Urologic Trauma Management for Military Providers.

INTRODUCTION: Genitourinary (GU) trauma resulting from combat and the treatment of these injuries is an inadequately explored subject. While historically accounting for 2 to 5% of combat-related injuries, GU-related injuries escalated considerably during U.S. involvements in Iraq and Afghanistan due to improvised explosive devices (IEDs). Advanced body armor increased survivability while altering injury patterns, with a shift toward bladder and external genitalia injuries. Forward-deployed surgeons and military medics manage treatment, with Role 2 facilities addressing damage control resuscitation and surgery, including GU-specific procedures. The review aims to provide an overview of GU trauma and enhance medical readiness for battlefield scenarios. MATERIALS AND METHODS: This review examined urologic trauma management in combat, searching PubMed, Cochrane Central, Scopus, and Web of Science databases with search terms "wounds" OR "injuries" OR "hemorrhage" AND "trauma" AND "penile" OR "genital" AND "combat." Records were then screened for inclusion of combat-related urologic trauma in conflicts after 2001 and which were English-based publications. No limits based on year of publication, study design, or additional patient-specific demographics were implemented in this review. RESULTS: Ultimately, 33 articles that met the inclusion criteria were included. Included texts were narrowed to focus on the management of renal injuries, ureteral trauma, bladder injuries, penile amputations, urethral injuries, testicular trauma, Central nervous system (CNS) injuries, and female GU injuries. CONCLUSIONS: In modern conflicts, treatment of GU trauma at the point of injury should be secondary to Advanced Trauma Life Support (ATLS) care in addition to competing non-medical priorities. This review highlights the increasing severity of GU trauma due to explosive use, especially dismounted IEDs. Concealed morbidity and fertility issues underscore the importance of protection measures. Military medics play a crucial role in evaluating and managing GU injuries. Adherence to tactical guidelines and trained personnel is vital for effective management, and GU trauma's integration into broader polytrauma care is essential. Adequate preparation should address challenges for deploying health care providers, prioritizing lifesaving and quality-of-life care for casualties affected by GU injuries.

Quantification by droplet digital PCR and species identification by metabarcoding of environmental (e)DNA from Blainville's beaked whales, with assisted localization from an acoustic array.

Detection and identification of species, subspecies or stocks of whales, dolphins and porpoises at sea remain challenging, particularly for cryptic or elusive species like beaked whales (Family: Ziphiidae). Here we investigated the potential for using an acoustically assisted sampling design to collect environmental (e)DNA from beaked whales on the U.S. Navy's Atlantic Undersea Test and Evaluation Center (AUTEC) in The Bahamas. During 12 days of August 2019, we conducted 9 small-boat surveys and collected 56 samples of seawater (paired subsamples of 1L each, including controls) using both a spatial collection design in the absence of visual confirmation of whales, and a serial collection design in the proximity of whales at the surface. There were 7 sightings of whales, including 11 Blainville's beaked whales (Mesoplodon densirostris). All whales were located initially with the assistance of information from a bottom-mounted acoustic array available on the AUTEC range. Quantification by droplet digital (dd)PCR from the four spatial design collections showed no samples of eDNA above the threshold of detection and none of these 20 samples yielded amplicons for conventional or next-generation sequencing. Quantification of the 31 samples from four serial collections identified 11 likely positive detections. eDNA barcoding by conventional sequencing and eDNA metabarcoding by next-generation sequencing confirmed species identification for 9 samples from three of the four serial collections. We further resolved five intra-specific variants (i.e., haplotypes), two of which showed an exact match to previously published haplotypes and three that have not been reported previously to the international repository, GenBank. A minimum spanning network of the five eDNA haplotypes, with all other published haplotypes of Blainville's beaked whales, suggested the potential for further resolution of differences between oceanic populations.

A history of neurosurgical capabilities in the United States Pacific Command: from World War II to present.

Neurosurgery has benefited from innovations as a result of military conflict. The volume and complexity of injuries sustained on the battlefield require medical teams to triage, innovate, and practice beyond their capabilities in order to treat wartime injuries. The neurosurgeons who practiced in the Pacific Command (PACOM) during World War II, the Korean War, and the War in Vietnam built upon field operating room knowledge and influenced the logistics of treating battle-injured patients in far-forward environments. Modern-day battles are held on new terrain, and the military neurosurgeon must adapt. War in the PACOM uniquely presented significant obstacles due to geographic isolation, ultimately accelerating the growth and adaptability of military neurosurgery and medical evacuation. The advancements in infrastructure and resource mobilization made during PACOM conflicts continue to inform modern-day practices and provide insight for future conflicts. In this historical article, the authors review the development and evolution of neurosurgical care, forward surgical teams, and mobile field hospitals with surgical capabilities through US conflicts in the PACOM.

Prehospital Anemia Care A Review of Symptoms, Evaluation, and Management.

The ongoing evolution of prehospital medical care continues to advance beyond immediate triage care. Prehospital care is even more important to consider in theaters with extended evacuation times and limited local medical assets. Although blood loss is often associated with settings of acute traumatic hemorrhage in military medicine, the possibility for other hematologic compromise necessitating urgent action requires medics operating in these environments to have a fundamental knowledge of the pathophysiology, manifestations, and stabilization measures of anemia to aid their patients prior to, or in lieu of, evacuation. Continued development of and access to point-of-care testing in increasingly forward-deployed settings further enable medics to perform these tasks. Here, we provide a brief review of hemoglobin function and composition, and presentation and management considerations of anemia, to assist medics in their treatment efforts. We also address specific concerns for battlefield and atraumatic presentations.

All We Can Be: Innovations to Improve the Pipeline of Military Veterans in Medical Schools.

ISSUE: Medical schools are increasingly identifying military veteran applicants as a source of diversity, resiliency, and commitment-often derived from their personal experiences in the military. Yet, veterans remain significantly under-represented in entering classes; moreover, those veterans who do matriculate are not yet fully reflective of the diversity that the Armed Forces have to offer. Fortunately, specific measures have been shown to be effective at increasing both the number and diversity of student veterans in medical school. EVIDENCE: In 2019, there were less than 60 military veterans who entered the 144 civilian medical schools in the United States, according to the Association of American Medical Colleges. We identify common barriers faced by military veterans and propose best practices for medical schools to recruit and sustain them. We draw on the existing medical education literature about veteran support systems, and we underscore the unique challenges of veterans in medicine. Finally, we highlight innovative programs currently in place at several US medical schools that seek to address the needs of student veterans. This article provides a guide for how to recruit, assess, and nurture student veterans, suggesting a new way of thinking about this population of nontraditional medical students. IMPLICATIONS: This dearth of servicemembers significantly below what would be expected based on national demographic data is indicative of how medical schools offer few pathways to entry for military servicemembers-and far fewer for enlisted personnel and other populations traditionally under-represented in medicine. Should schools aim to recruit a veteran population that is truly representative of the military, additional measures need to be taken into consideration during the admissions review process.

Marine Mammal Lung Dynamics when Exposed to Underwater Explosion Impulse.

Very little is known about marine mammal susceptibility to primary blast injury (PBI) except in rare cases of opportunistic studies. As a result, traditional analysis techniques relied on methods developed more than 30 years ago using terrestrial mammals as surrogates. Modeling tools available today have the computing power to vastly improve calculation of safe ranges and injury zones from underwater explosions (UNDEX) employing morphologically accurate proxies with material properties similar to marine mammal tissues. The Dynamic System Mechanics Advanced Simulation (DYSMAS) fluid-structure interaction (FSI) software is being used to simulate the complex phenomena of UNDEX, shock wave, and bubble pulse propagation through the water and transmission of energy to a cetacean focusing on the dynamic response of the thoracic cavity and air-filled lungs to a shock wave. The approach integrates fluid and structural analyses with the material properties of blubber, bone, and muscle using marine mammal morphometrics to eliminate unnecessary assumptions made during more traditional approaches to analysis developed before these types of data and computational power were available. DYSMAS analyses of a 1D gas bubble surrounded by water was found to closely match the classical bubble dynamics models. Further, DYSMAS models of a spherical gas bubble surrounded by tissue and rib structure demonstrate a global radial oscillation of the gas bubble, but also show significant local deflection and material strain in response to the UNDEX loading. The intended result of the investigation is an improved and scientifically defensible understanding of the effects of UNDEX on marine mammals. Anat Rec, 2018. © 2018 Wiley Periodicals, Inc. Anat Rec, 302:718-734, 2019. Published 2018. This article is a U.S. Government work and is in the public domain in the USA.

Does Chronic Unpredictable Stress during Adolescence Affect Spatial Cognition in Adulthood?

Spatial abilities allow animals to retain and cognitively manipulate information about their spatial environment and are dependent upon neural structures that mature during adolescence. Exposure to stress in adolescence is thought to disrupt neural maturation, possibly compromising cognitive processes later in life. We examined whether exposure to chronic unpredictable stress in adolescence affects spatial ability in late adulthood. We evaluated spatial learning, reference and working memory, as well as long-term retention of visuospatial cues using a radial arm water maze. We found that stress in adolescence decreased the rate of improvement in spatial learning in adulthood. However, we found no overall performance impairments in adult reference memory, working memory, or retention caused by adolescent-stress. Together, these findings suggest that adolescent-stress may alter the strategy used to solve spatial challenges, resulting in performance that is more consistent but is not refined by incorporating available spatial information. Interestingly, we also found that adolescent-stressed rats showed a shorter latency to begin the water maze task when re-exposed to the maze after an overnight delay compared with control rats. This suggests that adolescent exposure to reoccurring stressors may prepare animals for subsequent reoccurring challenges. Overall, our results show that stress in adolescence does not affect all cognitive processes, but may affect cognition in a context-dependent manner.