Military medicine
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Modern warfare operations are volatile, highly complex environments, placing immense physiological, psychological, and cognitive demands on the warfighter. To maximize cognitive performance and warfighter resilience and readiness, training must address psychological stress to enhance performance. Resilience in the face of adversity is fundamentally rooted in an individual's psychophysiological stress response and optimized through decreased susceptibility to the negative impact of trauma exposure. The current project aims to optimize warfighter expertise, resilience, adaptability, and performance by utilizing a validated Full Dive Virtual Reality (FDVR) training platform to provide high-fidelity, safe, and scalable, controlled stress exposure in highly realistic simulated training scenarios with the most advanced, immersive technology available. ⋯ The FDVR training platform overcomes the obstacles of in-person simulation training and provides the closest to real-life experience available. It will allow warfighters to train with their teams in immersive environments that replicate the conditions in which they are expected to perform their duties. The POC demonstrated that physiological responses can be mapped to scenario events to allow tracking of stress responses, cognitive load, as well as performance, and decision-making of the warfighter. The POC only involved 2 operators, but served to prove that the platform was safe and effective. Future testing plans to include 200 warfighters in operational teams of 10 to 12 to further validate the training effectiveness of the FDVR platform.
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Addressing hazing within the U.S. Military has become a critical concern to safeguard the well-being of service members; recent attempts to assess hazing prevalence in the military have been unsuccessful due to under representative data. ⋯ Distinct elements of military culture, such as the hierarchical chain of command, loyalty to the brotherhood/sisterhood, and the emphasis on resilience, likely amplify these responses. This study adds to the mounting evidence showcasing gaps in assessing hazing within the U.S. Military. It emphasizes the necessity for a comprehensive hazing prevention program. Presently, prevention relies on mandatory training, often integrated into safety briefings or harassment workshops. However, service members require further assistance in recognizing, rejecting, and reporting instances of hazing despite these trainings.
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Inhaled nitric oxide (INO) is a selective pulmonary vasodilator delivered from compressed gas cylinders filled to 2,200 psig (137.8 bar) with 800 ppm of NO in a balance of nitrogen. NO is currently FDA-approved for use in term or near-term infants with hypoxemia and signs of pulmonary hypertension in the absence of cardiac disease. INO has also been shown to improve oxygenation in adults with refractory hypoxemia. Current doctrine precludes the use of NO during military aeromedical transport owing to the requirement for large compressed gas cylinders. We performed a bench evaluation of 2 delivery systems that create NO from room air without the need for pressurized cylinders. ⋯ Both devices delivered a reliable INO dose at ground level. Altitude significantly affected INO delivery accuracy at 14,000 ft (4,267 meter) (P < 0.01) with both devices and at 8,000 ft (2,437 meter) (P < 0.01) with LungFit. Differences in INO dosage were not statistically significant with the Odic device at 8,000 ft (2,437 meter)(P > 0.05) although there were large variations with selected ventilator settings. With careful monitoring, devices creating INO from room air without cylinders could be used during aeromedical transport without the need for pressurized cylinders.
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Sternal intraosseous (IO) access has advantages over humeral and tibial access for fluid resuscitation in military medical settings due to superior flow rates and pharmacokinetics. However, the morphology of the young adult manubrial cortical and medullary bone as it relates to IO catheter tips of currently available FDA-approved IO access devices is unclear. ⋯ Present findings suggest that both FAST1 and TALON sternal IO catheter tips can be successfully placed into the target medullary bone with high accuracy in male military members aged 18 to 30 who require rapid resuscitation.
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Clinical investigations have attributed lumbar spine injuries in combat to the vertical vector. Injury prevention strategies include the determination of spine biomechanics under this vector and developing/evaluating physical devices for use in live fire and evaluation-type tests to enhance Warfighter safety. While biological models have replicated theater injuries in the laboratory, matched-pair tests with physical devices are needed for standardized tests. The objective of this investigation is to determine the responses of the widely used Hybrid III lumbar spine under the vertical impact-loading vector. ⋯ The Hybrid III lumbar spine when subjected to vertical impact simulating underbody blast levels showed that the impact is transmitted via the axial loading mechanism. This finding paralleled the results of axial force predominance over shear forces and axial loading injuries to human spines. Axial forces increased with increasing velocity suggesting the possibility of developing injury assessment risk curves, i.e., the manikin spine does not saturate, and its response is not a step function. It is possible to associate probability values for different force magnitudes. A similar conclusion was found to be true for both magnitudes of added effective torso mass at the superior end of the manikin spinal column. Additional matched-pair tests are needed to develop injury criteria for the Hybrid III male and female lumbar spines.