Unclaimed Bodies in Anatomical Education: Medical Student Attitudes at One U.S. Medical Institution.

PHENOMENON: Dissection of cadavers is a common practice in anatomical education. To meet demand for cadavers, some medical institutions facilitate dissection of individuals who did not provide consent during their life. This includes the bodies of individuals who passed away with either no living kin or no kin able to claim and bury their body. Recent literature demonstrates widespread discomfort with this practice among anatomy course directors at U.S. institutions, bringing into question continuation of this practice. However, attitudes among medical students must similarly be assessed as they represent key stakeholders in the dissection process. The purpose of this study was to assess prevailing attitudes among a sample of medical students at one U.S. medical institution regarding the dissection of unclaimed bodies and identify emerging themes in ethical viewpoints. APPROACH: Two-hundred-twelve students (35% response rate) at one U.S. medical institution completed an anonymous online survey. Students came from different class cohorts at various stages of their training. Survey items were developed to capture students' academic and emotional experience with anatomical dissection and to identify emerging themes in attitudes. FINDINGS: Students reported high regard for cadaveric dissection in general with 170 (80%) respondents endorsing it as critical to anatomical education. Regarding dissection of unclaimed bodies, 30% of students found the practice ethical while 47% of students found the practice unethical. Multivariate analysis found that ethical view was directly associated with comfort level (OR= 156.16; 95% CI: 34.04, 716.40). Most students expressed comfort dissecting self-donated bodies (n = 206, 97%), while fewer students expressed comfort dissecting unclaimed bodies (n = 66, 31.1%). This latter finding significantly correlated with gender (t = 3.361. p < 0.05), class cohort (F = 3.576, p < 0.01), but not with religious affiliation or age. Thematic analysis revealed the following themes in student responses: (1) invoking ethical paradigms to either justify or condemn the practice, (2) subjective experiences, and (3) withholding judgment of the practice. INSIGHTS: Many students expressed negative attitudes toward the dissection of unclaimed bodies, with some citing issues of social vulnerability, justice, and autonomy. These findings indicate that many students' ethical code may conflict with institutional policies which permit this practice. Medical school represents a critical time in the professional development of trainees, and development practices which align with the moral code of local institutions and stakeholders is crucial.

Effects of the COVID-19 early pandemic on delivery outcomes among women with and without COVID-19 at birth.

BACKGROUND: The COVID-19 pandemic may influence delivery outcomes through direct effects of infection or indirect effects of disruptions in prenatal care. We examined early pandemic-related changes in birth outcomes for pregnant women with and without a COVID-19 diagnosis at delivery. METHODS: We compared four delivery outcomes-preterm delivery (PTD), severe maternal morbidity (SMM), stillbirth, and cesarean birth-between 2017 and 2019 (prepandemic) and between April and December 2020 (early-pandemic) using interrupted time series models on 11.8 million deliveries, stratified by COVID-19 infection status at birth with entropy weighting for historical controls, from the Healthcare Cost and Utilization Project across 43 states and the District of Columbia. RESULTS: Relative to 2017-2019, women without COVID-19 at delivery in 2020 had lower odds of PTD (OR = 0.93; 95% CI = 0.92-0.94) and SMM (OR = 0.88; 95% CI = 0.85-0.91) but increased odds of stillbirth (OR = 1.04; 95% CI = 1.01-1.08). Absolute effects were small across race/ethnicity groups. Deliveries with COVID-19 had an excess of each outcome, by factors of 1.07-1.46 for outcomes except SMM at 4.21. The effect for SMM was more pronounced for Asian/Pacific Islander non-Hispanic (API; OR = 10.51; 95% CI = 5.49-20.14) and Hispanic (OR = 5.09; 95% CI = 4.29-6.03) pregnant women than for White non-Hispanic (OR = 3.28; 95% CI = 2.65-4.06) women. DISCUSSION: Decreasing rates of PTD and SMM and increasing rates of stillbirth among deliveries without COVID-19 were small but suggest indirect effects of the pandemic on maternal outcomes. Among pregnant women with COVID-19 at delivery, adverse effects, particularly SMM for API and Hispanic women, underscore the importance of addressing health disparities.

URiMs and Imposter Syndrome: Symptoms of Inhospitable Work Environments?

BACKGROUND AND OBJECTIVES: Workforce diversity is associated with improved health outcomes. Currently, primary care physicians who are underrepresented in medicine (URiM) disproportionately work in underserved areas. Increasingly, URiM faculty describe experiencing imposter syndrome (IS), including a sense of not belonging in their work environment and a lack of recognition. Studies of IS among family medicine faculty are not prevalent nor are the factors most associated with IS among URiMs and non-URiMs. The objectives of our study were to (1) determine prevalence of IS among URiM faculty compared to non-URiM faculty; (2) determine factors associated with IS among both URiM and non-URiM faculty. METHODS: Four hundred thirty participants completed anonymous, electronic surveys. We measured IS using a 20-item validated scale. RESULTS: Among all respondents, 43% reported frequent/intense IS. URiMs were not more likely than non-URiMs to report IS. Factors independently associated with IS for both URiM and non-URiM respondents include inadequate mentorship (P<.05) and poor professional belonging (P<.05). However, inadequate mentorship, low professional integration and belonging, and racial/ethnic discrimination-based exclusion from professional opportunities (all P<.05) were more prevalent among URiMs than non-URiMs. CONCLUSIONS: While URiMs are not more likely than non-URiMS to experience frequent/intense IS, they are more likely to report racial/ethnic discrimination, inadequate mentorship, and low professional integration and belonging. These factors are associated with IS and may be reflective of how institutionalized racism impedes mentorship and optimal professional integration, which may be internalized and perceived as IS among URiM faculty. Yet, URiM career success in academic medicine is crucial for achieving health equity.

Trends in Severe Maternal Morbidity in the US Across the Transition to ICD-10-CM/PCS From 2012-2019.

Importance: Surveillance of severe maternal morbidity (SMM) is critical for monitoring maternal health and evaluating clinical quality improvement efforts. Objective: To evaluate national and state trends in SMM rates from 2012 to 2019 and potential disruptions associated with the transition to International Classification of Diseases, 10th Revision, Clinical Modification and Procedure Coding System (ICD-10-CM/PCS) in October 2015. Design, Setting, and Participants: This repeated cross-sectional analysis examined delivery hospitalizations from 2012 through 2019 in the Healthcare Cost and Utilization Project's National Inpatient Sample and State Inpatient Databases, an all-payer compendium of hospital discharge records from community, nonrehabilitation hospitals. Trends were evaluated using segmented linear binomial regression models that allowed for discontinuities across the ICD-10-CM/PCS transition. Analyses were completed from April 2021 through March 2022. Exposures: Time, ICD-10-CM/PCS coding system, and state. Main Outcomes and Measures: SMM rates, excluding blood transfusion, per 10 000 delivery hospitalizations, overall and by indicator. Results: From 2012 to 2019, there were 5 964 315 delivery hospitalizations in the national sample representing a weighted total of 29.8 million deliveries with a mean (SD) maternal age of 28.6 (5.9) years. SMM rates increased from 69.5 per 10 000 in 2012 to 79.7 per 10 000 in 2019 (rate difference [RD], 10.2; 95% CI, 5.8 to 14.6) without a significant change across the ICD-10-CM/PCS transition (RD, -3.2; 95% CI, -6.9 to 0.6). Of 20 SMM indicators, rates for 10 indicators significantly increased while 3 significantly decreased; 5 of these changes were associated with ICD-10-CM/PCS transition. Acute kidney failure had the largest increase, from 6.4 to 15.3 per 10 000 delivery hospitalizations (RD, 8.9; 95% CI, 7.5 to 10.3) with no change associated with ICD transition (RD, -0.1; 95% CI, -1.2 to 1.1). Disseminated intravascular coagulation had the largest decrease from 31.3 to 21.2 per 10 000 (RD, 10.2; 95% CI, -12.8 to -7.5), with a significant drop associated with ICD transition (RD, -7.9; 95% CI, -10.2 to -5.6). State SMM rates significantly decreased for 1 state and significantly increased for 21 states from 2012 to 2019 and associations with ICD transition varied. Conclusions and Relevance: In this cross-sectional study, overall US SMM rates increased from 2012 to 2019, which was not associated with the ICD-10-CM/PCS transition. However, data for certain indicators and states may not be comparable across coding systems; efforts are needed to understand SMM increases and state variation.

Contributors to disparities in postpartum readmission rates between safety-net and non-safety-net hospitals: A decomposition analysis.

BACKGROUND: Safety-net hospitals (SNHs) treat more maternal patients with risk factors for postpartum readmission. OBJECTIVE: To assess how patient, hospital, and community characteristics explain the SNH/non-SNH disparity in postpartum readmission rates. DESIGN: A linear probability model assessed covariates associated with postpartum readmissions. Oaxaca-Blinder decomposition estimates quantified the contribution of covariates to the SNH/non-SNH disparity in postpartum readmission rates. SETTING: Healthcare Cost and Utilization Project 2016-2018 State Inpatient Databases from 25 states. PARTICIPANTS: 3.5 million maternal delivery stays. MEASUREMENTS: The outcome was inpatient readmission within 42 days of delivery. SNHs had a share of Medicaid/uninsured stays in the top quartile. A range of patient, hospital, and community characteristics was considered as covariates. RESULTS: The unadjusted postpartum readmission rate was 4.2 per 1000 index deliveries higher at SNHs than at non-SNHs (19.1 vs. 14.9, p < .001). Adjustment reduced the risk difference to 0.65 per 1000 (95% confidence interval [CI]: -0.14, 1.44). Patient (66%), hospital (14%), and community (4%) characteristics explained 84% of the disparity. The single largest contributors to the disparity were race/ethnicity (20%), hypertension (12%), hospital preterm delivery rate (10%), and preterm delivery (7%). Collectively, patient comorbidities explained 31% of the disparity. CONCLUSION: Higher postpartum readmission rates at SNHs versus non-SNHs were largely due to differences in the patient mix rather than hospital factors. Hospital initiatives are needed to reduce the risk of postpartum readmissions among SNH patients. Improving factors that contribute to the disparity, including underlying health conditions and health inequities associated with race, requires enduring investments in public health.

Contraceptive Decision-Making and the Importance of Side Effect Information Among a Sample of Latinas.

Context: U.S. Latinas have lower rates of contraceptive use and report more negative counseling experiences compared to non-Latina white women. Patient-centered approaches to contraceptive counseling are desired among Latinas and are also associated with patient satisfaction; yet, clinicians may not always use counseling methods that best support decision-making among marginalized groups. Objective: To examine Latinas' expectations of physician communication about contraceptive side effects, reported importance of personal knowledge about side effects, and the association of these with contraceptive use and use consistency. Materials and Methods: One hundred three self-identified Latinas aged 15-29 years at two urban federally qualified health centers completed a survey measuring factors associated with contraceptive use and consistency. Bivariate analysis was used to assess demographic and contraceptive information preferences. Associations between categorical variables were assessed using two-sided Fisher's exact tests. Continuous variables were compared using two-sided t-test. Results: The majority of respondents (85%) expected physicians to tell them about birth control side effects and reported that this information is important to use contraception, regardless of current contraceptive use. Among inconsistent and nonusers, importance of knowledge of side effects depended on expectations of information-sharing from physicians (p < 0.05). Conclusions: Expectations regarding side effect information-sharing by physicians and patient knowledge of side effects are important for the contraceptive decision-making process of this Latina group, regardless of contraceptive use. Clinicians engaging in contraceptive counseling should focus on providing clear and accurate information about side effects of discussed methods to facilitate informed decision-making and equitable, patient-centered contraceptive care for this vulnerable population.

Philippine Ayta possess the highest level of Denisovan ancestry in the world.

Multiple lines of evidence show that modern humans interbred with archaic Denisovans. Here, we report an account of shared demographic history between Australasians and Denisovans distinctively in Island Southeast Asia. Our analyses are based on ∼2.3 million genotypes from 118 ethnic groups of the Philippines, including 25 diverse self-identified Negrito populations, along with high-coverage genomes of Australopapuans and Ayta Magbukon Negritos. We show that Ayta Magbukon possess the highest level of Denisovan ancestry in the world-∼30%-40% greater than that of Australians and Papuans-consistent with an independent admixture event into Negritos from Denisovans. Together with the recently described Homo luzonensis, we suggest that there were multiple archaic species that inhabited the Philippines prior to the arrival of modern humans and that these archaic groups may have been genetically related. Altogether, our findings unveil a complex intertwined history of modern and archaic humans in the Asia-Pacific region, where distinct Islander Denisovan populations differentially admixed with incoming Australasians across multiple locations and at various points in time.

Multiple migrations to the Philippines during the last 50,000 years.

Island Southeast Asia has recently produced several surprises regarding human history, but the region's complex demography remains poorly understood. Here, we report ∼2.3 million genotypes from 1,028 individuals representing 115 indigenous Philippine populations and genome-sequence data from two ∼8,000-y-old individuals from Liangdao in the Taiwan Strait. We show that the Philippine islands were populated by at least five waves of human migration: initially by Northern and Southern Negritos (distantly related to Australian and Papuan groups), followed by Manobo, Sama, Papuan, and Cordilleran-related populations. The ancestors of Cordillerans diverged from indigenous peoples of Taiwan at least ∼8,000 y ago, prior to the arrival of paddy field rice agriculture in the Philippines ∼2,500 y ago, where some of their descendants remain to be the least admixed East Asian groups carrying an ancestry shared by all Austronesian-speaking populations. These observations contradict an exclusive "out-of-Taiwan" model of farming-language-people dispersal within the last four millennia for the Philippines and Island Southeast Asia. Sama-related ethnic groups of southwestern Philippines additionally experienced some minimal South Asian gene flow starting ∼1,000 y ago. Lastly, only a few lowlanders, accounting for <1% of all individuals, presented a low level of West Eurasian admixture, indicating a limited genetic legacy of Spanish colonization in the Philippines. Altogether, our findings reveal a multilayered history of the Philippines, which served as a crucial gateway for the movement of people that ultimately changed the genetic landscape of the Asia-Pacific region.

Frontotemporal EEG to guide sedation in COVID-19 related acute respiratory distress syndrome.

OBJECTIVE: To study if limited frontotemporal electroencephalogram (EEG) can guide sedation changes in highly infectious novel coronavirus disease 2019 (COVID-19) patients receiving neuromuscular blocking agent. METHODS: 98 days of continuous frontotemporal EEG from 11 consecutive patients was evaluated daily by an epileptologist to recommend reduction or maintenance of the sedative level. We evaluated the need to increase sedation in the 6 h following this recommendation. Post-hoc analysis of the quantitative EEG was correlated with the level of sedation using a machine learning algorithm. RESULTS: Eleven patients were studied for a total of ninety-eight sedation days. EEG was consistent with excessive sedation on 57 (58%) and adequate sedation on 41 days (42%). Recommendations were followed by the team on 59% (N = 58; 19 to reduce and 39 to keep the sedation level). In the 6 h following reduction in sedation, increases of sedation were needed in 7 (12%). Automatized classification of EEG sedation levels reached 80% (±17%) accuracy. CONCLUSIONS: Visual inspection of a limited EEG helped sedation depth guidance. In a secondary analysis, our data supported that this determination may be automated using quantitative EEG analysis. SIGNIFICANCE: Our results support the use of frontotemporal EEG for guiding sedation in patients with COVID-19.

Adverse Birth Outcomes Among Women of Advanced Maternal Age With and Without Health Conditions in Maryland.

BACKGROUND: Advanced maternal age (AMA) has been linked to both higher risk of adverse birth outcomes and higher levels of comorbidities. It is unclear if adverse outcomes are higher for older healthy women. This study examined the association between AMA and adverse birth outcomes among women with and without preexisting and pregnancy-related health conditions. METHODS: Analysis of data for 14,933 singleton births between 2004 and 2015 from the population-based Maryland Pregnancy Risk Assessment Monitoring System was conducted, comparing women aged 20-34 years and 35 years and older. Multivariable logistic regression estimated the difference in odds of preterm birth (PTB) and low birthweight (LBW) by age group among women with and without health conditions. The analysis of women without health conditions was stratified by parity. RESULTS: Among women without health conditions, AMA was associated with higher odds of PTB regardless of birthweight, LBW regardless of term, LBW term births, and LBW PTBs; stratified analysis showed higher risk of these outcomes among both older primiparas and multiparas. Compared with younger women with hypertensive disorders, older women with similar health conditions had higher odds of PTB regardless of birthweight. Older women with asthma had higher odds of LBW term births. CONCLUSIONS: AMA is associated with adverse birth outcomes among women with and without health conditions compared with younger women with similar health status. Improved screening and management of health conditions during pregnancy is needed for older women, regardless of parity.

First-Year Outcomes of Critical Congenital Heart Disease Screening in Maryland.

Objectives. Newborn screening for critical congenital heart disease (CCHD) was added to the Recommended Uniform Screening Panel in 2011, and states have been gradually adding pulse oximetry as point-of-care screening to panels. Few data are available on the effectiveness of pulse oximetry as a mandated screening. This study describes outcomes of the first year of screening in Maryland. Methods. A web-based data collection tool for screening results and outcomes, eScreener Plus, was utilized. Data collected from the start of screening from September 1, 2012, to December 31, 2013, were analyzed. Well-baby nursery data were evaluated separately from neonatal intensive care unit (NICU) data to determine whether setting influenced effectiveness. Results. In the first 15 months of newborn screening for CCHD in Maryland, 4 asymptomatic infants were diagnosed with a critical cardiac condition by newborn screening. Eleven infants passed but were later identified with a primary or secondary target condition. Seventy-one percent of infants with CCHD were identified prenatally or by clinical signs and symptoms. Pulse oximetry screening for CCHD had a specificity of more than 99% in both the well-baby nursery and the NICU. Sensitivity in the well-baby nursery was 10% and 60% in the NICU. Conclusion. Further investigation and interpretation of specific protocols that were used and outcomes of screening is needed for continued refinement of the well-baby algorithm and NICU protocol development. Pulse oximetry screening in newborns provides valuable clinical information, but many infants with CCHD are still not identified with current protocols.

Postpartum Health Care Use After Gestational Diabetes and Hypertensive Disorders of Pregnancy.

Objective: To examine postpartum health care utilization after a pregnancy complicated by gestational diabetes (GD) and hypertensive disorders of pregnancy (HDP) using nationally representative data. Materials and Methods: We examined longitudinal pooled panel data from the 1996-2007 Medical Expenditure Panel Survey with linked data from Pregnancy Detail Files on adult women (>18) with singleton pregnancies who reported an infant delivery. Multivariable weighted logistic regression analyses, including interactions, examined the associations between pregnancy complications (GD/HDP) and three postpartum health care utilization outcomes, adjusting for demographic characteristics. Results: The unweighted sample size included 304 women. Overall, 32% did not report an office visit within 12 weeks postpartum, and 15% did not report an office visit within 1 year postpartum. In addition, 15% had ≥1 emergency room (ER) visit 1 year postpartum. Women with GD/HDP compared with those with neither complication had more ER visits 1 year postpartum (unadjusted mean 4.9 vs. 2.3; p < 0.01). In multivariable analyses, GD and HDP were not independently associated with outcomes. However, education marginally modified the pregnancy complication-office visit 1 year postpartum relationship (p = 0.06). Other demographic characteristics were independently associated with each postpartum health care utilization outcome after adjustment. Conclusions: Women with GD/HDP did not differ from women with neither complication on postpartum utilization outcomes. Less educated women with GD/HDP were more likely to miss an office visit within 1 year postpartum than less educated women with neither complication. Certain subgroups of women were more likely to forego timely and appropriate postpartum care. Efforts to improve care coordination and insurance coverage access during the postpartum period are needed.

A Population-Based Study of School Readiness Determinants in a Large Urban Public School District.

Objectives We examined biologic and social determinants of school readiness in an urban population and whether childcare altered these associations. Methods A retrospective cohort study was conducted using school readiness data linked to birth certificates of first-time kindergarten students (n = 39,463) in a large, urban public-school district during 2002-2012. Multivariate linear regression models compared mean readiness scores (MRS) for students born low birthweight (LBW) or preterm (PTB) and by childcare type, adjusting for other student and parent risk factors. Results MRSs for moderately LBW (1000-2499 g), extremely LBW (< 1000 g), moderately PTB (28-36 weeks), early-term (37-38 weeks) and post-term (42 + weeks) students were significantly lower than scores for their normal weight or full-term peers, adjusting for childcare type and other student and parent characteristics. Childcare was an important predictor of MRSs. MRSs were highest for district prekindergarten (PK) students and for students of mothers with greater years of education. Conclusions for Practice Social and biologic differences in MRSs for children entering school in a large urban public-school district suggest the need for greater attention to family and child health backgrounds. Increased enrollment in formal childcare may improve school readiness in these settings.

Severe maternal morbidity and related hospital quality measures in Maryland.

OBJECTIVE: To determine hospital characteristics and quality metrics associated with severe maternal morbidity (SMM) in Maryland. STUDY DESIGN: A population-based observational study of 364,113 statewide delivery hospitalizations during 2010-2015 linked with socio-economic community measures and hospital characteristics and quality measures. Multivariable logistic regression models with generalized estimating equations estimated SMM adjusting for individual, community, and hospital-level factors and clustering within hospitals and residence zip codes. RESULTS: The SMM prevalence was 197 per 10,000 deliveries. Adjusted SMM risk ratios were higher for younger (<20 years), older (35+ years), non-White non-Hispanic, unmarried, multiple substance users, women with multiple gestations, and chronic medical and mental health conditions than their counterparts. Communities with greater socio-economic disadvantage and hospitals with poorer patient experience and clinical care quality had higher rates of SMM. CONCLUSION: Addressing socio-economic disparities and improving quality of care in delivery hospitals are key to reducing the SMM burden in Maryland.

Novel Agents for the Management of Endocrine Resistant Breast Cancer.

PURPOSE OF REVIEW: Most women with hormone receptor (HR)-positive, HER2-negative (HR+/HER2-) breast cancer will ultimately develop endocrine-resistant disease, either primary or acquired. This review will discuss the proposed mechanisms underlying endocrine resistance and key advances in the treatment of endocrine-resistant breast cancer. RECENT FINDINGS: Estrogen receptor 1 mutations (ESR1) occur in the majority of patients with HR+/HER2- metastatic breast cancer after prolonged exposure to aromatase inhibitors. Data from the SoFEA trial showed that patients had improved progression-free survival (PFS) after taking fulvestrant compared with exemestane. Fulvestrant is currently the only selective estrogen receptor degrader (SERD) available and development of oral novel SERDs with higher bioavailability and potency are currently being investigated. SUMMARY: Despite significant advances in the treatment of HR+/HER2- breast cancer over the past four decades, a significant proportion of patients do still develop endocrine resistance following optimal endocrine therapy. In this review, we aim to provide an overview of the different classes of novel agents currently being investigated to overcome endocrine resistance.

Who are the Philippine negritos? Evidence from language.

This article addresses the linguistic evidence from which details about Philippine "negritos" can be inferred. This evidence comes from the naming practices of both negrito and non-negrito peoples, from which it can be inferred that many negrito groups have maintained a unique identity distinct from other groups since the dispersal of Malayo-Polynesian languages. Other names, such as Dupaningan and Dumagat, reference locations, from which it is assumed the negritos left after contact with Malayo-Polynesian people. Evidence also comes from the relative positions of negrito groups vis-à-vis other groups within the subfamily with which their current language can be grouped. Many of these languages can be shown to be first order branches, suggesting early separation from the people whose languages they first acquired. The geospatial distribution of the northern languages of the Philippines closely matches the proposed dispersal routes of early Malayo-Polynesian peoples into the Cagayan River Valley and up the Chico and Magat tributaries from which negrito groups were displaced. One lexical item that is discussed is the word for the traditionally widespread practice of head-hunting, the term for which is reconstructible to Proto-Austronesian with reflexes throughout the Philippines and countries to the south. The practice was probably associated with agriculture and not only may have contributed to the early rapid spread south of Malayo-Polynesian languages through the Philippines and ultimately into the Pacific but also was later a major factor in the long periods of isolation of negrito peoples, during which the languages they had first acquired became very different from that of their former neighbors.

Does deployment to Iraq and Afghanistan affect respiratory health of US military personnel?

OBJECTIVE: To evaluate the association between postdeployment respiratory conditions and deployment to Iraq or Afghanistan. METHODS: We linked deployment history of US military personnel with postdeployment medical records. We then conducted a nested case-control study. RESULTS: Relative to a single deployment, multiple deployments were not significantly associated with obstructive pulmonary disease (odds ratio, 1.08; 95% confidence interval, 0.82 to 1.42). Cumulative time deployed was also not significantly associated with obstructive pulmonary disease. Nevertheless, we did note that the rate of respiratory symptoms and encounters for obstructive pulmonary diseases (predominantly asthma and bronchitis) increased from before to after deployment. CONCLUSIONS: In a population of active duty US military personnel, we observed an increase in postdeployment respiratory symptoms and medical encounters for obstructive pulmonary diseases, relative to predeployment rates, in the absence of an association with cumulative deployment duration or total number of deployments.

Respiratory health status of US Army personnel potentially exposed to smoke from 2003 Al-Mishraq Sulfur Plant fire.

OBJECTIVE: To assess the impact of exposure to a 2003 sulfur plant fire on the health of deployed US Army personnel. METHODS: The authors identified a small firefighter group known to be at the fire source and a larger, more dispersed population. Self-reported health status and respiratory health outcomes for these two groups were reviewed compared with two unexposed groups. RESULTS: Self-reported health concerns, difficulty breathing, and shortness of breath were common in the exposed. Rates for chronic respiratory conditions increased in all groups from before to after deployment. Postdeployment medical encounters for chronic respiratory conditions among the exposed did not differ significantly from the unexposed comparison groups. CONCLUSION: Potential exposure to the sulfur fire was positively associated with self-reported health concerns and symptoms but not with clinical encounters for chronic respiratory health conditions.

An overview of technologies related to care for venous leg ulcers.

Venous leg ulcers remain a major problem in the United States, with spending reaching more than $1 billion annually. Current treatment options for this condition center around the use of compression therapy delivered by bandages, medical-grade stockings, or pneumatic compression devices. While these forms of therapy can produce dramatic improvements, cost and patient compliance remain an issue. In parallel with this need, wearable, wireless health monitoring systems have recently emerged as a low-cost solution for management of chronic health conditions. To this end, researchers at the Center for Robotics and Intelligent Machines (North Carolina State University) and the Carolon Company (Rural Hall, NC) have proposed an integrated sensing and therapeutic compression module. This article will review technologies related to the design of such a device, as well as provide direction for future research.