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Elevated rates of musculoskeletal injuries (MSIs) and attrition are documented in military recruit training. By identifying and addressing modifiable risk factors, the rate of successful training completion and military readiness can be enhanced. Despite their impact, the causes of MSIs and attrition among U.S. Marine Corps (USMC) recruits remain underexplored. This study investigates demographic, psychological, and physiological predictors of MSIs and attrition among USMC recruits. ⋯ MSIs and attrition during USMC recruit training significantly undermine force readiness and escalate costs. Our research has pinpointed several modifiable risk factors, chiefly reduced muscular power and cigarette smoking. We advocate for neuromuscular training programs to bolster strength and power, integrated nutrition and exercise strategies for optimal body composition, and support for smoking cessation to alleviate the incidence of MSIs and curtail attrition. Initiating training with a gradual increase in activity intensity can provide a critical window to correct pre-existing neuromuscular imbalances and weaknesses, particularly those stemming from prior MSIs. Effectively addressing these risk factors is pivotal for diminishing the rates of MSIs and attrition among recruits, thereby enhancing overall military readiness and operational efficiency.
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Musculoskeletal injuries (MSIs) occur frequently in military personnel. U.S. Marine Corps (USMC) recruits participate in an intense 13-week training program designed to transform civilians into basically trained Marines, during which they are susceptible to MSIs. Previous injury epidemiology research with USMC recruits was conducted in a non-gender-integrated training. Data for the current study were derived from a larger study, the USMC Gender-Integrated Recruit Training study, that was initiated to provide data-driven recommendations for gender integration during USMC recruit training. The purpose of the current analysis was to describe the unique profile of MSIs during USMC recruit training and compare MSIs between female and male recruits in gender-integrated training. ⋯ This was the first study to assess the burden of MSIs concurrently among female and male USMC recruits in gender-integrated training. MSIs, especially those affecting the lower extremity, continue to occur frequently in this population. Female recruits are more susceptible to MSIs during USMC recruit training compared to male recruits and are especially prone to hip MSIs. Future research should focus on identifying modifiable risk factors for MSIs in this population, with a focus on reducing lower-extremity MSIs in all recruits and hip MSIs in female recruits.
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Injury epidemiology research with military populations typically utilizes data obtained through medical chart review (MCR) or injury self-reports (ISRs). MCR data will not capture musculoskeletal injury (MSKI) data for which medical care was not sought, which is common during military recruit training. Injury self-report is affected by issues with recall, especially for MSKIs perceived as less severe. U.S. Marine Corps (USMC) recruits participate in an intense 13-week recruit training program during which they are susceptible to MSKIs. The purpose of the current analysis was to utilize a novel statistical method, the capture-recapture (CRC) technique, to account for the undercounting inherent in MSKI data sources and estimate the ascertainment-corrected cumulative incidence of MSKIs during USMC recruit training. ⋯ This was the first study to utilize the CRC technique to access the ascertainment-corrected incidence of MSKIs among USMC recruits. There was significant undercounting in both sources of the data analyzed, and the extent of undercounting varied by both MSKI anatomical location and type. When 2 sources of data were utilized simultaneously, the percent of CRC-estimated MSKIs observed from 2 sources of data was more complete. There is a need for further application of the CRC technique to MSKI data in military populations to provide a more complete assessment of MSKIs. Identification of modifiable factors that influence completeness of MSKI data obtained during military recruit training is also warranted.