Military medicine
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We present a 20-year-old previously healthy male who suffered a gunshot wound to the abdomen and underwent multiple surgeries because of abdominal abscess and fistula formation. Pain control was difficult to achieve despite high-dose opioid therapy. Post-traumatic stress disorder was a confounding factor in treating this patient's pain. ⋯ The patient presented to the intensive care unit after a 12-hour operation with an open abdomen and the requirement of mechanical ventilation, sedation, and analgesia. Sedation and analgesia were difficult to achieve and maintain with combinations of extremely high doses of midazolam, lorazepam, propofol, and fentanyl (motor assessment activity scale [MAAS] scores of 5), but profoundly achievable with dexmedetomidine. Dexmedetomidine also improved the patient's mental stability, which resulted in improved patient care through compliance with physicians, nurses, and physical therapists.
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To examine the relative importance of harassment-tolerant norms emanating from troops senior officers, immediate supervisors, and units on troops' sexual stressor experiences and to see whether associations differed by sex. ⋯ Senior officers' norms did not appear to affect troops' reports of military sexual stressors, but unit norms and immediate supervisors' norms did.
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We conducted a retrospective study of 473,964 U. S. Army soldiers deployed to Iraq and Afghanistan through December 2004 using deployment and admission records. ⋯ Combat units in Iraq demonstrated higher risk of any mental disorder and anxiety problems compared to combat support units. Younger women had the highest incidence of attempted suicide/ self-inflicted injuries. Further mental disorders surveillance is recommended.
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Historical Article
Military chemical warfare agent human subjects testing: part 1--history of six-decades of military experiments with chemical warfare agents.
Military chemical warfare agent testing from World War I to 1975 produced thousands of veterans with concerns of possible long-term health consequences. Clinical and research evaluation of potential long-term health effects has been difficult because the exposures occurred decades ago, the identity of troops exposed and exposure magnitudes are uncertain, and acute effects during experiments poorly documented. In contrast, a companion article describes the large amount of information available about the specific agents tested and their long-term health effects. ⋯ S. military chemical-agent experiments with human subjects and identifies tested agents. Finally, the demonstrated need to anticipate future health concerns from military personnel involved in such military testing suggests current and future military researchers should be required, by law and regulation, to fully record the identity of those exposed, relevant exposure magnitude, and complete medical information for all subjects. New study protocols and institutional review board approvals for research involving military personnel should reflect this need.
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U. S. casualties have developed multidrug-resistant (MDR) bacterial infections. A surveillance project to evaluate U. ⋯ S., 9 developed infections. Carefully obtained screening cultures immediately after injury combined with look-back monitoring supports the role of nosocomial transmission. Consistent infection control strategies are needed for the entire MHS.