Introduction to Treating Patients Exposed to Chemical, Biological, Radiological, and Nuclear (CBRN) Threats: A Military Medical Case-Based Curriculum.

Introduction: Ensuring proficiency in responding to, evaluating, and treating chemical, biological, radiological, and nuclear (CBRN) casualties is a critical component of military medical student education. To meet this objective, we developed a case-based CBRN curriculum that can serve as a model to address potential curricular gaps for civilian prehospital, UME, and GME programs.

Methods: The curriculum was administered in two sessions, 1 month apart, each with individual student preparation, including an optional asynchronous online module and a review of clinical practice guidelines.

Expectant Casualty Care Training Needs for Future Conflicts.

Introduct Ion: The demands of future large-scale combat operations may require medics and corpsmen to increasingly perform expectant casualty care (ECC). However, no detailed guidelines currently exist for providing ECC within military medicine. To guide the development of education and training guidelines and advance team training of both medics and non-medics, an in-depth understanding is first needed regarding caregivers' experiences providing ECC in recent conflicts as well as perceived training gaps.

Evaluation of maternal serum protein biomarkers in the prenatal evaluation of placenta accreta spectrum: A systematic scoping review.

Introduction: Placenta accreta spectrum (PAS) is an increasingly commonly reported condition due to the continuous increase in the rate of cesarean deliveries (CD) worldwide; however, the prenatal screening for pregnant patients at risk of PAS at birth remains limited, in particular when imaging expertise is not available.

Material And Methods: Two major electronic databases (MEDLINE and Embase) were searched electronically for articles published in English between October 1992 and January 2023 using combinations of the relevant medical subject heading terms and keywords. Two independent reviewers selected observational studies that provided data on one or more measurement of maternal blood-specific biomarker(s) during pregnancies with PAS at birth.

Cluster Analysis Methods to Support Population Health Improvement Among US Counties.

Context: Population health rankings can be a catalyst for the improvement of health by drawing attention to areas in need of relative improvement and summarizing complex information in a manner understood by almost everyone. However, ranks also have unintended consequences, such as being interpreted as "hard truths," where variations may not be significant. There is a need to improve communication about uncertainty in ranks, with accurate interpretation.

Red line the red line: Optimizing emergency medicine physicians and surgeons collaborative roles on trauma teams.

It has long been the standard for surgical and EM teams to both be present upon patient arrival and work together for the sickest trauma patients, yielding improved outcomes. It is important to dismantle divisive perceptions, confront system constraints, and promote new strategies that optimize the engagement of trauma team members. The focus should be on the patient, whose injury care starts with prevention and extends seamlessly through prehospital, hospital and rehabilitation.

Keeping It Political and Powerful: Defining the Structural Determinants of Health.

Policy Points The structural determinants of health are 1) the written and unwritten rules that create, maintain, or eliminate durable and hierarchical patterns of advantage among socially constructed groups in the conditions that affect health, and 2) the manifestation of power relations in that people and groups with more power based on current social structures work-implicitly and explicitly-to maintain their advantage by reinforcing or modifying these rules. This theoretically grounded definition of structural determinants can support a shared analysis of the root causes of health inequities and an embrace of public health's role in shifting power relations and engaging politically, especially in its policy work. Shifting the balance of power relations between socially constructed groups differentiates interventions in the structural determinants of health from those in the social determinants of health.

The Impact of Progressive Simulation-Based Training on Tourniquet Application.

The Advanced Combat Medical Experience (ACME) is a progressive simulation-based training held for second-year medical students at the Uniformed Services University (USU). This study explored the impact of participating in ACME on students' tourniquet application skills. A panel of emergency medicine physician experts developed an assessment to evaluate the participants' performance.

Total Force Fitness Standardization: Leveraging Policy and Metrics to Inform and Accelerate Implementation.

Total Force Fitness (TFF) metrics inform leaders at every level as they develop and evaluate policies, practices, and programs that enable soldiers, airmen, sailors, marines, guardians, and operators to achieve human performance optimization in all eight domains as defined by the TFF framework. The Standardization Workgroup was a facilitated discussion breakout session among a group of uniquely informed and engaged attendees who were invited to be part of the TFF summit that was hosted in Bethesda, Maryland, on September 14 and 15, 2021. The Standardization Workgroup explored the 2018 TFF shift in perspective to consider human performance optimization in the context of a military unit's fitness for missions and identified several challenges, opportunities, and action items for improving the implementation and sustainment of TFF throughout the services.

Total Force Fitness Summit 2021: Maximizing the Health and Well-being of Service Members and Their Families.

Total Force Fitness (TFF) is a multidomain, holistic framework that provides the Department of Defense (DoD) with the capability to assess, promote, and sustain human performance optimization across the full spectrum of components key to meeting mission requirements. On September 14 and 15, 2021, in Bethesda, MD, The Consortium for Health and Military Performance convened a second TFF Summit with the goal of promoting the mission of optimizing the health and well-being of our service members across their careers. Participants included scientists, clinicians, educators, public health professionals, and military leaders from all the services.

Force Health Protection Education: A Pilot Approach to Applying Military Frameworks to Service Member Health Education.

Ensuring Force Health Protection (FHP) is one of the most critical priorities in the DoD; however, there is no systematic approach for individual service members to address their own FHP. This paper outlines the FHP Education workshop, a model program fielded at 3rd Special Forces Group, Fort Bragg, NC, which applies military processes, principles, and frameworks to teaching special operations forces operators and enablers how to address their own FHP by identifying and mitigating threats to health and performance in the military operational environment. The FHP Education workshop has the potential to be a well-received and impactful program that offers a proactive, whole of person, community-based preventive system aligned with the Total Force Fitness framework to enable individual service members to conduct FHP.

Occupational and Environmental Challenges for Women.

The prevalence of women in the global workforce is increasing. Women increasingly participate in nontraditional employment settings in previously male-dominated industries and manually intensive professions, such as military service, emergency response, health care, aviation, space, agriculture, and technical trades. Limited occupational and environmental hazard data specific to women exist for these work environments.

Discounting Health Grades for Disparity: The 2021 Wisconsin Population Health and Equity Report Card.

We describe updates to the University of Wisconsin Population Health Institute's methodology for a state health report card, first described in Preventing Chronic Disease in 2010, and the considerations that were weighed in making those updates. These methods have been used since 2006 to issue a periodic report entitled Health of Wisconsin Report Card. The report highlights Wisconsin's standing among other states and serves as an example for others seeking to measure and improve their population's health.

Evidence Clearinghouses as Tools to Advance Health Equity: What We Know from a Systematic Scan.

Evidence clearinghouses evaluate and summarize literature to help decision-makers prioritize and invest in evidence-informed interventions. Clearinghouses and related practice-oriented tools are continuously evolving; however, it is unclear the extent to which these tools assess and summarize evidence describing an intervention's impact on health equity. We conducted a systematic scan to explore how clearinghouses communicated an intervention's equity impact and reviewed their underlying methods and how they defined and operationalized health equity.

Assessing pregnancy outcomes in cow-calf operations after administration of modified-live or killed virus vaccinations at the initiation of synchronization for fixed-time AI.

The objective of this study was to compare the reproductive outcomes (artificial insemination [AI] pregnancy rates, season pregnancy rates, AI pregnancy losses) and calf traits (birth and weaning weights) after vaccination of suckled beef cows against bovine herpesvirus 1 and bovine viral diarrhea virus using commercially-available modified-live virus (MLV) or killed virus (KV) vaccine at the initiation of a fixed-time AI program. Previously-vaccinated cows (n = 2138) on 14 farms throughout Virginia were enrolled in the study during the Fall 2017 and Spring 2018 breeding seasons. Animals received a single vaccination injection at 10 d pre-breeding, corresponding with time of CIDR insertion at initiation of the 7-d CO-Synch + CIDR synchronization protocol.

Theory in Action: Public Health and Community Power Building for Health Equity.

Context: Within the field of public health, there is growing awareness of how complex social conditions shape health outcomes and the role that power plays in driving health inequities. Despite public health frameworks lifting up the need to tackle power imbalances to advance equity, there is little guidance on how to accomplish this as an integral part of health promotion.

Objective: This article addresses the need for public health professionals to better understand power and identifies opportunities for shifting power to achieve more equitable outcomes.

Clinical Update on Uses for Mifepristone in Obstetrics and Gynecology.

Importance: Mifepristone (RU-486) is a selective progesterone receptor modulator that has antagonist properties on the uterus and cervix. Mifepristone is an effective abortifacient, prompting limitations on its use in many countries. Mifepristone has many uses outside of induced abortion, but these are less well known and underutilized by clinicians because of challenges in accessing and prescribing this medication.

Trends in Unplanned Peripartum Hysterectomy in the United States, 2009-2020.

The incidence of unplanned peripartum hysterectomy is increasing nationwide, which may reflect an increase in placenta accreta spectrum disorders.

Considerations and Recommendations for Pregnancy and Postpartum Care for People Living With Human Immunodeficiency Virus.

Considerable strides have been made in reducing the rate of perinatal human immunodeficiency virus (HIV) transmission within the United States and around the globe. Despite this progress, preventable perinatal HIV transmission continues to occur. Adherence to HIV screening and treatment recommendations preconception and during pregnancy can greatly reduce the risk of perinatal HIV transmission.

Internal State: Dynamic, Interconnected Communication Loops Distributed Across Body, Brain, and Time.

Internal state profoundly alters perception and behavior. For example, a starved fly may approach and consume foods that it would otherwise find undesirable. A socially engaged newt may remain engaged in the presence of a predator, whereas a solitary newt would otherwise attempt to escape.

Trends in infants born at low birthweight and disparities by maternal race and education from 2003 to 2018 in the United States.

Background: Understanding current levels, as well as past and future trends, of the percentage of infants born at low birthweight (LBW) in the United States is imperative to improving the health of our nation. The purpose of this study, therefore, was to examine recent trends in percentage of LBW, both overall and by maternal race and education subgroups. Studying disparities in percentage of LBW by these subgroups can help to further understand the health needs of the population and can inform policies that can close race and class disparities in poor birth outcomes.

Preterm birth among pregnant women living in areas with high social vulnerability.

Background: Communities and individuals widely vary in their resources and ability to respond to external stressors and insults. To identify vulnerable communities, the Centers for Disease Control and Prevention developed the Social Vulnerability Index, an integrated tool to assess community resources and preparedness; it is based on 15 factors and includes individual scores in the following 4 themes: socioeconomic status (theme 1), household composition and disability (theme 2), minority status and language (theme 3), and housing type and transportation (theme 4) and an overall composite score. Several Social Vulnerability Index components have been independently associated with an increased risk of preterm birth.