Evaluation of urological and gynecological surgeons as force multipliers for mass casualty trauma care.

Background: The clinical demands of mass casualty events strain even the most well-equipped trauma centers and are especially challenging in resource-limited rural, remote, or austere environments. Gynecologists and urologists care for patients with pelvic and abdominal injuries, but the extent to which they are able to serve as "force multipliers" for trauma care is unclear. This study examined the abilities of urologists and gynecologists to perform 32 trauma procedures after mentored training by expert trauma educators to inform the potential for these specialists to independently care for trauma patients.

Putting the ready in readiness: A post hoc analysis of surgeon performance during a military mass casualty situation in Afghanistan.

Background: All military surgeons must maintain trauma capabilities for expeditionary care contexts, yet most are not trauma specialists. Maintaining clinical readiness for trauma and mass casualty care is a significant challenge for military and civilian surgeons. We examined the effect of a prescribed clinical readiness program for expeditionary trauma care on the surgical performance of 12 surgeons during a 60-patient mass-casualty situation (MASCAL).

Committee on Surgical Combat Casualty Care position statement: Neurosurgical capability for the optimal management of traumatic brain injury during deployed operations.

Background: Experiences over the last three decades of war have demonstrated a high incidence of traumatic brain injury (TBI) resulting in a persistent need for a neurosurgical capability within the deployed theater of operations. Despite this, no doctrinal requirement for a deployed neurosurgical capability exists. Through an iterative process, the Joint Trauma System Committee on Surgical Combat Casualty Care (CoSCCC) developed a position statement to inform medical and nonmedical military leaders about the risks of the lack of a specialized neurosurgical capability.

Five Influential Factors for Clinical Team Performance in Urgent, Emergency Care Contexts.

Introduction: In deployed contexts, military medical care is provided through the coordinated efforts of multiple interdisciplinary teams that work across and between a continuum of widely distributed role theaters. The forms these teams take, and functional demands, vary by roles of care, location, and mission requirements. Understanding the requirements for optimal performance of these teams to provide emergency, urgent, and trauma care for multiple patients simultaneously is critical.

Dunning-Kruger Effect Between Self-Peer Ratings of Surgical Performance During a MASCAL Event and Pre-Event Assessed Trauma Procedural Capabilities.

Objectives: The research question asked to what extent do self-rated performance scores of individual surgeons correspond to assessed procedural performance abilities and to peer ratings of procedural performance during a mass casualty (MASCAL) event?

Background: Self-assessment using performance rating scales is ubiquitous in surgical education as a proxy for direct measurement of competence. The validity and reliability of self-ratings as competency measures are susceptible to cognitive biases such as Dunning-Kruger effects, which describe how individuals over/underestimate their own performance compared to assessments from independent sources. The ability of surgeons to accurately self-assess their procedural performance remains undetermined.

Data-driven readiness: A preliminary report on cataloging best practices in military civilian partnerships.

Background: Between conflicts, many of the combat casualty care lessons learned are lost as the nation shifts priorities and providers leave the military. Solutions are needed to bridge the knowledge gap created by interwar periods. One of the foremost solutions is partnerships between civilian trauma centers and the military health system.

Upper-Extremity Vascular Exposures for Trauma: Comparative Performance Outcomes for General Surgeons and Orthopedic Surgeons.

Introduction: As combat-related trauma decreases, there remains an increasing need to maintain the ability to care for trauma victims from other casualty events around the world (e.g., terrorism, natural disasters, and infrastructure failures).

Damage Control Resuscitation: A Narrative Review of Goals, Techniques, and Components.

Damage control resuscitation (DCR) simultaneously tackles hemorrhage control and balanced resuscitation in complex multisystem trauma patients. This technique can improve patient outcomes. This review outlines the importance of DCR with hemorrhage control and administration of fresh whole blood or component therapy if not available and avoiding crystalloid administration.

Extreme ultraviolet photon conversion efficiency of tetraphenyl butadiene.

Extreme ultraviolet (EUV) radiation can be converted to visible light using tetraphenyl butadiene (TPB) as a phosphor. 1 µm films of TPB were prepared using thermal vapor deposition of the pure material and by spin coating suspensions of TPB in high-molecular-weight polystyrene/toluene solutions. Calibrated sources and detectors were used to determine the effective photon conversion efficiency of the films for incident EUV radiation in the wavelength range of $125\;{\rm nm}\le\lambda\le 200\;{\rm nm}$125nm≤λ≤200nm.

Maintaining Surgical Readiness While Deployed to Low-Volume Military Treatment Facilities: A Pilot Program for Clinical and Operational Sustainment Training in the Deployed Environment.

Introduction: Maintaining readiness among Army surgeons is increasingly challenging because of declining operative experience during certain deployments. Novel solutions should be considered.

Materials And Methods: A pilot program was conducted to rotate surgical teams from a military treatment facility with a low volume of combat casualty care to one with a higher volume.

Recurrent bacteremia: A 10-year retrospective study in combat-related burn casualties.

Introduction: Surviving the first episode of bacteremia predisposes burn casualties to its recurrence. Herein, we investigate the incidence, mortality, bacteriology, and source of infection of recurrent bacteremia in military burn casualties admitted to the U.S.

Burn Casualty Care in the Deployed Setting.

Management of wartime burn casualties can be very challenging. Burns frequently occur in the setting of other blunt and penetrating injuries. This clinical practice guideline provides a manual for burn injury assessment, resuscitation, wound care, and specific scenarios including chemical and electrical injuries in the deployed or austere setting.

Electric generation and ratcheted transport of contact-charged drops.

We describe a simple microfluidic system that enables the steady generation and efficient transport of aqueous drops using only a constant voltage input. Drop generation is achieved through an electrohydrodynamic dripping mechanism by which conductive drops grow and detach from a grounded nozzle in response to an electric field. The now-charged drops are transported down a ratcheted channel by contact charge electrophoresis powered by the same voltage input used for drop generation.

The American Association for the Surgery of Trauma Severity Grade is valid and generalizable in adhesive small bowel obstruction.

Background: The American Association for the Surgery of Trauma (AAST) anatomic severity grading system for adhesive small bowel obstruction (ASBO) was validated at a single institution. We aimed to externally validate the AAST ASBO grading system using the Eastern Association for the Surgery of Trauma multi-institutional small bowel obstruction prospective observational study.

Methods: Adults (age ≥ 18) with (ASBO) were included.

Burns to the genitalia, perineum, and buttocks increase the risk of death among U.S. service members sustaining combat-related burns in Iraq and Afghanistan.

Purpose: Among service members injured in Iraq and Afghanistan, to determine the risk of mortality associated with combat-related burns to the genitalia, perineum, and buttocks.

Materials And Methods: The prospectively maintained burn registry from the United States Army Institute of Surgical Research was retrospectively reviewed to identify all service members with combat-related burns sustained in Iraq and Afghanistan from March 2003 to October 2013. The two primary risk factors of interest were (1) any burn to the genitals, perineum, and/or buttocks (PB) and (2) burns involving the entire perineal, genital, and buttock region (complete PB).

Multi-institutional, prospective, observational study comparing the Gastrografin challenge versus standard treatment in adhesive small bowel obstruction.

Introduction: Existing trials studying the use of Gastrografin for management of adhesive small bowel obstruction (SBO) are limited by methodological flaws and small sample sizes. We compared institutional protocols with and without Gastrografin (GG), hypothesizing that a SBO management protocol utilizing GG is associated with lesser rates of exploration, shorter length of stay, and fewer complications.

Methods: A multi-institutional, prospective, observational study was performed on patients appropriate for GG with adhesive SBO.

Burn Shock and Resuscitation: Proceedings of a Symposium Conducted at the Meeting of the American Burn Association, Chicago, IL, 21 April 2015.

The Special Interest Groups of the American Burn Association provide a forum for interested members of the multidisciplinary burn team to congregate and discuss matters of mutual interest. At the 47th Annual Meeting of the American Burn Association in Chicago, IL, the Fluid Resuscitation Special Interest Group sponsored a special symposium on burn resuscitation. The purpose of the symposium was to review the history, current status, and future direction of fluid resuscitation of patients with burn shock.

Mechanical Response of Thermally Annealed Nafion Thin Films.

Perfluorinated ionomers, in particular, Nafion, are a critical component in hydrogen fuel cells as the ion conducting binder within the catalyst layer in which it can be confined to thicknesses on the order of 10 nm or less. It is well reported that many physical properties, such as the Young's modulus, are thickness dependent when the film thickness is less than 100 nm. Here we utilize a cantilever bending methodology to quantify the swelling-induced stresses and relevant mechanical properties of Nafion films as a function of film thickness exposed to cyclic humidity.

Care of the Burn Casualty in the Prolonged Field Care Environment.

Burns are frequently encountered on the modern battlefield, with 5% - 20% of combat casualties expected to sustain some burn injury. Addressing immediate life-threatening conditions in accordance with the MARCH protocol (massive hemorrhage, airway, respirations, circulation, hypothermia/head injury) remains the top priority for burn casualties. Stopping the burning process, total burn surface area (TBSA) calculation, fluid resuscitation, covering the wounds, and hypothermia management are the next steps.

Antifungal wound penetration of amphotericin and voriconazole in combat-related injuries: case report.

Background: Survivors of combat trauma can have long and challenging recoveries, which may be complicated by infection. Invasive fungal infections are a rare but serious complication with limited treatment options. Currently, aggressive surgical debridement is the standard of care, with antifungal agents used adjunctively with uncertain efficacy.

Oxalate Nephropathy After Continuous Infusion of High-Dose Vitamin C as an Adjunct to Burn Resuscitation.

Fluid resuscitation is the foundation of management in burn patients and is the topic of considerable research. One adjunct in burn resuscitation is continuous, high-dose vitamin C (ascorbic acid) infusion, which may reduce fluid requirements and thus decrease the risk for over resuscitation. Research in preclinical studies and clinical trials has shown continuous infusions of high-dose vitamin C to be beneficial with decrease in resuscitative volumes and limited adverse effects.

Increased Education is Associated with Decreased Compliance in an Urban Multi-Ethnic Lupus Cohort.

Objectives: To investigate the factors associated with medication compliance in a multi-ethnic population of patients with systemic lupus erythematosus in an urban community.

Methods: We surveyed patients in our cohort using the standardized measures of the Compliance-Questionnaire-Rheumatology (CQR), the Beliefs about Medications Questionnaire (BMQ), as well as patient self-reported compliance. Demographic and clinical characteristics of compliant and non-compliant patients underwent bivariate analysis.

FitKids360: design, conduct, and outcomes of a stage 2 pediatric obesity program.

This paper describes FitKids360, a stage 2 pediatric weight management program. FitKids360 is a physician-referred, multicomponent, low-cost healthy lifestyle program for overweight and obese youth 5-16 years of age and their families. FitKids360 provides an evidence-based approach to the treatment of pediatric overweight by targeting patients' physical activity, screen time, and dietary behaviors using a family-centered approach.