Improvised Inguinal Junctional Tourniquets: Recommendations From the Special Operations Combat Medical Skills Sustainment Course.

Effectively and rapidly controlling significant junctional hemorrhage is an important effort of Tactical Combat Casualty Care (TCCC) and can potentially contribute to greater survival on the battlefield. Although the US Food and Drug Administration (FDA) has approved labeling of four devices for use as junctional tourniquets, many Special Operations Forces (SOF) medics do not carry commercially marketed junctional tourniquets. As part of ongoing educational improvement during Special Operations Combat Medical Skills Sustainment Courses (SOCMSSC), the authors surveyed medics to determine why they do not carry commercial tourniquets and present principles and methods of improvised junctional tourniquet (IJT) application. The authors describe the construction and application of IJTs, including the use of available pressure delivery devices and emphasizing that successful application requires sufficient and repetitive training.

Parameter redundancy in mark-recovery models.

We provide a definitive guide to parameter redundancy in mark-recovery models, indicating, for a wide range of models, in which all the parameters are estimable, and in which models they are not. For these parameter-redundant models, we identify the parameter combinations that can be estimated. Simple, general results are obtained, which hold irrespective of the duration of the studies. We also examine the effect real data have on whether or not models are parameter redundant, and show that results can be robust even with very sparse data. Covariates, as well as time- or age-varying trends, can be added to models to overcome redundancy problems. We show how to determine, without further calculation, whether or not parameter-redundant models are still parameter redundant after the addition of covariates or trends.

Inclusion of the ligand field contribution in a polarizable molecular mechanics: SIBFA-LF.

To account for the distortion of the coordination sphere that takes place in complexes containing open-shell metal cations such as Cu(II), we implemented, in sum of interactions between fragments ab initio computed (SIBFA) molecular mechanics, an additional contribution to take into account the ligand field splitting of the metal d orbitals. This term, based on the angular overlap model, has been parameterized for Cu(II) coordinated to oxygen and nitrogen ligands. The comparison of the results obtained from density functional theory computations on the one hand and SIBFA or SIBFA-LF on the other shows that SIBFA-LF gives geometric arrangements similar to those obtained from quantum mechanical computations. Moreover, the geometric improvement takes place without downgrading the energetic agreement obtained from SIBFA. The systems considered are Cu(II) interacting with six water molecules, four ammonia or four imidazoles, and four water plus two formate anions.