Effect of Melittin Complexes with Graphene and Graphene Oxide on Triple-Negative Breast Cancer Tumors Grown on Chicken Embryo Chorioallantoic Membrane.

One of the components of bee venom is melittin (M), which has strong lysing properties on membranes. M has high toxicity to cancer cells, but it also affects healthy cells, making it necessary to use methods for targeted delivery to ensure treatment. This research is a continuation of previous studies using graphene nanomaterials as M carriers to breast cancer cells. The studies described below are conducted on a more organized biological structure than what is found in vitro cells, namely, cancerous tumors grown on a chicken embryo chorioallantoic membrane. Caspase 3 and 8 levels are analyzed, and the level of oxidative stress markers and changes in protein expression for cytokines are examined. The results show that M complexes with nanomaterials reduce the level of oxidative stress more than M alone does, but the use of graphene (GN) as a carrier increases the level of DNA damage to a greater extent than the increase caused by M alone. An analysis of cytokine levels shows that the use of the M and GN complex increases the level of proteins responsible for inhibiting tumor progression to a greater extent than the increase occasioned by a complex with graphene oxide (GO). The results suggest that the use of GN as an M carrier may increase the toxic effect of M on structures located inside a cell.

Effects of Metallic and Carbon-Based Nanomaterials on Human Pancreatic Cancer Cell Lines AsPC-1 and BxPC-3.

Pancreatic cancer, due to its asymptomatic development and drug-resistance, is difficult to cure. As many metallic and carbon-based nanomaterials have shown anticancer properties, we decided to investigate their potential use as anticancer agents against human pancreatic adenocarcinoma. The objective of the study was to evaluate the toxic properties of the following nanomaterials: silver (Ag), gold (Au), platinum (Pt), graphene oxide (GO), diamond (ND), and fullerenol (C60(OH)40) against the cell lines BxPC-3, AsPC-1, HFFF-2, and HS-5. The potential cytotoxic properties were evaluated by the assessment of the cell morphology, cell viability, and cell membrane damage. The cancer cell responses to GO and ND were analysed by determination of changes in the levels of 40 different pro-inflammatory proteins. Our studies revealed that the highest cytotoxicity was obtained after the ND treatment. Moreover, BxPC-3 cells were more sensitive to ND than AsPC-1 cells due to the ND-induced ROS production. Furthermore, in both of the cancer cell lines, ND caused an increased level of IL-8 and a decreased level of TIMP-2, whereas GO caused only decreased levels of TIMP-2 and ICAM-1 proteins. This work provides important data on the toxicity of various nanoparticles against pancreatic adenocarcinoma cell lines.

Graphene Oxide Scaffold Stimulates Differentiation and Proangiogenic Activities of Myogenic Progenitor Cells.

The physiological process of muscle regeneration is quite limited due to low satellite cell quantity and also the inability to regenerate and reconstruct niche tissue. The purpose of the study was to examine whether a graphene oxide scaffold is able to stimulate myogenic progenitor cell proliferation and the endocrine functions of differentiating cells, and therefore, their active participation in the construction of muscle tissue. Studies were carried out using mesenchymal cells taken from 6-day-old chicken embryos and human umbilical vein endothelial cells (HUVEC) were used to assess angiogenesis. The graphene scaffold was readily colonized by myogenic progenitor cells and the cells dissected from heart, brain, eye, and blood vessels did not avoid the scaffold. The scaffold strongly induced myogenic progenitor cell signaling pathways and simultaneously activated proangiogenic signaling pathways via exocrine vascular endothelial growth factor (VEGF) secretion. The present study revealed that the graphene oxide (GO) scaffold initiates the processes of muscle cell differentiation due to mechanical interaction with myogenic progenitor cell.

Simple Blood Test Indicating Sepsis Relapse: A Case Report.

Delays in the diagnosis and management of sepsis are associated with higher mortality. Moreover, routine blood tests performed just before hospital discharge are still insufficient for sepsis survivors. In this report, for the first time, dramatic hematological changes found in the blood of a sepsis survivor are described. The pictorial information from microscope images associated with an appropriate set of multiparameter laboratory test results enabled for prediction of sepsis relapse four days before its clinical recognition. Thus, the role of this case report is to encourage medical practitioners to introduce (or re-introduce) blood smears as the helpful adjunctive extension of routine blood testing, especially when sepsis is suspected.

Advances in Management of Fournier's Gangrene by Coupling Intensive Hospital Treatment With Innovative Post-discharge Hyperbaric Oxygen Therapy Rehabilitation: A Case Report.

Fournier's gangrene (FG) is a rare form of necrotizing soft tissue infection characterized by an acute, aggressive, and rapidly progressive course. In this case report, we describe advanced therapy combining critical care, surgery, pharmacotherapy, extended biochemical/cellular blood diagnostics, and post-discharge hyperbaric oxygen therapy rehabilitation. Such an intervention resulted in survival and improved health status and quality of life of the patient with FG and septic shock.

Cell Line-Dependent Adhesion and Inhibition of Proliferation on Carbon-Based Nanofilms.

Introduction: Disorganisation of the extracellular matrix (ECM) is strongly connected to tumor progression. Even small-scale changes can significantly influence the adhesion and proliferation of cancer cells. Therefore, the use of biocompatible nanomaterials capable of supporting and partially replenishing degraded ECM might be essential to recover the niche after tumor resection. The objective of this study was to evaluate the influence of graphene, graphene oxide, fullerene, and diamond nanofilms on breast cancer and glioblastoma grade IV cell lines. Methods: Nanomaterials were characterized using SEM and TEM techniques; zeta potential analysis was also performed. Nanofilms of graphene, fullerene, and diamond nanoparticles were also characterized using AFM. The toxicity was tested on breast cancer MDA.MB.231 and glioblastoma grade IV U-87 MG cell lines, using LDH assay and by counting stained dead cells in bioprinted 3D models. The following parameters were analyzed: proliferation, adhesion to the nanofilm, and adhesion to particular ECM components covered with diamond nanoparticles. Results and Discussion: Our studies demonstrated that nanofilms of graphene and diamond nanoparticles are characterized by cell-specific toxicity. Those nanomaterials were non-toxic to MDA.MB.231 cells. After applying bioprinted 3D models, diamond nanoparticles were not toxic for both cell lines. Nanofilms made of diamond nanoparticles and graphene inhibit the proliferation of MDA.MB.231 cells after 48 and 72 hours. Increased adhesion on nanofilm made of diamond nanoparticles was only observed for MDA.MB.231 cells after 30 and 60 minutes from seeding the cells. However, analysis of adhesion to certain ECM components coated with diamond nanoparticles revealed enhanced adhesion to tenascin and vitronectin for both tested cell lines. Conclusion: Our studies show that nanofilm made of diamond nanoparticles is a non-toxic and pro-adhesive nanomaterial that might stabilize and partially replenish the niche after breast tumor resection as it enhances the adhesion of breast cancer cells and inhibits their proliferation.

Differences in the Cell Type-Specific Toxicity of Diamond Nanoparticles to Endothelial Cells Depending on the Exposure of the Cells to Nanoparticles.

Introduction: Diamond nanoparticles are considered to be one of the most cytocompatible carbon nanomaterials; however, their toxicity varies significantly depending on the analysed cell types. The aim was to investigate the specific sensitivity of endothelial cells to diamond nanoparticles dependent on exposure to nanoparticles. Methods: Diamond nanoparticles were characterized with Raman spectroscopy, Fourier-transform infrared spectroscopy (FTIR) and dynamic light scattering (DLS). Toxicity of diamond nanoparticles was assessed for endothelial cells (HUVEC), human mammary epithelial cells (HMEC) and HS-5 cell line. The effect of diamond nanoparticles on the level of ROS, NO, NADPH and protein synthesis of angiogenesis-related proteins of endothelial cells was evaluated. Results and Discussion: Our studies demonstrated severe cell type-specific toxicity of diamond nanoparticles to endothelial cells (HUVEC) depending on nanoparticle surface interaction with cells. Furthermore, we have assessed the effect on cytotoxicity of the bioconjugation of nanoparticles with a peptide containing the RGD motive and a serum protein corona. Our study suggests that the mechanical interaction of diamond nanoparticles with the endothelial cell membranes and the endocytosis of nanoparticles lead to the depletion of NADPH, resulting in an intensive synthesis of ROS and a decrease in the availability of NO. This leads to severe endothelial toxicity and a change in the protein profile, with changes in major angiogenesis-related proteins, including VEGF, bFGF, ANPT2/TIE-2, and MMP, and the production of stress-related proteins, such as IL-6 and IL-8. Conclusion: We confirmed the presence of a relationship between the toxicity of diamond nanoparticles and the level of cell exposure to nanoparticles and the nanoparticle surface. The results of the study give new insights into the conditioned toxicity of nanomaterials and their use in biomedical applications.

Dependence of diamond nanoparticle cytotoxicity on physicochemical parameters: comparative studies of glioblastoma, breast cancer, and hepatocellular carcinoma cell lines.

Reports on the cytotoxicity of diamond nanoparticles (ND) are ambiguous and depend on the physicochemical properties of the material and the tested cell lines. Thus, the aim of this research was to evaluate the influence of thirteen types of diamond nanoparticles, differing in production method, size, and surface functional groups, on their cytotoxicity against four tumor cell lines (T98G, U-118 MG, MCF-7, and Hep G2) and one non-tumor cell line (HFF-1). In order to understand the dependence of diamond nanoparticles on physicochemical properties, the following parameters were analyzed: viability, cell membrane damage, morphology, and the level of intracellular general ROS and mitochondrial superoxide. The performed analyses revealed that all diamond nanoparticles showed no toxicity to MCF-7, Hep G2, and HFF-1 cells. In contrast, the same nanomaterials were moderately toxic for the glioblastoma T98G and U-118 MG cell lines. In general, the effect of the production method did not influence ND toxicity. Some changes in cell response after treatment with modified nanomaterials were observed, with the presence of carboxyl groups having a more detrimental effect than the presence of other functional groups. Although nanoparticles of different sizes caused similar toxicity, nanomaterials with bigger particles caused a more pronounced effect.

Nanocomposites of Graphene Oxide-Silver Nanoparticles for Enhanced Antibacterial Activity: Mechanism of Action and Medical Textiles Coating.

The resistance of microorganisms to antibiotics is a crucial problem for which the application of nanomaterials is among a growing number of solutions. The aim of the study was to create a nanocomposite (composed of graphene oxide and silver nanoparticles) with a precise mode of antibacterial action: what enables textiles to be coated in order to exhibit antibacterial properties. A characterization of nanomaterials (silver nanoparticles and graphene oxide) by size distribution, zeta potential measurements, TEM visualization and FT-IR was performed. The biological studies of the nanocomposite and its components included the toxicity effect toward two pathogenic bacteria species, namely Pseudomonas aeruginosa and Staphylococcus aureus, interaction of nanomaterials with the outer layer of microorganisms, and the generation of reactive oxygen species and lipid peroxidation. Afterwards, antibacterial studies of the nanocomposite's coated textiles (cotton, interlining fabric, polypropylene and silk) as well as studies of the general toxicity towards a chicken embryo chorioallantoic membrane model were conducted. The toxicity of the nanocomposite used was higher than its components applied separately (zones of growth inhibition for P. aeruginosa for the final selected concentrations were as follows: silver nanoparticles 21 ± 0.7 mm, graphene oxide 14 ± 1.9 mm and nanocomposite 23 ± 1.6 mm; and for S. aureus were: silver nanoparticles 27 ± 3.8 mm, graphene oxide 14 ± 2.1 mm, and nanocomposite 28 ± 0.4 mm. The viability of P. aeruginosa and S. aureus after treatment with selected GO-Ag decreased to 27% and 31%, respectively, compared to AgNPs, when the viability of both species was 31% and 34%, accordingly). The coated textiles showed encouraging antibacterial features without general toxicity towards the chicken embryo chorioallantoic membrane model. We demonstrated that graphene oxide might constitute a functional platform for silver nanoparticles, improving the antibacterial properties of bare silver. Due to the application of the nanocomposite, the textiles showed promising antibacterial features with a low general toxicity, thereby creating a wide possibility for them to be used in practice.

Synthesis and properties of functionalized oligo(arylene) molecular wires with thiolated termini: competing thiol-Au and nitro-Au assembly.

We report the synthesis by Suzuki cross-coupling methodology of oligo(arylene) molecular wires with protected thiolates at both termini and a central electron-acceptor unit (3,5-dinitrofluorenone, compounds 10-12) or an electron-donor unit [9-(1,3-dithiol-2-ylidene)fluorene, compounds 14-17] in the backbone. Core reagents are 2,7-dibromo-3,5-dinitrofluorenone 7 (obtained by nitration of 2,7-dibromofluorenone) and 2,7-dibromo-9-(4,5-dimethyl-1,3-dithiol-2-ylidene)fluorene 13. The solution electrochemical redox properties of these oligo(arylene) derivatives have been studied. The reduction CVs of the dinitrofluorenone-containing molecules display three reversible/quasireversible couples yielding, sequentially, radical anion, dianion, and radical trianion species, e.g., for 11 E(1red) -1.02 V (vs. Ag/Ag(+) in THF). The 1,3-dithiol-2-ylidene unit imparts good electron donor properties to molecules 14, 15, and 16 with radical cation formation observed at E(ox) ca. 0.65 V (vs. Ag/Ag(+) in DCM). We also report studies on the assembly of 11 and 15 on gold substrates. Current-voltage (I-V) characteristics and X-ray photoelectron spectra of the monolayers reveal that 11 assembles via competing S-Au and NO(2)-Au interactions. This unusual phenomenon is ascribed to the very electron deficient dinitrofluorenone core of 11 weakening the S-Au interaction. An important conclusion is that thiolated molecules which possess strongly electron-withdrawing core units, especially those containing nitro groups, may not be suitable for controlled assembly in junctions. In contrast, 15 assembles via conventional S-Au interactions.

Army Physician Career Satisfaction Based on a Medical Corps Survey.

INTRODUCTION: It is critical the U.S. Army retains skilled physicians in the Medical Corps (MC) to ensure direct support to military operations and medical readiness. The purpose of this study was to examine U.S. Army physicians' opinions concerning: readiness to perform required duties, work environment, support and recognition they receive, military career intentions, and how these factors may relate to Army physician job satisfaction. MATERIALS AND METHODS: A cross-sectional study of Army physicians was conducted using a 45-item web-based survey tool, "Army Medicine Medical Corps (MC) Engagement/Satisfaction Survey 2018." The survey used a combination of multiple choice (Likert-scaled and categorical) and open text statements and questions. Satisfaction with their Army physician career was measured using a 5-point unipolar Likert scale response on level of satisfaction. Chi-square tests of independence were conducted on all demographic characteristics to examine if levels of satisfaction with Army physician career were associated with a particular demographic profile. Agreement opinions expressed on 20 statements about professional readiness, work environment, and job recognition were summarized and rank-ordered by percentage of "strongly agree" responses. Categorical responses to several questions related to career intentions were summarized overall and by career satisfaction level. Multivariate logistic regression was performed to identify demographic factors, which may influence career satisfaction as an Army physician. RESULTS: Approximately 47% (2,050/4,334) of U.S. Army physicians participated in the MC 2018 survey. Career satisfaction percentages overall were: "extremely satisfied" (10.0%), "quite satisfied" (24.8%), "moderately satisfied" (33.9%), "slightly satisfied" (22.6%), and "not at all satisfied" (8.3%). Respondents were in least agreement to statements about sufficient administrative support and recognition of doing good work. Logistic regression results showed military rank as a significant predictor of negative career satisfaction as an Army physician. For Captains, the odds for being "not at all satisfied" with their military career were almost nine times that of Colonels. Also, compared to their baseline group, physicians who completed their graduate medical education training, mission critical surgeons, and physicians who worked in military treatment facilities that were either a hospital (not a medical center) or a clinic-ambulatory surgery center had a greater risk of being "not at all satisfied" with their career as an Army physician. CONCLUSIONS: There is significant room for improvement in MC officer career satisfaction. The drivers of satisfaction are multiple and apply differently among MC officers of varied ranks and experience. Senior officers are the ones who are the most satisfied with their military career. Results of this novel MC officer study may serve as an impetus to identify existing shortcomings and make necessary changes to retain skilled Army physicians. Army leaders should invest resources to develop and sustain initiatives that improve military career satisfaction and retention of MC officers.

Hospital admissions related to mental disorders in U.S. Army soldiers in Iraq and Afghanistan.

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. We categorized mental disorder diagnoses using the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) and identified attempted suicide/ self-inflicted injuries using ICD-9-CM diagnosis codes E950-E959. We estimated and evaluated relative risks (RR) using Poisson regression models. Analysis found 1,948 psychiatric hospitalizations of deployed soldiers. The most common mental problems were mood, adjustment, and anxiety disorders (including post-traumatic stress disorder [PTSD]). RR of mental disorders ranged from 1.6 to 3 for females and 2 to 6 for enlisted soldiers compared to their counterparts. Younger soldiers had 30-60% higher substance abuse disorders. 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.

Exploration of Different Rehabilitation Routes for Sepsis Survivors with Monitoring of Health Status and Quality of Life: RehaSep Trial Protocol.

INTRODUCTION: This project addresses the important problem of sepsis sequelae resulting in frequent hospital readmissions and higher mortality rate in the post-discharge period. However, neither specific diagnostic methods nor standards for rehabilitation of sepsis patients have been introduced yet. The aim of this study is to evaluate the effectiveness of two different multiparameter-monitored rehabilitation treatments in order to improve the health status and quality of life of sepsis survivors. METHODS: Decades of failed randomized controlled trials involving sepsis patients strongly suggest the need for a paradigm change. Therefore, we designed a prospective, interventional, controlled, pragmatic, patient-centred trial based on the principles of personalized medicine. Sixty post-sepsis patients after hospital discharge will be individually assigned to a control group (without intervention) and two groups with 3-month diagnostically monitored rehabilitation programs based either on the recumbent cycloergometer training or on the experimental hyperbaric oxygen therapy. In all of the patients a wide range of physiological (spirometry, ECG/cycloergometer exercise test), haematological (microscopy) and biochemical (blood tests) parameters will be assessed at hospital discharge and during subsequent 3 months in order to monitor changes of their physical capacity, immunity and degree of post-sepsis organ damage/recovery. For quality of life monitoring a novel tool-"Life After Sepsis Survey"-will be applied. PLANNED OUTCOMES: A set of composite quantitative indices resulting from laboratory measurement data combined with the quality of life questionnaire data will constitute the primary outcomes whereas mortality rate and hospital readmission number will be counted as the secondary outcomes. CONCLUSIONS: Critical analysis of past trials prompted us to implement multiple improvements in tools and procedures. The results of this trial will contribute to the development of rehabilitation therapy addressing not only weakness but also organ damage problems of sepsis survivors. TRIAL REGISTRATION: ANZCTR ( http://www.anzctr.org.au ): ACTRN12618000347268, U1111-1210-6110. FUNDING: This research was funded by the National Science Center, Poland.

U.S. Army disease and nonbattle injury model, refined in Afghanistan and Iraq.

Previous analysis of Operation Desert Shield/Operation Desert Storm data yielded a disease and nonbattle injury (DNBI) model using distinct 95th percentile daily admission rates during the three phases of a war-fighting operation to predict medical requirements. This study refines the model with data from Operation Enduring Freedom (OEF) and Operation Iraqi Freedom (OIF). Inpatient health care records of U.S. Army soldiers deployed to OEF and OIF who were admitted with DNBI diagnoses were analyzed. DNBI admission rates for OEF and OIF were compared with rates for Operation Desert Shield/Operation Desert Storm. DNBI admission rates for OEF and OIF were lower than those for Operation Desert Shield/Operation Desert Storm. Rates among the phases of OIF were distinctly different. DNBI admission rates have been reduced during recent deployments. The concepts of the original model based on Operation Desert Shield/Operation Desert Storm data were validated by experiences during OEF and OIF. Continuous surveillance of DNBI admission rates is recommended.

Comparison of Operation Iraqi Freedom and Patient Workload Generator injury distributions.

The Patient Workload Generator (PATGEN) simulation model is an important part of the Army Medical Department force requirement planning. The current version of the PATGEN model is based on historical major combat operations such as World War II and the Korean War. The purpose of this study was to determine whether there was a significant difference between injury distributions used in the PATGEN model and the injury distributions based on the data from Operation Iraqi Freedom (OIF). To make the comparison feasible, the PATGEN injury categories were created using the Barell Injury Matrix. Analyses were performed using two independent OIF data sources, the Joint Theater Trauma Registry and the Standard Inpatient Data Record. Based on X2 test results, both analyses suggest a significant difference between PATGEN and OIF injury distributions. A major concern is the underestimation by PATGEN of battle injuries with multiple wounds. The findings support future use of data-driven diagnosis-based injury distributions for current operations and new more flexible simulation models that will allow for changes in injury probability distributions.

Effects of different rehabilitation models on erythrocyte deformability and nitrite plus nitrate as end-products of nitric oxide levels in elderly women.

AIM: The aim of the present study was to analyze the effects of two rehabilitation protocols, dance movement therapy exercises (DMT) and general rehabilitation exercises (GRE), on erythrocyte deformability and plasma levels of nitrite plus nitrate as end products of nitric oxide (NOx) in elderly women. METHODS: The study included 39 women aged 61-82 years, subjected to either GRE (n = 20) or DMT (n = 19). Women were subjected to 5-months programs of GRE and DMT, with each session lasting no longer than 45-50 min, and the intensity of exercising corresponding to no more than 40-60% of heart rate reserve. Plasma levels of NOx were determined spectrophotometrically before and at the end of the intervention. RESULTS: A significant increase in the total nitrate/nitrite concentration from 1.341 µmol/L to 1.590 µmol/L (7.3%) was observed in women subjected to the DMT rehabilitation program. Furthermore, an increase in erythrocyte deformability was observed in this group at shear stress 0.30. No significant difference was found between the pre- and post-rehabilitation NOx levels of women participating in the GRE program. CONCLUSIONS: Participation in DMT rehabilitation program might be reflected by an increase in plasma NOx levels and an improvement of erythrocyte deformability at lesser shear stress, and thus could potentially result in better vascular function. DMT should be offered to older adults, especially to persons who do not find conventional forms of rehabilitation as attractive, as they might refrain from physical activity and suffer from a faster decline in nitric oxide production. Geriatr Gerontol Int 2017; 17: 2479-2484.

The challenge of mapping between two medical coding systems.

OBJECTIVE: Deployable medical systems patient conditions (PCs) designate groups of patients with similar medical conditions and, therefore, similar treatment requirements. PCs are used by the U.S. military to estimate field medical resources needed in combat operations. Information associated with each of the 389 PCs is based on subject matter expert opinion, instead of direct derivation from standard medical codes. Currently, no mechanisms exist to tie current or historical medical data to PCs. Our study objective was to determine whether reliable conversion between PC codes and International Classification of Diseases, 9th Revision, Clinical Modification (ICD-9-CM) diagnosis codes is possible. METHODS: Data were analyzed for three professional coders assigning all applicable ICD-9-CM diagnosis codes to each PC code. Inter-rater reliability was measured by using Cohen's K statistic and percent agreement. Methods were developed to calculate kappa statistics when multiple responses could be selected from many possible categories. RESULTS: Overall, we found moderate support for the possibility of reliable conversion between PCs and ICD-9-CM diagnoses (mean kappa = 0.61). CONCLUSION: Current PCs should be modified into a system that is verifiable with real data.

Data-driven Casualty Estimation and Disease Nonbattle Injury/Battle Injury Rates in Recent Campaigns.

To ensure Soldiers are properly equipped and mission capable to perform full spectrum operations, Army medical planners use disease nonbattle injury (DNBI) and battle injury (BI) admission rates in the Total Army Analysis process to support medical deployment and force structure planning for deployed settings. For more than a decade, as the proponent for the DNBI/BI methodology and admission rates, the Statistical Analysis Cell (previously Statistical Analysis Branch, Center for Army Medical Department Strategic Studies) has provided Army medical planners with DNBI/BI rates based upon actual data from recent operations. This article presents the data-driven methodology and casualty estimation rates developed by the Statistical Analysis Cell and accredited for use by 2 Army Surgeon Generals, displays the top 5 principal International Classification of Disease, 9th Revision, Clinical Modification (ICD-9-CM) diagnoses for DNBI/BI in Operation Iraqi Freedom/Operation New Dawn (OIF/OND), and discusses trends in DNBI rates in OIF/OND during the stabilization period. Our methodology uses 95th percentile daily admission rates as a planning factor to ensure that 95% of days in theater are supported by adequate staff and medical equipment. We also present our DNBI/BI estimation methodology for non-Army populations treated at Role 3 US Army medical treatment facilities.

Status of trauma care in U.S. Army hospitals.

OBJECTIVE: This study documents the recent trends and current state of inpatient trauma care in U.S. Army hospitals. METHODS: Inpatient trauma cases from Army hospitals worldwide from October 1988 through April 2001 were analyzed. Facilities included 3 Certified Trauma Centers (CTCs), 7 non-CTC Army Medical Centers, and 42 Army Community Hospitals. Logistic regression identified mortality risk factors. RESULTS: Overall, the Army treated 166,124 trauma cases, with a mortality rate of 0.8% (trend of 0.66% to 1.18% in fiscal years 1989-2000, p < 0.0001). The number of Army hospitals decreased by 44% and the number of trauma cases decreased by nearly 75%. Injury severity, patient age, hospital trauma volume, beneficiary category, hospital type, and a resource intensity measure were all significantly associated with the probability of death. CONCLUSIONS: The overall trauma mortality rate at Army hospitals during the study period was lower than that reported for civilian trauma centers. However, changes in patient profiles, increased average severity, and decreased trauma volume might have contributed to a 13% increase in mortality rates at CTCs.