Mortality in hypotensive combat casualties who require emergent laparotomy in the forward deployed environment.

INTRODUCTION: Mortality rates among hypotensive civilian patients requiring emergent laparotomy exceed 40%. Damage control (DCR) principles were incorporated into the military's Clinical Practice Guidelines (CPG) in 2008. We examined combat casualties requiring emergent laparotomy to characterize how mortality rates compare to hypotensive civilian trauma patients. METHODS: The DoD Trauma Registry (2004-2020) was queried for adults who underwent combat laparotomy. Patients who were hypotensive were compared to normotensive patients. Mortality was the outcome of interest. Mortality rates before (2004-2007) and after (2009-2020) DCR CPG implementation were analyzed. RESULTS: 1051 patients were studied. Overall mortality was 6.5% for normotensive casualties and 28.7% for hypotensive casualties. Mortality decreased in normotensive patients but remained unchanged in hypotensive patients following the implementation of the DCR CPG. CONCLUSION: Hypotensive combat casualties undergoing emergent laparotomy demonstrated a mortality rate of 29.5%. Despite many advances, mortality rates remain high in hypotensive patients requiring emergent laparotomy.

From the War on Terror to the Moral Crusade Against Female Genital Mutilation: Anti-Muslim Racism and Femonationalism in the United States.

This article investigates the recent flurry of state-level legislation regarding female genital mutilation (FGM), which occurred in the aftermath of the first federal criminal court case of FGM in 2017. Drawing on publicly available material, it shows how this court case, which involved a group of Muslims of Indian heritage, elicited a moral crusade against FGM, largely led by Republican lawmakers, and spurred a resurgence of anti-Muslim discourses, which first came to the fore after 9/11 to legitimate the "war on terror." Although FGM is not an Islamic practice and is also carried out by non-Muslim groups, the author concludes that femonationalism and anti-Muslim racism are important analytical lens for understanding the recent history of legislative efforts to combat FGM in the U.S.

International law and mental health evaluations at Guantanamo: Is medical repatriation a solution for most detainees?

This article analyzes the ruling in al-Qahtani v. Trump which establishes a new legal mechanism for Guantanamo detainees being held in indefinite detention to receive independent psychiatric evaluations from mixed medical commissions in order to determine eligibility for repatriation on humanitarian grounds. The article first reviews how the U.S. government created a legal framework for Global War on Terror detainees that differs from established conventions under international humanitarian law to protect prisoners of war. It discusses the circumstances of a Guantanamo detainee named Mohammed al-Qahtani who was tortured in U.S. custody, according to Guantanamo's top official. The U.S. government has declined to refer legal charges against him but also refused to release him since he has been considered a threat to U.S. national security. The article analyzes how al-Qahtani's attorneys challenged the legality of his detention and referred to an independent psychiatric evaluation played to establish the legal basis for "irreparable harm." al-Qahtani's independent psychiatric evaluation asserted that he displayed symptoms consistent with those exhibited by survivors of torture. Legally, the ruling establishes a precedent for Guantanamo detainees who are being held in indefinite detention to compel the U.S. government to clarify their legal status or arrange an examination by a mixed medical commission. Twenty-two other detainees out of the forty still at Guantanamo fall in this legal category, so the precedent has far-reaching consequences. Finally, the prospect of mixed medical commissions composed of international experts who are collaborating to render a medical opinion raises questions about how independent psychiatric evaluations would be conducted in practice.

United States of America v. Majid Shoukat Khan: Guantánamo's first ruling to consider torture in mitigating sentencing for detainees.

In June 2020, a Guantánamo military judge ruled in United States of America v. Majid Shoukat Khan that he has the legal authority to mitigate Khan's criminal sentence as a remedy for illegal pretrial punishment if his attorneys prove that he suffered torture and other cruel, inhuman, and degrading treatment in government custody. This commentary analyzes the ruling and its implications for Guantánamo's legal system, detainees, and forensic medicine.

Nation, Narration, and Health in Mohamedou Ould Slahi's Guantánamo Diary.

Scholars have mostly analyzed information from mental health practitioners, attorneys, and institutions to critique mental health practices in the War on Terror. These sources offer limited insights into the suffering of detainees. Detainee accounts provide novel information based on their experiences at Guantánamo. Mohamedou Ould Slahi's Guantánamo Diary is the only text from a current detainee that provides a first-person account of his interrogations and interactions with health professionals. Despite being advertised as a diary, however, it has undergone redaction from American government officials. This article examines Slahi's account of his interrogations and representations of mental health at Guantánamo and considers its role within the narrative function of the nation. At stake is the right of detainees to narrate, scholars to critique medical practices in the War on Terror, and the nation's attempts to control its narration.

Deployed Women Veterans: Important Culturally Sensitive Care.

PROBLEM: Today, with almost 23 million veterans in the nation, and currently only about 10 million, or less, of them seeking active services associated with the Veterans Administration (VA) health facilities, these men and women veterans will be seeking some, more, or even all of their health care over their life time in civilian-based facilities. METHODS: Pertinent literary sources were reviewed to gather applicable data about the problem. FINDINGS: Every patient that enters your health facility should be asked an essential assessment question: "Have you served in the military?" Importantly, to gain effective rapport when they present, civilian nurses will need to anticipate their health needs and provide culturally sensitive care. Specific issues of deployed women veterans are provided in a series of two articles. CONCLUSION: This article provides a snapshot of the uniquely entrenched military culture, as well as women service member experiences in wartime, including the Global War on Terror (Iraq and Afghanistan). The next article discusses the various healthcare differences (e.g., post-traumatic stress disorder and military sexual trauma), difficulties (e.g., reproductive, gynecologic, urinary, employment, homelessness issues), and gender disparities (varied treatment patterns) so the civilian nurse can better advocate for women veterans.

British torture in the 'war on terror'.

Despite long-standing allegations of UK involvement in prisoner abuse during counterterrorism operations as part of the US-led 'war on terror', a consistent narrative emanating from British government officials is that Britain neither uses, condones nor facilitates torture or other cruel, inhuman or degrading treatment and punishment. We argue that such denials are untenable. We have established beyond reasonable doubt that Britain has been deeply involved in post-9/11 prisoner abuse, and we can now provide the most detailed account to date of the depth of this involvement. We argue that it is possible to identify a peculiarly British approach to torture in the 'war on terror', which is particularly well-suited to sustaining a narrative of denial. To explain the nature of UK involvement, we argue that it can be best understood within the context of how law and sovereign power have come to operate during the 'war on terror'. We turn here to the work of Judith Butler, and explore the role of Britain as a 'petty sovereign', operating under the state of exception established by the US executive. UK authorities have not themselves suspended the rule of law so overtly; indeed, they have repeatedly insisted on their commitment to it. Nevertheless, they have been able to construct a rhetorical, legal and policy 'scaffold' that has enabled them to demonstrate at least procedural adherence to human rights norms while, at the same time, allowing UK officials to acquiesce in the arbitrary exercise of sovereignty over individuals who are denied any access to appropriate representation or redress in compliance with the rule of law.

Standardizing psycho-medical torture during the War on Terror: Why it happened, how it happened, and why it didn't work.

After 9/11/2001 the United States launched a global War on Terror. As part of this War, terrorism suspects were detained by the U.S. military and by the C.I.A. It is now widely recognized that the United States tortured a number of these detainees in the context of its 'enhanced interrogation' programme. This article examines how and why U.S. organizations developed standards that allowed healthcare professionals to become involved in torture; why the standards developed by U.S. security institutions failed to control the actions of enhanced interrogation personnel on the ground; and what the role of standards were in stopping the enhanced interrogation initiative. The article concludes by discussing the general lessons that the enhanced interrogation programme has for social science research on standards, namely that individuals can experience ambivalence when caught between competing organizational and professional standards and that it might be inherently difficult to successfully enact certain protocols when these relate to deviant or destructive acts.

On Belonging: The American Adolescent of Arab Descent.

Although American families of Arab origin come from 22 countries and from varied backgrounds and cultures, reports suggest that they suffer equally from acculturation stress, stereotyping, discrimination, and the reverberations of the aftermath of September 11 as well as global affairs. However, because children and adolescents from these families, particularly those who are newly arrived immigrants, tend to do well in school, they are rarely targeted by research or policy. This article uses the narratives of 5 middle school age male students from Arab descent who were in a support group that met for 3 years (2004-2007), beginning shortly after President George W. Bush's declaration of the war on the "axis of evil." I used vignettes from this group to illustrate the stressors this population faces. The final section suggests an option for supporting this population.

Why Did U.S. Healthcare Professionals Become Involved in Torture During the War on Terror?

This article examines why U.S. healthcare professionals became involved in "enhanced interrogation," or torture, during the War on Terror. A number of factors are identified including a desire on the part of these professionals to defend their country and fellow citizens from future attack; having their activities approved and authorized by legitimate command structures; financial incentives; and wanting to prevent serious harm from occurring to prisoners/detainees. The factors outlined here suggest that psychosocial factors can influence health professionals' ethical decision-making.

Los equipos quirúrgicos avanzados en los escenarios contemporáneos de acciones combativas / Advanced surgical teams in contemporary scenarios of combat actions

Introducción: con el uso de la plataforma de Servicios de Información Ebsco Host, se accedió a las bases de datos a texto completo Academic Search Premier y Medline Complete.Objetivo: revisar la información contenida en los Descriptores MeSH 2014 acerca de Forward Surgical Teams, Iraq and Afghanistan. De dicha búsqueda surgieron evidencias bibliográficas de la utilización, empleo y desarrollo de los Forward Surgical Teams de los Servicios Médicos de las Fuerzas Armadas Norteamericanas (Ejército de Tierra), Francia, Reino Unido y Finlandia.Métodos: se expone el modo de empleo y la sucesiva tendencia a su perfeccionamiento operacional y tecnológico durante las últimas guerras en Medio Oriente a propósito del despliegue de tropas norteamericanas y de la coalición de la ONU en la cruzada contra el terror liderada por los Estados Unidos de Norteamérica. Los aspectos reportados en el artículo se refieren a la composición, despliegue y utilización táctica de los Forward Surgical Teams, a la aplicación de diversos protocolos de diagnóstico y tratamiento para la recepción y manejo de las bajas sanitarias debido a las acciones combativas y el afrontamiento de la preparación del personal médico y de enfermería antes, durante y después del despliegue de la institución médica(AU)

Introduction: Using Ebsco Host Information Services platform, the full-text Academic Search Premier and Medline complete databases were accessed.Objective: Review the information contained in 2014 MeSH Descriptors about Forward Surgical Teams, Iraq and Afghanistan. From this search bibliographical evidences emerged of the use, employment and development of the Forward Surgical Teams of the Medical Services of the Armed Forces in United States of America (Army), France, United Kingdom, and Finland.Method: It is presented here the way of employment and the successive trend towards its operational and technological improvement during the last wars in the Middle East on the deployment of US troops and the UN coalition in the United States-led crusade against terror of North America. The aspects reported in the article refer to the composition, deployment and tactical use of the Forward Surgical Teams, to the application of various diagnostic and treatment protocols for the reception and management of health casualties due to combat actions and the coping of the preparation of medical and nursing personnel before, during, and after deployment of the medical institution(AU)

Los equipos quirúrgicos avanzados en los escenarios contemporáneos de acciones combativas / Advanced surgical teams in contemporary scenarios of combat actions

Introducción: con el uso de la plataforma de Servicios de Información Ebsco Host, se accedió a las bases de datos a texto completo Academic Search Premier y Medline Complete. Objetivo: revisar la información contenida en los Descriptores MeSH 2014 acerca de Forward Surgical Teams, Iraq and Afghanistan. De dicha búsqueda surgieron evidencias bibliográficas de la utilización, empleo y desarrollo de los Forward Surgical Teams de los Servicios Médicos de las Fuerzas Armadas Norteamericanas (Ejército de Tierra), Francia, Reino Unido y Finlandia. Métodos: se expone el modo de empleo y la sucesiva tendencia a su perfeccionamiento operacional y tecnológico durante las últimas guerras en Medio Oriente a propósito del despliegue de tropas norteamericanas y de la coalición de la ONU en la cruzada contra el terror liderada por los Estados Unidos de Norteamérica. Los aspectos reportados en el artículo se refieren a la composición, despliegue y utilización táctica de los Forward Surgical Teams, a la aplicación de diversos protocolos de diagnóstico y tratamiento para la recepción y manejo de las bajas sanitarias debido a las acciones combativas y el afrontamiento de la preparación del personal médico y de enfermería antes, durante y después del despliegue de la institución médica(AU)

Introduction: Using Ebsco Host Information Services platform, the full-text Academic Search Premier and Medline complete databases were accessed. Objective: Review the information contained in 2014 MeSH Descriptors about Forward Surgical Teams, Iraq and Afghanistan. From this search bibliographical evidences emerged of the use, employment and development of the Forward Surgical Teams of the Medical Services of the Armed Forces in United States of America (Army), France, United Kingdom, and Finland. Method: It is presented here the way of employment and the successive trend towards its operational and technological improvement during the last wars in the Middle East on the deployment of US troops and the UN coalition in the United States-led crusade against terror of North America. The aspects reported in the article refer to the composition, deployment and tactical use of the Forward Surgical Teams, to the application of various diagnostic and treatment protocols for the reception and management of health casualties due to combat actions and the coping of the preparation of medical and nursing personnel before, during, and after deployment of the medical institution(AU)

Advocating for Deployed Women Veterans' Health Differences, Difficulties, and Disparities.

PROBLEM: The preceding article presented a glimpse of deployed women veterans, their military culture, and their experiences in the Global War on Terror (Iraq and Afghanistan) to assist civilian nurses to gain significant rapport and provide important culturally sensitive care. METHODS: Pertinent literary sources were reviewed to gather applicable data about the problem. FINDINGS: A confirmatory answer from the assessment question of "Have you served in the military?" and the use of the Military Health History Pocket Card for Clinicians (available at http://www.va.gov.oaa/pocketcard) will assist with revealing possible health risks from the increased amounts of military men and women veterans seeking (and/or returning to) a variety of community-based health services. This article about deployed women veterans examines their specific health differences (e.g., research literature, post-traumatic stress disorder, and military sexual trauma), difficulties (e.g., reproductive, gynecologic, urinary, suicide), and gender disparities (varied treatment patterns). CONCLUSION: Understanding these gender situations, civilian nurses can better advocate with increasing evidence-based decisions that their physical and behavioral responses were different from their male counterparts. Continual assessment, knowledgeable care, ongoing literature review, interdisciplinary health team development, and the presence of resourceful community agencies should be a significant part of their holistic care. Conard Armstrong.

Intimate Partner Violence Between Male Iraq and Afghanistan Veterans and Their Female Partners Who Seek Couples Therapy.

The current study has three aims: (1) to describe the frequency, gender differences, and agreement in couples' reports of male-to-female and female-to-male intimate partner violence (IPV) reported by male veterans and their female partners who were seeking couples therapy; (2) to describe the pattern of violence reported by these couples (e.g., one-sided, mutual) and determine if frequency of violence varied based on patterns; and (3) to examine whether frequency of violence or pattern of violence were associated with veteran diagnosis of posttraumatic stress disorder (PTSD). One hundred heterosexual couples (male Iraq/Afghanistan veteran, female civilian) seeking couples therapy at a Veterans Affairs (VA) clinic completed self-report measures of violence in their relationship. Almost all couples reported verbal aggression. Men reported perpetrating more frequent sexual coercion, and women reported perpetrating more frequent physical aggression. Correspondence in partners' reports of violence varied based on type of violence from high correspondence on verbal aggression to low correspondence on sexual coercion. Three patterns of violence were identified: verbally aggressive (n = 45), one-sided physically aggressive (n = 27), and mutually physically aggressive (n = 26). Mutually physically aggressive couples generally reported the most frequent violence. Frequency and pattern of violence were not associated with veteran diagnosis of PTSD. Findings underscore the need for clinicians to assess both partners for violence perpetration and the need for effective prevention strategies and treatments for IPV among veterans.

Reflections: Service to Our Nation.

Service to others is something that physicians understand and undertake on a daily basis. Military physicians are in a unique role of serving both our patients and our nation. Millions of Americans have answered the call to military service since the attacks of September 11, 2001. As otolaryngologists, we will increasingly care for veterans of the Global War on Terror. Service to our nation is a mutual goal that brings together people from very different walks of life.

Vicarious revenge and the death of Osama bin Laden.

Three hypotheses were derived from research on vicarious revenge and tested in the context of the assassination of Osama bin Laden in 2011. In line with the notion that revenge aims at delivering a message (the "message hypothesis"), Study 1 shows that Americans' vengeful desires in the aftermath of 9/11 predicted a sense of justice achieved after bin Laden's death, and that this effect was mediated by perceptions that his assassination sent a message to the perpetrators to not "mess" with the United States. In line with the "blood lust hypothesis," his assassination also sparked a desire to take further revenge and to continue the "war on terror." Finally, in line with the "intent hypothesis," Study 2 shows that Americans (but not Pakistanis or Germans) considered the fact that bin Laden was killed intentionally more satisfactory than the possibility of bin Laden being killed accidentally (e.g., in an airplane crash).