Objective Response of Saliva Biomarkers After High-Stress and Mass Casualty Scenarios: A Pilot Study.

Introduction: Surgeons and military personnel are subjected to high-stress scenarios, which leads to greater rates of burnout. There is room to optimize performance and longevity in these careers by better understanding the body's stress response and applying it to stress management training. This study aims to understand the physiological response in those engaged in trauma scenarios by examining 6 hormones and 42 cytokines during the Intensive Surgical and Trauma Skills Course held at Strategic Operations Inc in San Diego, CA.

Using Full Dive Virtual Reality to Operationalize Warfighter Resilience: From Proof of Concept and Usability of Hardware and Software to Upcoming Integrated Psychological Skills Training.

Introduction: Modern warfare operations are volatile, highly complex environments, placing immense physiological, psychological, and cognitive demands on the warfighter. To maximize cognitive performance and warfighter resilience and readiness, training must address psychological stress to enhance performance. Resilience in the face of adversity is fundamentally rooted in an individual's psychophysiological stress response and optimized through decreased susceptibility to the negative impact of trauma exposure.

A distinct immune cytokine profile is associated with morning cortisol and repeated stress.

Objective: The objective of this study was to investigate possible immune cytokine trends throughout a week-long surgical simulation mass-casualty training session in order to determine the effects of stress inoculation on the immune system.

Methods: Thirty-seven military medical students participated in a hyper-realistic surgical simulation training event conducted at Strategic Operations site in San Diego, California. Salivary samples were collected every morning of the stress training exercise for 4 consecutive days.

Exploring the relationship of supernumerary recurrent renal calculi formation and tick-borne infections: a case report.

A 51-year-old male with a history of Cacchi-Ricci disease and long-standing infection with various species of presented with recurrent symptoms of right-sided flank pain. Numerous renal calculi were identified on imaging. The etiology of the calculi had not been previously elucidated.

A Pictorial Essay Describing the CT Imaging Features of COVID-19 Cases throughout the Pandemic with a Special Focus on Lung Manifestations and Extrapulmonary Vascular Abdominal Complications.

With the Omicron wave, SARS-CoV-2 infections improved, with less lung involvement and few cases of severe manifestations. In this pictorial review, there is a summary of the pathogenesis with particular focus on the interaction of the immune system and gut and lung axis in both pulmonary and extrapulmonary manifestations of COVID-19 and the computed tomography (CT) imaging features of COVID-19 pneumonia from the beginning of the pandemic, describing the typical features of COVID-19 pneumonia following the Delta variant and the atypical features appearing during the Omicron wave. There is also an outline of the typical features of COVID-19 pneumonia in cases of breakthrough infection, including secondary lung complications such as acute respiratory distress disease (ARDS), pneumomediastinum, pneumothorax, and lung pulmonary thromboembolism, which were more frequent during the first waves of the pandemic.

Galcanezumab treatment changes visual related EEG connectivity patterns in migraine patients.

Background: Monoclonal antibodies against calcitonin gene-related peptides (CGRP) are innovative therapies for migraine treatment. Although they are clinically effective, how anti-CGRP treatment reduces migraine attacks still remains unclear.

Objective: In this observational case-control study, we aimed to apply graph theory to EEG data from 20 migraine patients and 10 controls to investigate the effects of 3 months of galcanezumab on brain connectivity.

Cytokine fluctuation during acute stress is correlated to life trauma.

Background: Multiple studies have demonstrated that human neurobiology and behavior are inextricably linked to the activity of our immune systems. Trauma is associated with a multitude of immune system changes; reflecting this, posttraumatic stress disorder (PTSD) is often comorbid with immune-related conditions such as autoimmune disorders. To further investigate this phenomenon, we tested our hypothesis that cytokine fluctuations during and after an acute stress response correlates with experienced life trauma.

Clinical Correlates of Osmophobia in Primary Headaches: An Observational Study in Child Cohorts.

Primary headaches, especially migraines, have a significant impact on physical and mental health, as well as on the scholarly performance and quality of life of children and adolescents. Osmophobia could be a potential diagnostic marker of migraine diagnosis and disability. This multicenter observational cross-sectional study included 645 children, aged 8-15, with a diagnosis of primary headaches.

Spontaneous resolution of gallstone ileus followed by imaging: A case report and a literature review.

Gallstone ileus (GI) is a rare cause of acute abdomen in an emergency setting and a rare complication of cholelithiasis in the elderly, with a female prevalence. Radiologists play a key role in the diagnosis and management of this condition and, with a multimodal approach, diagnostic accuracy usually increases. Spontaneous resolution of GI has previously been reported for stones smaller than 2 cm.

A Mixed Methods Investigation on the Relationship Between Perceived Self-Regard, Self-Efficacy, and Commitment to Serve Among Military Medical Students.

Introduction: Routinely faced with potentially traumatizing situations, resilience is critical for military physicians. However, related studies are limited in scope. The current study distinctively combines hyper-realistic immersion training for military medical students with emotional intelligence and hardiness measures.

Principal component analysis of salivary cytokines and hormones in the acute stress response.

The acute stress response is characterized by activation of multiple interconnected systems in the body, resulting in the release of a flood of hormones and immune mediators into circulation. In addition to detection of these molecules in the serum, saliva can serve as a source of these markers as well and can be collected in a non-invasive way. The complete profile of salivary biomarkers associated with the hypothalamic pituitary adrenal/gonadal axes and the immune system during the acute stress response has not been fully elucidated.

Website Usability Analysis of U.S. Military Residency Programs.

Introduction: The Military Match is the residency matching system for medical students attending the Uniformed Services University of Health Sciences, and the students were funded by the Health Professions Scholarship Program through the U.S. Army, Air Force, and Navy.

Robotically applied hemostatic clamping for care-under-fire: harnessing bomb robots for hemorrhage control.

Background: Early hemorrhage control after interpersonal violence is the most urgent requirement to preserve life and is now recognized as a responsibility of law enforcement. Although earlier entry of first responders is advocated, many shooting scenes remain unsafe for humans, necessitating first responses conducted by robots. Thus, robotic hemorrhage control warrants study as a care-under-fire treatment option.

Point-of-Care Ultrasound Use by EMS Providers in Out-of-Hospital Cardiac Arrest.

Aim: Paramedics received training in point-of-care ultrasound (POCUS) to assess for cardiac contractility during management of medical out-of-hospital cardiac arrest (OHCA). The primary outcome was the percentage of adequate POCUS video acquisition and accurate video interpretation during OHCA resuscitations. Secondary outcomes included POCUS impact on patient management and resuscitation protocol adherence.

Delayed care in myocardial infarction and ischemic stroke patients during the COVID-19 pandemic.

Unlabelled: COVID-19 has profound direct health consequences, however secondary effects were much broader as rates of hospital visits steeply declined for non-COVID-19 concerns, including myocardial infarction (MI) and stroke, with patients choosing to wait longer before symptoms convince them to seek medical attention. Thus, patients where ischemia leads to tissue loss should be a major concern.

Methods: The months of March to June 2019 and 2020 were compared to each other at 4 Denver area hospitals.

Osmophobia in primary headache patients: associated symptoms and response to preventive treatments.

Background: Osmophobia, is common among primary headaches, with prevalence of migraine. The study aimed to evaluate prevalence and clinical characteristics of patients with osmophobia in a cohort of primary headache patients selected at a tertiary headache center. The second aim was to verify the possible predicting role of osmophobia in preventive treatment response in a sub cohort of migraine patients.

Emotional intelligence, cortisol and α-amylase response to highly stressful hyper-realistic surgical simulation of a mass casualty event scenario.

Lifetime exposure to stress leads to risk of suffering from cumulative detrimental physiological and psychological ailments. Due to the nature of healthcare and exposure to trauma, medical professionals are particularly susceptible to the negative impacts of high stress environments. emotional intelligence plays a role in ameliorating the risk of being negatively impacted by these stressors.

The next nine minutes: Lessons learned from the large-scale active shooter training prior to the STEM school shooting.

Objective: As the incidence of active shooters increase, local emergency response has also changed. South Metro Fire Rescue coordinated a series of hyper-realistic active shooter simulation drills involving multiple agencies.

Methods: "The Next Nine Minutes" was one of the largest active shooter drills performed to date with 904 personnel that were trained in 18 mass casualty active shooter drills.

Medical Students Immersed in a Hyper-Realistic Surgical Training Environment Leads to Improved Measures of Emotional Resiliency by Both Hardiness and Emotional Intelligence Evaluation.

Background: Burnout is being experienced by medical students, residents, and practicing physicians at significant rates. Higher levels of Hardiness and Emotional Intelligence may protect individuals against burnout symptoms. Previous studies have shown both Hardiness and Emotional IntelIigence protect against detrimental effects of stress and can be adapted through training; however, there is limited research on how training programs affect both simultaneously.

Strategies to improve communication in telementoring in acute care coordination: a scoping review.

Background: Telementoring facilitates the coordination of advanced medical care in rural, remote or austere environments. Because the interpersonal element of telementoring has been relatively underexplored, we conducted a scoping review to identify strategies to improve communication in telementoring.

Methods: Two independent reviewers searched all English-language articles in MEDLINE and Scopus from 1964 to 2017, as well as reference lists of relevant articles to identify articles addressing telementored interactions between health care providers.

An Expanded Surface-Enhanced Raman Scattering Tags Library by Combinatorial Encapsulation of Reporter Molecules in Metal Nanoshells.

Raman-encoded gold nanoparticles (NPs) have been widely employed as photostable multifunctional probes for sensing, bioimaging, multiplex diagnostics, and surface-enhanced Raman scattering (SERS)-guided tumor therapy. We report a strategy toward obtaining a particularly large library of Au nanocapsules encoded with Raman codes defined by the combination of different thiol-free Raman reporters, encapsulated at defined molar ratios. The fabrication of SERS tags with tailored size and predefined codes is based on the incorporation of Raman reporter molecules inside Au nanocapsules during their formation galvanic replacement coupled to seeded growth on Ag NPs.

The Effect of Hyper-Realistic Trauma Training on Emotional Intelligence in Second Year Military Medical Students.

Intro: This project expanded upon previous exploration of emotional intelligence during the habituation for military second year medical students undergoing high-stress simulation with trauma and surgical skill training. The objective was to interpret emotional intelligence data before and after hyper-realistic immersion trauma training and to include a larger sample size than previously investigated.

Methods: Fifty increasingly intense mass casualty scenarios with simulated Emergency Department (ED) and Operating Room (OR) procedures were performed while students lived as if deployed in an Afghan village.