A simulation study of in-situ NAPL remediation treatment by using surfactant and foam processes in a military base South Korea.

Surfactant and foam processes have been widely used to enhance oil recovery from petroleum-bearing geological formations, and also been recently extended to remediate non-aqueous-phase-liquid (NAPL) contaminants from the shallow subsurface. This study investigates the potential of using surfactant and foam processes for the in-situ remediation treatments within a military base in South Korea: first, optimizing the subsurface permeability and net-to-gross (NTG) values based on history matching and machine-learning algorithm; second, performing simulations that successfully predict the surfactant/foam processes applied in the field; and third, expanding simulations that evaluate different scenarios that might have been used for field tests. The site for the pilot-scale testing, located in the existing fuel-distribution facilities within a military base, has 5 m × 5 m treatment area with 3 m depth, prepared with 3 injection wells and 3 extraction wells. The NAPL of interest is a mixture of various oil compounds showing the average oil saturation of 5%. The overall remediation process applied consists of two major steps: the first is a 20-day injection of surfactant solution (Tween 80) to mobilize the oleic phase trapped by capillary force, and the second is a 3-day injection of foam (i.e., gas and surfactant co-injection) to control the mobility of injected gas and overcome the heterogeneity of the underground system. The major findings of this study are (i) surfactant/foam processes can be an effective means of NAPL recovery from shallow subsurface recovering more than 90% of contaminants, and (ii) computer simulations can be a useful tool for evaluating the in-situ treatment and improving the design of similar operations.

Definitive Treatment of Neurological Decompression Sickness in a Resource Limited Location.

BACKGROUND: While Fairbanks, AK, USA, is a remote location with significant constraints on medical resources and specialty care, a small U.S. Air Force clinic was able to provide a pilot with definitive care for neurological decompression sickness.CASE REPORT: A 31-yr-old female patient presented to her flight surgeon in Anchorage, AK, USA, with migrating polyarthropathy and headaches 48 h after a flight which included planned aircraft decompression for high altitude low opening (HALO) jump operations. In order to get definitive treatment in a hyperbaric chamber, the patient typically would have to be flown to Seattle, WA, USA. This transfer of care would cost the Air Force approximately 150,000 and may have led to more complicated disease. Fortunately, Eielson Air Force Base (AFB) in Fairbanks had previously procured a Hyperlite hyperbaric chamber specifically for this situation. After consultation with a hyperbaric specialist, the team decided that the most appropriate course of action was to transfer her by car 6 h north from Anchorage to Fairbanks. On initiation of the Hart treatment table, she experienced immediate reduction in joint pain with a reversal of neurological symptoms.DISCUSSION: This patients care could not have been done without the procurement of a hyperbaric chamber. This case demonstrates the utility and necessity for these capabilities at more facilities that manage significant flying operations. Military bases should ensure that hyperbaric treatment capabilities are available within a close proximity.Petruso MJ, Philbrick SM. Definitive treatment of neurological decompression sickness in a resource limited location. Aerosp Med Hum Perform. 2021; 92(1):4749.

Living near an active U.S. military base in Iraq is associated with significantly higher hair thorium and increased likelihood of congenital anomalies in infants and children.

In Iraq, war contamination is the result of dispensed bombs, bullets, detonation of chemical and conventional weapons, and burn-pit emissions by US bases. Increases in congenital anomalies were reported from Iraqi cities post-2003. These cities were heavily bombed and encircled by US bases with burn-pits. Thorium is a radioactive compound and a direct depleted-uranium decay-product. Radioactive materials, including depleted uranium, are routinely stored in US bases and they have been shown to leak into the environment. We conducted a case-control study to investigate associations of residential proximity to Tallil Air Base, a US military base near Nasiriyah, as well as levels of uranium and thorium in hair and deciduous teeth with congenital anomalies. The study was based on a sample of 19 cases and 10 controls who were recruited during late Summer and early Fall of 2016. We developed mixed effects logistic regression models with village as the random effect, congenital anomaly as the outcome and distance to the US base and hair metal levels (one at a time) as the predictor variable, controlling for child's age, sex and paternal education. We also explored the mediation of the association between proximity to the base and congenital anomalies by hair metal levels. We found an inverse association between distance to Tallil Air Base and risk of congenital anomalies and hair levels of thorium and uranium. The results of our mediation analyses were less conclusive. Larger studies are necessary to understand the scope of war contamination and its impact on congenital anomalies in Iraq.

US Air Force Behavioral Health Optimization Program: team members' satisfaction and barriers to care.

BACKGROUND: Research has shown significant contribution of integrated behavioural health care; however, less is known about the perceptions of primary care providers towards behavioural health professionals. OBJECTIVE: The current study examined barriers to care and satisfaction with integrated behavioural health care from the perspective of primary care team members. DESIGN: This study utilized archival data from 42 treatment facilities as part of ongoing program evaluation of the Air Force Medical Service's Behavioral Health Optimization Program. SETTING: This study was conducted in a large managed health care organization for active duty military and their families, with specific clinic settings that varied considerably in regards to geographic location, population diversity and size of patient empanelment. STUDY PARTICIPANTS: De-identified archival data on 534 primary care team members were examined. RESULTS: Team members at larger facilities rated access and acuity concerns as greater barriers than those from smaller facilities (t(533) = 2.57, P < 0.05). Primary Care Managers (PCMs) not only identified more barriers to integrated care (ß = -0.07, P < 0.01) but also found services more helpful to the primary care team (t(362.52) = 1.97, P = 0.05). Barriers to care negatively impacted perceived helpfulness of integrated care services for patients (ß = -0.12, P < 0.01) and team members, particularly among non-PCMs (ß = -0.11, P < 0.01). CONCLUSIONS: Findings highlight the potential benefits of targeted training that differs in facilities of larger empanelment and is mindful of team members' individual roles in a Patient Centered Medical Home. In particular, although generally few barriers were perceived, given the impact these barriers have on perception of care, efforts should be made to decrease perceived barriers to integrated behavioural health care among non-PCM team members.

Use of complementary health approaches at military treatment facilities, active component, U.S. Armed Forces, 2010-2015.

Survey-based research has demonstrated the increasing use and acceptance of complementary and alternative medicine (CAM) in general and military populations. This report summarizes the use of three CAM procedures (chiropractic/osteopathic manipulation, acupuncture, and biofeedback) among active component service members from 2010 through 2015. Findings document a marked increase in the use of chiropractic/osteopathic manipulation and acupuncture procedures since 2010. The majority of the 240 military installations in this analysis provided chiropractic/osteopathic manipulation; more than three-quarters provided acupuncture; and approximately one-third provided biofeedback procedures. "Other and unspecified disorders of the back" was the most frequent condition for which chiropractic/osteopathic manipulation and acupuncture were used. "Non-allopathic lesions not elsewhere classified" was the second most frequent diagnosis during chiropractic/osteopathic manipulation-related visits. The second and third most frequent diagnoses during acupuncture-related visits were "acute and chronic pain" and "adjustment reaction," respectively. "Adjustment reaction" was the second most frequent diagnosis associated with biofeedback. Continued research is needed to gain a better understanding of why military personnel are using CAM and the role these procedures play in their health care.

Characterization of culturable heterotrophic bacteria in hydrocarbon-contaminated soil from an alpine former military site.

We characterized the culturable, heterotrophic bacterial community in soil collected from a former alpine military site contaminated with petroleum hydrocarbons. The physiologically active eubacterial community, as revealed by fluorescence-in situ-hybridization, accounted for 14.9 % of the total (DAPI-stained) bacterial community. 4.0 and 1.2 % of the DAPI-stained cells could be attributed to culturable, heterotrophic bacteria able to grow at 20 and 10 °C, respectively. The majority of culturable bacterial isolates (23/28 strains) belonged to the Proteobacteria with a predominance of Alphaproteobacteria. The remaining isolates were affiliated with the Firmicutes, Actinobacteria and Bacteroidetes. Five strains could be identified as representatives of novel species. Characterization of the 28 strains demonstrated their adaptation to the temperature and nutrient conditions prevailing in the studied soil. One-third of the strains was able to grow at subzero temperatures (-5 °C). Studies on the effect of temperature on growth and lipase production with two selected strains demonstrated their low-temperature adaptation.

Evaluation and comparison of urinary metabolic biomarkers of exposure for the jet fuel JP-8.

A study of workers exposed to jet fuel propellant 8 (JP-8) was conducted at U.S. Air Force bases and included the evaluation of three biomarkers of exposure: S-benzylmercapturic acid (BMA), S-phenylmercapturic acid (PMA), and (2-methoxyethoxy)acetic acid (MEAA). Postshift urine specimens were collected from various personnel categorized as high (n = 98), moderate (n = 38) and low (n = 61) JP-8 exposure based on work activities. BMA and PMA urinary levels were determined by high-performance liquid chromatography-tandem mass spectrometry (HPLC-MS/MS), and MEAA urinary levels were determined by gas chromatography-mass spectrometry (GC-MS). The numbers of samples determined as positive for the presence of the BMA biomarker (above the test method's limit of detection [LOD = 0.5 ng/ml]) were 96 (98.0%), 37 (97.4%), and 58 (95.1%) for the high, moderate, and low (control) exposure workgroup categories, respectively. The numbers of samples determined as positive for the presence of the PMA biomarker (LOD = 0.5 ng/ml) were 33 (33.7%), 9 (23.7%), and 12 (19.7%) for the high, moderate, and low exposure categories. The numbers of samples determined as positive for the presence of the MEAA biomarker (LOD = 0.1 µ g/ml) were 92 (93.4%), 13 (34.2%), and 2 (3.3%) for the high, moderate, and low exposure categories. Statistical analysis of the mean levels of the analytes demonstrated MEAA to be the most accurate or appropriate biomarker for JP-8 exposure using urinary concentrations either adjusted or not adjusted for creatinine; mean levels of BMA and PMA were not statistically significant between workgroup categories after adjusting for creatinine.

Thermotherapy. An alternative for the treatment of American cutaneous leishmaniasis.

BACKGROUND: Pentavalent antimonials (Sb5) and miltefosine are the first-line drugs for treating cutaneous leishmaniasis in Colombia; however, toxicity and treatment duration negatively impact compliance and cost, justifying an active search for better therapeutic options. We compared the efficacy and safety of thermotherapy and meglumine antimoniate for the treatment of cutaneous leishmaniasis in Colombia. METHOD: An open randomized Phase III clinical trial was performed in five military health centres. located in northwestern, central and southern Colombia. Volunteers with parasitological positive diagnosis (Giemsa-stained smears) of cutaneous leishmaniasis were included. A single thermotherapy session involving the application of 50°C at the center and active edge of each lesion. Meglumine antimoniate was administered intramuscularly at a dose of 20 mg Sb5/kg weight/day for 20 days. RESULTS: Both groups were comparable. The efficacy of thermotherapy was 64% (86/134 patients) by protocol and 58% (86/149) by intention-to-treat. For the meglumine antimoniate group, efficacy by protocol was 85% (103/121 patients) and 72% (103/143) by intention-to-treat, The efficacy between the treatments was statistically significant (p 0.01 and < 0.001) for analysis by intention to treat and by protocol, respectively. There was no difference between the therapeutic response with either treatment regardless of the Leishmania species responsible for infection. The side effects of meglumine antimoniate included myalgia, arthralgia, headache and fever. Regarding thermotherapy, the only side effect was pain at the lesion area four days after the initiation of treatment. CONCLUSION: Although the efficacy rate of meglumine antimoniate was greater than that of thermotherapy for the treatment of cutaneous leishmaniasis, the side effects were also greater. Those factors, added to the increased costs, the treatment adherence problems and the progressive lack of therapeutic response, make us consider thermotherapy as a first line treatment for cutaneous leishmaniasis.

Third-party certification of dietary supplements: prevalence and concerns.

According to recent studies, over 50% of the general population (and nearly 70% of military personnel) report regular use of dietary supplements (DS). Military personnel may be at greater risk for adverse reactions to DS because of operational environments and stressors (extreme heat, altitude, or sleep deprivation) associated with military deployments and training. As a recent example, the Department of Defense placed a medical hold on all DS containing the ingredient 1,3-dimethylamylamine in response to several fatalities linked to the use of this product. This study investigated product certification for DS in military commissaries (grocery stores), exchanges (department stores), and civilian retail stores. Overall, only 12% of the available products were certified by an independent scientific agency. Consumers should be aware that most over-the-counter DS do not have independent certification of product integrity. Although "third-party certification" does not ensure DS safety or effectiveness, it is important that consumers and health care providers are made aware that such product screening takes place, to help patients make more informed decisions about the purchase and use of DS.

Complementary and alternative medicine in a military primary care clinic: a 5-year cohort study.

Previous studies have found that complementary and alternative medication (CAM) use is common. We enrolled 500 adults presenting to a primary care military clinic. Subjects completed surveys before the visit, immediately afterwards, at 2 weeks, 3 months, and 5 years. Over 5 years, 25% used CAM for their presenting symptom. Most (72%) reported that CAM helped their symptom. Independent predictors of CAM use included female sex (odds ratio [OR], 2.0; 95% confidence interval [CI], 1.1-3.7), college educated (OR, 3.4; 95% CI, 1.8-6.3), more severe symptoms (OR, 1.14; 95% CI, 1.01-1.28), and persistence of symptom beyond 3 months (OR, 3.9; 95% CI, 2.0-7.5). We concluded that a quarter of military primary care patients use CAM over 5 years of follow-up and most find it helpful. CAM users tend to be female and better educated. Patients with more severe symptoms or symptoms that persist beyond 3 months are also more likely to turn to CAM.