Military medicine
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Like civilian health systems, the United States Military Health System (MHS) confronts challenges in achieving the aims of reducing cost, and improving quality, access, and safety, but historically has lacked coordinated health services research (HSR) capabilities that enabled knowledge translation and iterative learning from its wealth of data. A military-civilian academic partnership called the Comparative Effectiveness and Provider-Induced Demand Collaboration (EPIC), formed in 2011, demonstrated early proof-of-concept in using the MHS claims database for research focused on drivers of variation in health care. This existing partnership was reorganized in 2015 and its topics expanded to meet the need for HSR in support of emerging priorities and to develop current and HSR capacity within the MHS. ⋯ EPIC, through its Donabedian framework and utilization of the MHS Data Repository as a research tool, generates actionable findings and builds capacity for continued HSR across the MHS. Eight years after its reorganization in 2015, EPIC continues to provide a platform for capacity building and knowledge translation.
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Medical assistance to populations (MAP) is a rich and varied activity, but it is not well known, and its modalities are inconsistent and unclear, particularly in the pediatric field; they can confront the military doctor with difficult management issues. Today, a military doctor deployed in foreign operations (FOs) does not know if he will perform MAP. He does not know how it will be carried out, nor if it will include a pediatric component. Finally, he does not know what difficulties he will face and therefore cannot prepare himself effectively. The primary objective of this work is to describe the modalities of MAP in FO, with an emphasis on the pediatric activity. The secondary objective is to develop a template for a post-session MAP registry. ⋯ MAP in FO is an activity in which modalities are very variable depending on the theater. Practitioners must have a solid theoretical and practical preparation beforehand, particularly in pediatrics. Keeping a specific activity register is an essential basis for judiciously adapting human and material resources dedicated to this activity. Future studies should aim to investigate more precisely the difficulties encountered.
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Pilots of high-performance F15 and F16 jets must undergo periodic assessment of +8.5 Gz tolerance in a centrifuge, which is classified as a high-intensity exercise. Prior research has indicated that exercise performance may be correlated with alpha-actinin3 (ACTN3) and angiotensin-converting enzyme (ACE) genes, frequently termed the sports genes. This study aimed to investigate how ACTN3 and ACE genotypes correlate with high-g tolerance of Korean F15 and F16 pilots. ⋯ In a preliminary study, the RR ACTN3 genotype showed a significant correlation with +8.5 Gz tolerance. Pilots with the DI genotype showed the highest high-g tolerance in this test; however, the test pass rate was higher in pilots with the DD genotype in the preliminary study. This result shows the possibility of test passing and tolerance superiority consisting of two different factors in the relationship between high-g tolerance and ACE genotype. This study showed that pilots with the RR + DI genotype had the highest high-g tolerance, which correlated with the presence of the R and D alleles of the ACTN3 and ACE genes, respectively. However, body composition parameters were not significantly correlated with genotype. These results could suggest a plural gene effect on high-g tolerance; further follow-up is required to determine the practical usage and applications of these results.
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Enterobius vermicularis is the most common helminthic infection in the United States, infecting an estimated 40 million persons. A rare complication of E. vermicularis infestation is appendicitis. The diagnosis must be considered during pathologic examination to ensure appropriate treatment with anti-helminthic therapy.