Supervening Abscess Resulting in Streptococcus pyogenes Toxic Shock Syndrome Complicated by a Recent MRSA Infection in an Active Duty Military Member.

An 18-year-old male active duty US Army service member presented to the emergency department with a lower leg abscess in the region of a previously debrided methicillin-resistant Staphylococcus aureus abscess. After initial presentation, the patient became hypotensive, exhibited signs of renal failure, and developed a diffuse erythematous rash. Streptococcus pyogenes was grown from intraoperative cultures, and he was diagnosed with Streptococcal toxic shock syndrome (STSS).

The last days: The medical response of United States and allied military teams during the Afghanistan Exodus.

Objectives: The objective of this study is to describe the United States and allied military medical response during the withdrawal from Afghanistan.

Background: The military withdrawal from Afghanistan concluded with severe hostilities resulting in numerous civilian and military casualties. The clinical care provided by coalition forces capitalized on decades of lessons learned and enabled unprecedented accomplishments.

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.

Augmented Reality Forward Damage Control Procedures for Nonsurgeons: A Feasibility Demonstration.

Introduction: This article presents an emerging capability to project damage control procedures far forward for situations where evacuation to a formal surgical team is delayed. Specifically, we demonstrate the plausibility of using a wearable augmented reality (AR) telestration device to guide a nonsurgeon through a damage control procedure.

Methods: A stand-alone, low-profile, commercial-off-the-shelf wearable AR display was utilized by a remotely located surgeon to synchronously guide a nonsurgeon through proximal control of the distal external iliac artery on a surgical manikin.

Sliding Hip Screw for Fixation of Fracture Through a Previously Arthrodesed Hip.

Hip arthrodesis is a treatment option for painful chronic hip conditions. Hip fractures through a previously arthrodesed hip are relatively uncommon as indications for hip arthrodesis are rare. The following case reports on the use of a sliding hip screw and a pelvic reconstruction plate to address arthrodesed hip fracture in an 81-year-old man.

Patella Fracture in US Servicemember in an Austere Location.

Review the management of a patient with acute patella fracture supported by telemedical consultation. Clinical Context: Regionally Aligned Forces (RAF) supporting US Army Africa/Southern European Task Force (USARAF/ SETAF) in Africa Command area of responsibility. Care was provided by a Role I facility on the compound.

Health trends in the wake of the financial crisis-increasing inequalities?

Aim: The financial crisis that hit Europe in 2007-2008 and the corresponding austerity policies have generated concern about increasing health inequalities, although impacts have been less salient than initially expected. One explanation could be that health inequalities emerged first a few years into the crisis. This study investigates health trends in the wake of the financial crisis and analyses health inequalities across a number of relevant population subgroups, including those defined by employment status, age, family type, gender, and educational attainment.

Epidural Neostigmine versus Fentanyl to Decrease Bupivacaine Use in Patient-controlled Epidural Analgesia during Labor: A Randomized, Double-blind, Controlled Study.

Background: The addition of opioids to epidural local anesthetic reduces local anesthetic consumption by 20% but at the expense of side effects and time spent for regulatory compliance paperwork. Epidural neostigmine also reduces local anesthetic use. The authors hypothesized that epidural bupivacaine with neostigmine would decrease total hourly bupivacaine use compared with epidural bupivacaine with fentanyl for patient-controlled epidural analgesia.

Infection of rhesus macaques with a pool of simian immunodeficiency virus with the envelope genes from acute HIV-1 infections.

Background: New simian-human immunodeficiency chimeric viruses with an HIV-1 env (SHIVenv) are critical for studies on HIV pathogenesis, vaccine development, and microbicide testing. Macaques are typically exposed to single CCR5-using SHIVenv which in most instances does not reflect the conditions during acute/early HIV infection (AHI) in humans. Instead of individual and serial testing new SHIV constructs, a pool of SHIVenv_B derived from 16 acute HIV-1 infections were constructed using a novel yeast-based SHIV cloning approach and then used to infect macaques.

Infection After Orthopaedic Trauma: Prevention and Treatment.

Trauma to the extremities is disproportionately represented in casualties of recent conflicts, accounting for >50% of injuries sustained during operations in Iraq and Afghanistan. Infectious complications have been reported in >25% of those evacuated for trauma, and 50% of such patients were treated in the intensive care unit (ICU). Osteomyelitis has been reported in 9% (14% of intensive care unit patients), and deep-wound infection in 27% of type III open-tibia fractures.

Decomposing the effect of social policies on population health and inequalities: an empirical example of unemployment benefits.

Aim: The purpose of this study is to discuss and empirically contrast different conceptualizations and operationalizations of social policies in analysing health and educational differences in health cross-nationally.

Methods: Country-level institutional and expenditure data on unemployment benefit schemes and individual-level data from the EU-SILC for 23 countries were used to analyse the association between unemployment benefits and self-assessed health for individuals with different educational attainment.

Results: The analyses indicate that higher coverage rate (i.

Salsalate, an old, inexpensive drug with potential new indications: a review of the evidence from 3 recent studies.

Background: Diabetes is a well-known growing epidemic, but prediabetes is increasing at an even greater rate. Lifestyle changes are effective tools to prevent the progression of prediabetes to diabetes, yet many people are unable to follow such changes. Salsalate has been suggested as a possible treatment for diabetes as early as 1876 and as recently as in a 2013 study.

Association between cervical and thoracic somatic dysfunction among second-year osteopathic medical students.

Context: The ubiquitous nature of cervical and thoracic somatic dysfunction requires osteopathic physicians to have a strong working knowledge of regional spinal mechanics and their functional and dysfunctional interrelationships.

Objective: To determine whether cervical and thoracic somatic dysfunction occur concomitantly, particularly somatic dysfunction of the occipitoatlantal (OA) and upper thoracic (T1-T4) region of the spine.

Methods: A retrospective analysis of cervical and thoracic somatic dysfunction prevalence diagnosed by faculty in second-year osteopathic medical students was conducted.

Welfare states and population health: the role of minimum income benefits for mortality.

The causes of cross-national differences in population health are subject for intense discussion, often focusing on the role of structural economic factors. Although population health is widely believed to reflect the living conditions in society, surprisingly few comparative studies systematically assess policy impacts of anti-poverty programs. In this paper we estimate the influence of minimum income benefits on mortality using international data on benefit levels in 18 countries 1990-2009.

Unemployment insurance and deteriorating self-rated health in 23 European countries.

Background: The global financial crisis of 2008 is likely to have repercussions on public health in Europe, not least through escalating mass unemployment, fiscal austerity measures and inadequate social protection systems. The purpose of this study is to analyse the role of unemployment insurance for deteriorating self-rated health in the working age population at the onset of the fiscal crisis in Europe.

Methods: Multilevel logistic conditional change models linking institutional-level data on coverage and income replacement in unemployment insurance to individual-level panel data on self-rated health in 23 European countries at two repeated occasions, 2006 and 2009.

Pelvic trauma: What are the predictors of mortality and cardiac, venous thrombo-embolic and infectious complications following injury?

Introduction: This study sought to determine risk factors that influence mortality, cardiac events, venous thrombo-embolic disease (VTED), and infection following fractures of the pelvis and/or acetabulum.

Methods: The 2008 National Sample Program (NSP) of the National Trauma Databank was queried to identify all patients who sustained pelvic and acetabular fractures. Demographic data, injury-specific and surgical characteristics, and medical co-morbidities were abstracted.

Genomewide molecular and biologic characterization of biomembrane formation adjacent to a methacrylate spacer in the rat femoral segmental defect model.

Objectives: This study focuses upon the morphologic and molecular features of the layer of cells, termed the "biomembrane," which forms around methacrylate spacers in bone segmental defects. The objective of this research was to assess the biomembrane formed in a novel rodent femoral segmental defect model at 4, 8, and 16 weeks with histologic and molecular studies.

Methods: Following Institutional Animal Care and Use Committee approval, a segmental defect was created in the rat femur and stabilized with the AO LockingRatNail and analyzed at 4, 8, and 16 weeks postsurgery using digital radiologic imaging, morphological and immunohistochemical studies, and genomewide gene expression studies employing microarray analysis.

The nature and incidence of musculoskeletal combat wounds in Iraq and Afghanistan (2005-2009).

Objectives: This investigation sought to describe orthopaedic wounds sustained by service members deployed to Iraq or Afghanistan from 2005 to 2009.

Design: Retrospective review of prospective data.

Setting: : Joint Theater Trauma Registry (JTTR).

Metaphyseal and diaphyseal chondroblastomas.

Objective: Epiphyseal/apophyseal locations are important diagnostic radiological features of chondroblastomas (CB). Although the tumor may secondarily involve the metaphysis, reports of primary metaphyseal or diaphyseal CB without any epiphyseal or apophyseal involvement are exceptionally rare and frequently present as a diagnostic dilemma. The purpose of this study was to present seven cases of pure metaphyseal and/or diaphyseal CB along with a review of pertinent literature.

Enrichment of intersubtype HIV-1 recombinants in a dual infection system using HIV-1 strain-specific siRNAs.

Background: Intersubtype HIV-1 recombinants in the form of unique or stable circulating recombinants forms (CRFs) are responsible for over 20% of infections in the worldwide epidemic. Mechanisms controlling the generation, selection, and transmission of these intersubtype HIV-1 recombinants still require further investigation. All intersubtype HIV-1 recombinants are generated and evolve from initial dual infections, but are difficult to identify in the human population.

Blood pressure, but not cerebrospinal fluid fentanyl concentration, predicts duration of labor analgesia from spinal fentanyl.

Background: There is a wide variability in dilution of drugs in cerebrospinal fluid after spinal injection, as measured near the site of injection. With local anesthetics, there is a wide variability in speed of onset, which correlates with block duration. The authors tested whether local cerebrospinal fluid drug concentrations and onset time would predict duration of analgesia from spinal fentanyl in laboring women.

Success of spinal and epidural labor analgesia: comparison of loss of resistance technique using air versus saline in combined spinal-epidural labor analgesia technique.

Background: Comparison of air versus saline for loss of resistance technique (LORT) in combined spinal epidural labor analgesia (CSE) has not been evaluated, and neither has the relation between CSE characteristics (the presence/absence of initial spontaneous clear fluid return or upon aspiration) and spinal/epidural analgesia outcomes. The authors hypothesized that there is no difference in the spinal analgesia success or epidural catheter efficacy between using air versus saline LORT for CSE.

Methods: A total of 360 patients were randomized to air or saline LORT for CSE.