Readiness Of Medical Providers In The Military Health System: Overview Of Operational And Policy Considerations.

US military forces have diverse missions, including combat, response to natural disasters, humanitarian assistance, training, and diplomacy. The military's medical forces, composed of clinical providers from the Army, Navy, and Air Force, support these operations-often on a moment's notice. The Military Health System (MHS) must ensure that medical providers are always trained and equipped to deliver care when deployed on missions in often austere environments. As part of its approach to this challenge, the MHS has initiated a data-driven effort to determine required clinical competencies by identifying and measuring the knowledge, skills, and abilities required for care in these environments. These efforts are being implemented while the MHS is undergoing significant organizational change. In this article we describe past and current efforts to maintain a "ready medical force" as well as current challenges and opportunities related to maintaining the readiness of medical providers while the MHS intends to evolve into an integrated health system.

Current and Future Challenges in Group Therapy.

This article reviews changes and considers challenges in group therapy since AGPA's 50th anniversary 25 years ago. The authors acknowledge the many important changes that have occurred in research, theory, and practice in the last two and a half decades, but focus on four topics: treating trauma with cultural sensitivity; the impact of technology on groups; challenges for LGBTQ clients in group; and the future for psychodynamic groups. The authors review the literature and provide recommendations on how to address the challenges.

Group and the Hispanic prenatal patient.

A small group approach was implemented to meet the educational and emotional needs of a Hispanic prenatal hospital population, which staff characterized as hysterical and hard to manage during labor and delivery. Group sessions revealed that this behavior was due largely to lack of preparation and emotional support. Staff-patient communication improved, enhancing the quality of the medical care provided.

Protein adsorption and human osteoblast-like cell attachment and growth on alkylthiol on gold self-assembled monolayers.

Protein adsorption and growth of primary human osteoblasts on self-assembled monolayers of alkylthiols on gold (SAMs) with carboxylic acid and hydroxyl and methyl termini were investigated. Single-component SAMs and SAMs patterned by photolithographic techniques were used. Cell growth on patterned SAMs demonstrated preferences for one pattern region in all combinations of alkylthiols, with the hierarchical preference COOH > OH > CH(3). Patterned SAMs and immunochemistry were used to investigate adsorption of fibronectin and albumin with respect to different alkylthiol termini. Fibronectin adsorption from both pure solution and serum containing cell culture medium (SDMEM) followed the sequence COOH > OH > CH(3). Albumin adsorption from pure solution followed the sequence OH > COOH > CH(3); from SDMEM the sequence was CH(3) > OH > COOH. Cell attachment to SAMs with the above termini, after preadsorption with fibronectin, albumin, or mixtures of fibronectin and albumin, was measured. Attachment was maximal on COOH-terminated SAMs precoated with fibronectin. Attachment to COOH was significantly reduced only when fibronectin was omitted from the protein preadsorption solution. On OH and CH(3) SAMs increasing the proportion of albumin in the solution was sufficient to significantly reduce cell attachment. The distribution vinculin and the integrins alpha(5)beta(1) and alpha(v)beta(3) indicated that focal contact formation by cells varied with alkylthiol termini in the following sequence: COOH > OH > CH(3).