Association Between Finger Plethysmographic Features and Impedance-Based Thoracic Fluid Content Measurement in a Lower Body Negative Pressure Model of Hemorrhagic Shock.

Introduction: Timely identification of the need for lifesaving intervention in battlefield conditions may be improved through automated monitoring of the injured warfighter. Technologies that combine maximal noninvasive insight with minimal equipment footprint give the greatest opportunity for deployment at scale with inexperienced providers in forward areas. Finger photoplethysmography (PPG) signatures are associated with impending hemorrhagic shock but may be insufficient alone.

Autonomous precision resuscitation during ground and air transport of an animal hemorrhagic shock model.

We tested the ability of a physiologically driven minimally invasive closed-loop algorithm, called Resuscitation based on Functional Hemodynamic Monitoring (ReFit), to stabilize for up to 3 h a porcine model of noncompressible hemorrhage induced by severe liver injury and do so during both ground and air transport. Twelve animals were resuscitated using ReFit to drive fluid and vasopressor infusion to a mean arterial pressure (MAP) > 60 mmHg and heart rate < 110 min 30 min after MAP < 40 mmHg following liver injury. ReFit was initially validated in 8 animals in the laboratory, then in 4 animals during air (23nm and 35nm) and ground (9 mi) to air (9.

Adopting and expanding ethical principles for generative artificial intelligence from military to healthcare.

In 2020, the U.S. Department of Defense officially disclosed a set of ethical principles to guide the use of Artificial Intelligence (AI) technologies on future battlefields.

Rectal administration of tacrolimus protects against post-ERCP pancreatitis in mice.

Objective: There is an unmet clinical need for effective, targeted interventions to prevent post-ERCP pancreatitis (PEP). We previously demonstrated that the serine-threonine phosphatase, calcineurin (Cn) is a critical mediator of PEP and that the FDA-approved calcineurin inhibitors, tacrolimus (Tac) or cyclosporine A, prevented PEP. Our recent observations in preclinical PEP models demonstrating that Cn deletion in both pancreatic and hematopoietic compartments is required for maximal pancreas protection, highlighted the need to target both systemic and pancreas-specific Cn signaling.

Preclinical safety evaluation of calcineurin inhibitors delivered through an intraductal route to prevent post-ERCP pancreatitis demonstrates endocrine and systemic safety.

Objective: There is an urgent need for safe and targeted interventions to mitigate post-ERCP pancreatitis (PEP). Calcineurin inhibitors (CnIs) offer therapeutic promise as calcineurin signaling within acinar cells is a key initiating event in PEP. In previous proof-of-concept studies using experimental models, we showed that concurrent intra-pancreatic ductal administration of the CnIs, tacrolimus (Tac) or cyclosporine A (CsA) with the ERCP radiocontrast agent (RC) prevented PEP.

Telehealth in the Military Health System: Impact, Obstacles, and Opportunities.

Background: The U.S. Military Health System (MHS) pioneered the use of telehealth in deployed environments in the early 1990s.

Artificial Intelligence in Health: Enhancing a Return to Patient-Centered Communication.

The medical environment is on the verge of a dramatic transformation as artificial intelligence (AI) evolves. With the inevitable shift toward AI in health care delivery, there are concerns around its implementation, including ethics, privacy, data representation, and the potential for eliminating physicians. However, AI cannot replicate a physician's knowledge and understanding of the patient as a person and the conditions in which he or she lives.

Development and Validation of Telemedicine for Disaster Response: The North Atlantic Treaty Organization Multinational System.

Background: Disasters, whether natural or manmade, are unpredictable. While there may be some forewarning as in natural disasters like a hurricane, response is often suboptimal. There is a need for an integrated and structured action for all three well defined phases of disaster management (pre-, during, and postdisaster) that must be addressed to ameliorate the impact on life and the necessary steps for recovery.

Assessment of patient engagement with a mobile application among service members in transition.

Objective: This article examines engagement with a mobile application ("mCare") for wounded Service Members rehabilitating in their communities. Many had behavioral health problems, Traumatic Brain Injury (TBI), and/or post-traumatic stress disorder (PTS). The article also examines associations between Service Members' background characteristics and their engagement with mCare.

The empirical foundations of telemedicine interventions for chronic disease management.

The telemedicine intervention in chronic disease management promises to involve patients in their own care, provides continuous monitoring by their healthcare providers, identifies early symptoms, and responds promptly to exacerbations in their illnesses. This review set out to establish the evidence from the available literature on the impact of telemedicine for the management of three chronic diseases: congestive heart failure, stroke, and chronic obstructive pulmonary disease. By design, the review focuses on a limited set of representative chronic diseases because of their current and increasing importance relative to their prevalence, associated morbidity, mortality, and cost.

mCare: using secure mobile technology to support soldier reintegration and rehabilitation.

Background: The U.S. Army Medical Department conducted a pilot mobile health project to determine the requirements for coordination of care for "Wounded Warriors" using mobile messaging.

The U.S. Army Telemedicine and m-Health Program: making a difference at home and abroad.

This article highlights the deployment of telemedicine by the U.S. Army through the various echelons of care and in overseas locations, including range and scope of health services provided by telemedicine in a challenging environment.

Challenges, solutions, and best practices in telemental health service delivery across the pacific rim-a summary.

The Telemedicine and Advanced Technology Research Center, U.S. Army Medical Research and Materiel Command, in conjunction with the American Telemedicine Association's Annual Mid-Year Meeting, conducted a 1-day workshop on how maturing and emerging processes and applications in the field of telemental health (TMH) can be expanded to enhance access to behavioral health services in the Pacific Rim.

Mobile health evaluation methods: the Text4baby case study.

Mobile phones have been shown effective in several public health domains. However, there are few evaluations of the effectiveness of mobile health in health promotion. Also, although many studies have referenced behavioral theory, none appears to have explicitly tested theoretical assumptions or demonstrated mechanisms of change.

A standard telemental health evaluation model: the time is now.

The telehealth field has advanced historic promises to improve access, cost, and quality of care. However, the extent to which it is delivering on its promises is unclear as the scientific evidence needed to justify success is still emerging. Many have identified the need to advance the scientific knowledge base to better quantify success.

Cell phones in telehealth and otolaryngology.

The worldwide prevalence of mobile phones makes them a powerful platform for providing individualized health care delivered at the patient's convenience. They have the potential to extend the health care interaction from a brief office visit to a continuous monitoring via body sensors of either a specific healthcare parameter or with multiple sensors in wireless body area networks. Remote data collection by way of mobile phones in underserved areas allows for better management of public health and provides the opportunity for timely intervention.

Defining core issues in utilizing information technology to improve access: evaluation and research agenda.

The Department of Veterans Affairs (VA) has been at the vanguard of information technology (IT) and use of comprehensive electronic health records. Despite the widespread use of health IT in the VA, there are still a variety of key questions that need to be answered in order to maximize the utility of IT to improve patient access to quality services. This paper summarizes the potential of IT to enhance healthcare access, key gaps in current evidence linking IT and access, and methodologic challenges for related research.

Application of health technology in humanitarian response: U.S. Military deployed health technology summit--a summary.

Disasters are unpredictable, occurring without notice. They have a devastating effect and forever change the people they affect. We have witnessed the devastation from several significant events in 2010 and 2011, including the horrendous earthquakes in Haiti, Chili, New Zealand, and Japan.

The United States Army Ocular Teleconsultation program 2004 through 2009.

Purpose: To describe the United States Army Ocular Teleconsultation program and all consultations received from its inception in July 2004 through December 2009.

Design: Retrospective, noncomparative, consecutive case series.

Methods: All 301 consecutive ocular teleconsultations received were reviewed.

Innovative new technologies to identify and treat traumatic brain injuries: crossover technologies and approaches between military and civilian applications.

Traumatic brain injury (TBI) has become the signature injury of Operation Iraqi Freedom and Operation Enduring Freedom. The use of improvised explosive devices has seen an exponential increase in both Iraq and Afghanistan. In previous conflicts prior to Iraq, survivability of such an injury was far less.

Use of mobile phones as a tool for United States health diplomacy abroad.

Rapidly emerging mobile communications platforms, such as mobile phones, in countries across Africa, Iraq, and Afghanistan offer new opportunities for direct public engagement in health systems, placing tools and timely information into the hands of those who need it most. Early results from pioneering work suggest real benefits of mobile devices in addressing access to care, monitoring and treating diseases, and providing continuous medical education and training. The Military Health System, a $43-billion global healthcare system within the U.

Developing next-generation telehealth tools and technologies: patients, systems, and data perspectives.

The major goals of telemedicine today are to develop next-generation telehealth tools and technologies to enhance healthcare delivery to medically underserved populations using telecommunication technology, to increase access to medical specialty services while decreasing healthcare costs, and to provide training of healthcare providers, clinical trainees, and students in health-related fields. Key drivers for these tools and technologies are the need and interest to collaborate among telehealth stakeholders, including patients, patient communities, research funders, researchers, healthcare services providers, professional societies, industry, healthcare management/economists, and healthcare policy makers. In the development, marketing, adoption, and implementation of these tools and technologies, communication, training, cultural sensitivity, and end-user customization are critical pieces to the process.