Combating the Current Pandemic and Preparing for the Next: Lessons Learned From the COVID-19 Pandemic From the Perspective of Deployed Special Operations Forces.

The coronavirus 2019 (COVID-19) pandemic continues to be a threat to global health, including the health of deployed armed forces. Servicemembers had to adjust to the "new normal" while maintaining the interests of the nation's security as well as that of our host nation partners. This commentary examines how Special Operations Forces operating within four different regions worldwide leveraged the challenges presented by the onset of this pandemic in maintaining stability, sustaining a ready force, and operating forward deployed. Deployed forces face constant difficulties with logistical support, varied medical resources access and a medical system predominantly focused on trauma care. At the onset of the COVID-19 pandemic there was little guidance specific to these circumstances which required an improvised adaptation of the recommendations set by national and Department of Defense medical authorities. Plans were constantly revised to match the ever changing medical and operational environment. Strategies such as the "Bubble Philosophy" and tiered force protection measures helped our units to maintain a rigorous training cycle. New methods of communication and training with our host nation partners such as the use of Unmanned Aerial Systems (UAS) platforms to survey host nation training became standard. Through these measures all of our forces were able to maintain operational capacity, protect the force, and maintain rapport with the host nations. We hope these experiences will provide a rough framework for future forces faced with a similar struggle. We also want to stress that challenges vary depending on the area of operations and the pathogen responsible for the pandemic. Any feedback and collaboration that may come from this work is appreciated and encouraged.

Cyberbullying Among Adolescents: Stakeholder-Driven Concept Mapping Approach.

BACKGROUND: Cyberbullying includes bullying behaviors on the Web; these behaviors are inconsistently measured and lack standardized definitions. The Uniform Definition of Bullying provides a consensus-based definition of bullying, and it highlights the need for an evidence-based definition of a model for cyberbullying. OBJECTIVE: Toward understanding the key elements and constructs defining cyberbullying, the objective of this study was to develop a stakeholder-driven conceptual model of cyberbullying. METHODS: Concept mapping is a validated research method that leverages both qualitative and quantitative approaches to integrate stakeholder input on complex topics. This process was used to develop a concept map and adapt it through participant input to a conceptual model. The validated concept mapping approach includes 5 steps: preparation, generation (brainstorming), structuring (sorting), representation (statistical analysis), and interpretation. We recruited stakeholder participants, including adolescents, as well as parents and professionals representing education, health, and the justice system. Analysis included hierarchical cluster analysis to develop a cluster map representing cyberbullying, followed by adaptation of that map to a conceptual model through qualitative participant feedback. RESULTS: A total of 177 participants contributed to the concept mapping process, including 69% females, 50% adults, and 68% Caucasian, representing each of our stakeholder groups. A total of 228 brainstorming items were generated and sorted into a concept map that included 9 clusters. Clusters included topics that had strong overlap with traditional bullying, such as consequences for perpetrators and targets, with example items "alienating" and "crippling." Some clusters were unique, such as cyberbullying techniques, with example item "excessive messaging," and characteristics of the cyberbullying experience, with example item "constant." Through the interpretation step, a conceptual model emerged, illustrating connections and distinctions between traditional bullying and cyberbullying. CONCLUSIONS: We found that in generating a stakeholder-driven concept map of cyberbullying, participants could not describe cyberbullying without integrating key concepts from traditional bullying. On the basis of our conceptual model, there are unique characteristics of cyberbullying that suggest that uniform definitions of bullying need to be evaluated to ensure their application to cyberbullying.

Radiologic, endoscopic, and functional patterns in patients with symptomatic gastroesophageal reflux disease after Roux-en-Y gastric bypass.

BACKGROUND: Roux-en-Y gastric bypass (RYGB) is considered the gold standard in treatment of morbid obesity and gastroesophageal reflux disease (GERD). Resolution of GERD symptoms is reported to be approximately 85% to 90%. OBJECTIVE: To evaluate patients with persistent GERD symptoms after RYGB and to identify contributing factors. SETTING: University hospital, cross-sectional study. METHODS: Data of patients evaluated for persistent GERD with a history of RYGB between January 2012 and December 2015 were reviewed. GERD was assessed with questionnaires, endoscopy, 24-hour pH-impendance manometry, and barium swallow. RESULTS: Of 47 patients, 44 (93.6%) presented with typical GERD, 18 (38.3%) with obstruction, 8 (17%) with pulmonary symptoms, and 21 (44.7%) with pain. The interval between RYGB and evaluation was a median of 3.8 years (range .8-12.6); median patient age was 36.5 years (19.1-67.2). Median body mass index was 30.3 kg/m2 (20.3-47.2). Pouch gastric fistulas were seen in 2 (5.1%), enlarged pouches in 5 (10.6%), and hiatal hernias in 25 patients (53.2%). Twelve (23.4%) had esophagitis>Los Angeles (LA) grade B. Manometry was performed in 45 (95.7%) and off-proton pump inhibitor 24-hour pH-impedance-metry in 44 patients (94.6%). Seventeen patients (37.8%) had esophageal hypomotility or aperistalsis; hypotensive lower esophageal sphincter was seen in 26 patients (57.8%). Increased esophageal acid exposure (>4% pH<4) was found in 27 (61.4%), an increased number of reflux episodes (>53) in 30 patients (68.2%). Symptoms were deemed as functional in 6 (12.8%). CONCLUSION: The evaluation for persistent GERD after RYGB revealed a high percentage of hiatal hernias, hypotensive lower esophageal sphincter, and severe esophageal motility disorders. These findings might have an influence on hiatal hernia closure concomitant with RYGB and the role of pH manometry in the preoperative bariatric assessment.

Long-Term Follow-Up After Non-operative Management of Blunt Splenic and Liver Injuries: A Questionnaire-Based Survey.

BACKGROUND: Non-operative management (NOM) of blunt splenic or liver injuries (solid organ injury, SOI) has become the standard of care in hemodynamically stable patients. However, the incidence of long-term symptoms in these patients is currently not known. The aim of this study was to assess long-term symptoms in patients undergoing successful NOM (sNOM) for SOI. METHODS: Long-term posttraumatic outcomes including chronic abdominal pain, irregular bowel movements, and recurrent infections were assessed using a specifically designed questionnaire and analyzed by univariable analysis. RESULTS: Eighty out of 138 (58%) patients with SOI undergoing sNOM) responded to the questionnaire. Median (IQR) follow-up time was 48.8 (28) months. Twenty-seven (34%) patients complained of at least one of the following symptoms: 17 (53%) chronic abdominal pain, 13 (41%) irregular bowel movements, and 8 (25%) recurrent infections. One female patient reported secondary infertility. No significant association between the above-mentioned symptoms and the Injury Severity Score, amount of hemoperitoneum, or high-grade SOI was found. Patients with chronic pain were significantly younger than asymptomatic patients (32.1 ± 14.5 vs. 48.3 ± 19.4 years, p = 0.002). Irregular bowel movements were significantly more frequent in patients with severe pelvic fractures (15.4 vs. 0.0%, p = 0.025). A trend toward a higher frequency of recurrent infections was found in patients with splenic injuries (15.9 vs. 2.8%, p = 0.067). CONCLUSION: A third of patients with blunt SOI undergoing sNOM reported long-term abdominal symptoms. Younger age was associated with chronic abdominal symptoms. More studies are warranted to investigate long-term outcomes immunologic sequelae in patients after sNOM for SOI.

Efecto de un programa de pausa activa más folletos informativos en la disminución de molestias musculoesqueléticas en trabajadores administrativos / Effect of Rest Pauses Combined with Information Leaflets on the Decrease in Musculoskeletal Pain in Administrative Workers

RESUMEN Objetivos Comprobar el efecto de un programa de pausa activa más folletos informativos, en la disminución de molestias musculoesqueléticas en trabajadores administrativos de una institución pública de Lima, Perú. Materiales y métodos Se realizó un estudio cuasiexperimental con grupo control, no aleatorizado, en dos sedes en una institución pública. El grupo intervención (n=135) recibió folletos informativos una vez por semana, adicionalmente realizó el programa de pausas activas supervisadas, las cuales consistían en ejercicios de respiración, estiramiento y calentamiento. El grupo control (n=127) solo recibió folletos informativos una vez por semana. Se midió la frecuencia e intensidad de molestias musculoesqueléticas en los últimos siete días. Resultados La edad promedio fue 38 años. Los segmentos más afectados fueron el cuello y dorso lumbar. El grupo intervención redujo 20% la frecuencia de molestias musculoesqueléticas en cuello en los últimos siete días (p<0,001) y 17% en la zona dorso lumbar (p<0,001), el grupo control solo redujo la frecuencia en la zona dorso lumbar (p=0,029). Respecto a intensidad del dolor, el grupo de intervención tuvo mayor disminución en todos los segmentos evaluados (p<0,05). Conclusiones Las pausas activas supervisadas más folletos informativos lograron disminuir las molestias musculoesqueléticas en trabajadores administrativos. Por ello, puede ser implementado en otras instituciones públicas o privadas.

ABSTRACT Objectives To assess the effect of work pauses combined with information leaflets on the reduction of musculoskeletal pain in administrative workers of a public institution in Lima, Peru. Materials and methods This quasi-experimental study was conducted in two offices of a public institution and included an intervention group and a non-randomized control group. The intervention group (n = 135) was provided with information leaflets once a week, in addition to a program of rest pauses consisting of breathing exercises, stretching, and encouragement. The control group (n = 127) received information leaflets once a week. To assess outcomes, the rate and intensity of musculoskeletal pain over the previous 7 days were measured. Results The mean age of participants was 38 years. The most affected body regions were the neck and lumbar spine. In the intervention group, the rate of musculoskeletal pain was reduced by 20% in the neck (p<0.001) and 17% in the lumbar spine (p<0.001) over the previous 7 days. In the control group, the rate of musculoskeletal pain was decreased only in the lumbar spine (p=0.029). The intervention group reported less pain in all evaluated body regions (p<0.05). Conclusions Rest pauses combined with information leaflets resulted in decreased musculoskeletal pain in administrative workers, indicating that this strategy can be implemented in public and private institutions.

[Effect of Rest Pauses Combined with Information Leaflets on the Decrease in Musculoskeletal Pain in Administrative Workers]. / Efecto de un programa de pausa activa más folletos informativos en la disminución de molestias musculoesqueléticas en trabajadores administrativos.

OBJECTIVES: To assess the effect of work pauses combined with information leaflets on the reduction of musculoskeletal pain in administrative workers of a public institution in Lima, Peru. MATERIALS AND METHODS: This quasi-experimental study was conducted in two offices of a public institution and included an intervention group and a non-randomized control group. The intervention group (n = 135) was provided with information leaflets once a week, in addition to a program of rest pauses consisting of breathing exercises, stretching, and encouragement. The control group (n = 127) received information leaflets once a week. To assess outcomes, the rate and intensity of musculoskeletal pain over the previous 7 days were measured. RESULTS: The mean age of participants was 38 years. The most affected body regions were the neck and lumbar spine. In the intervention group, the rate of musculoskeletal pain was reduced by 20% in the neck (p<0.001) and 17% in the lumbar spine (p<0.001) over the previous 7 days. In the control group, the rate of musculoskeletal pain was decreased only in the lumbar spine (p=0.029). The intervention group reported less pain in all evaluated body regions (p<0.05). CONCLUSIONS: Rest pauses combined with information leaflets resulted in decreased musculoskeletal pain in administrative workers, indicating that this strategy can be implemented in public and private institutions.

OBJETIVOS: Comprobar el efecto de un programa de pausa activa más folletos informativos, en la disminución de molestias musculoesqueléticas en trabajadores administrativos de una institución pública de Lima, Perú. MATERIALES Y MÉTODOS: Se realizó un estudio cuasiexperimental con grupo control, no aleatorizado, en dos sedes en una institución pública. El grupo intervención (n=135) recibió folletos informativos una vez por semana, adicionalmente realizó el programa de pausas activas supervisadas, las cuales consistían en ejercicios de respiración, estiramiento y calentamiento. El grupo control (n=127) solo recibió folletos informativos una vez por semana. Se midió la frecuencia e intensidad de molestias musculoesqueléticas en los últimos siete días. RESULTADOS: La edad promedio fue 38 años. Los segmentos más afectados fueron el cuello y dorso lumbar. El grupo intervención redujo 20% la frecuencia de molestias musculoesqueléticas en cuello en los últimos siete días (p<0,001) y 17% en la zona dorso lumbar (p<0,001), el grupo control solo redujo la frecuencia en la zona dorso lumbar (p=0,029). Respecto a intensidad del dolor, el grupo de intervención tuvo mayor disminución en todos los segmentos evaluados (p<0,05). CONCLUSIONES: Las pausas activas supervisadas más folletos informativos lograron disminuir las molestias musculoesqueléticas en trabajadores administrativos. Por ello, puede ser implementado en otras instituciones públicas o privadas.

Ethics of social media research: common concerns and practical considerations.

Social media Websites (SMWs) are increasingly popular research tools. These sites provide new opportunities for researchers, but raise new challenges for Institutional Review Boards (IRBs) that review these research protocols. As of yet, there is little-to-no guidance regarding how an IRB should review the studies involving SMWs. The purpose of this article was to review the common risks inherent in social media research and consider how researchers can consider these risks when writing research protocols. We focused this article on three common research approaches: observational research, interactive research, and survey/interview research. Concomitant with these research approaches, we gave particular attention to the issues pertinent to SMW research, including privacy, consent, and confidentiality. After considering these challenges, we outlined key considerations for both researchers and reviewers when creating or reviewing SMW IRB protocols. Our goal in this article was to provide a detailed examination of relevant ethics and regulatory issues for both researchers and those who review their protocols.

Older adolescents' views regarding participation in Facebook research.

PURPOSE: Facebook continues to grow in popularity among adolescents as well as adolescent researchers. Guidance on conducting research using Facebook with appropriate attention to privacy and ethics is scarce. To inform such research efforts, the purpose of this study was to determine older adolescents' responses after learning that they were participants in a research study that involved identification of participants using Facebook. METHODS: Public Facebook profiles of older adolescents aged 18-19 years from a large state university were examined. Profile owners were then interviewed. During the interview, participants were informed that they were identified by examining publicly available Facebook profiles. Participants were asked to discuss their views on this research method. RESULTS: A total of 132 participants completed the interview (70% response rate); the average age was 18.4 years (SD = .5); and our sample included 64 male participants (48.5%). Participant responses included endorsement (19.7%), fine (36.4%), neutral (28.8%), uneasy (9.1%), and concerned (6.1%). Among participants who were uneasy or concerned, the majority voiced confusion regarding their current profile security settings (p = .00). CONCLUSIONS: The majority of adolescent participants viewed the use of Facebook for research positively. These findings are consistent with the approach taken by many U.S. courts. Researchers may consider these findings when developing research protocols involving Facebook.