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PubMed1995

[Niger: nutritional recuperation and education in a sub-Saharan urban area].

Located in Niamey, capital of Niger, a Sub-Saharian country where the rate of acute malnutrition in children is estimated at 16.8 percent, the National Armed Forces Center for Nutritional Rehabilitation and Education has been expanding its activities since 1986. The center offers curative and educational services to the children of military personnel and the population in neighboring districts. These services are regularly scheduled two and a half or three hours each morning five days a week. In 1990 our center received 115 malnourished children detected either during consultations or infant weighing sessions. Twenty-seven presented moderate protein-caloric malnutrition and 28 serious malnutrition. Medium age at admission was 11 months 16 days and medium length of stay was 9.5 days. Long-term recovery was confirmed in 30.5% while 69.5% were lost from follow-up. Keeping a healthbook throughout the weight control period, enforcing coercive measures for military families, organizing a permanent campaign to maintain awareness of nutritional problems, prolonging opening hours to improve access to the center, and above all improving the level of women's education are necessary to improve these results. Primary prevention requires better family planning with a longer interval between births.

Child Nutrition Disorders↗
PubMed2003

The relationship between proinflammatory mediators and heat stress induced rhabdomyolysis in exercising marines.

The problem of heat stress continues to plague military combat units deployed worldwide. Heat stroke is the most severe form of heat illness and carries 10% mortality despite intervention. Proteolytic and pyrogenic pro-inflammatory mediators, such as IL-6, are released into peripheral circulation in heat illness. It is not known how these mediators affect the outcome of heat illness. Identifying relationships between release of proinflammatory mediators and extent of rhabdomyolysis may lead to an intervention to reduce severity of outcome. This article presents the most current knowledge regarding the physiologic and pathophysiologic manifestations of heat illness. Based on this current state of the science the article introduces a study that will be conducted to address military unique heat stress research.

Body Temperature Regulation↗
PubMed1998

Medical preparedness for a terrorist incident involving chemical or biological agents during the 1996 Atlanta Olympic Games.

During the 1996 Centennial Olympic Games in Atlanta, Georgia, unprecedented preparations were undertaken to cope with the health consequences of a terrorist incident involving chemical or biological agents. Local, state, federal, and military resources joined to establish a specialized incident assessment team and science and technology center. Critical antimicrobials and antidotes were strategically stockpiled. First-responders received specialized training, and local acute care capabilities were supplemented. Surveillance systems were augmented and strengthened. However, this extensive undertaking revealed a number of critical issues that must be resolved if our nation is to successfully cope with an attack of this nature. Emergency preparedness in this complex arena must be based on carefully conceived priorities. Improved capabilities must be developed to rapidly recognize an incident and characterize the agents involved, as well as to provide emergency decontamination and medical care. Finally, capabilities must be developed to rapidly implement emergency public health interventions and adequately protect emergency responders.

Anti-Infective Agents↗
PubMed2001

Outbreaks of medically unexplained physical symptoms after military action, terrorist threat, or technological disaster.

Medically unexplained physical symptoms (MUPS) may present a challenge to clinicians, disaster response organizations, and scientists after future military actions, terrorist threats, or technological disasters. Polarized public discussion over science, policy, and media evidence following such incidents may reinforce the notion of cover-ups, create mutual doctor-patient mistrust, amplify symptom-related psychosocial distress and disability, and lead to unnecessary use of services. Under these circumstances, the clinician must always show respect, empathy, and validation for a patient's concerns. A skeptical attitude may induce efforts by patients to "prove" their symptoms are "real." If MUPS are discounted as a "non-problem," they may become a much bigger public health problem when patients feel their symptoms and concerns have been discounted by unfeeling government clinicians, and patient "horror stories" become grist for media and political mills.

Disease Outbreaks↗
PubMedDate not supplied

James P. Bagian on patient safety initiatives. Interview by Deborah Mears.

James P. Bagian, MD, is director of the Veterans Health Administration (VHA) National Center for Patient Safety (NCPS). With a focus on systems and an emphasis on "prevention not punishment," NCPS is working to improve patient safety, prevent health care errors, and nurture a culture of safety throughout the 173 VHA medical centers. Previously, Dr. Bagian served as deputy director of the Regional and State Programs Division, Office of Mobile Sources, Environmental Protection Agency. From 1980 to 1995, Dr. Bagian served as a NASA astronaut. He took part in both the planning and provision of emergency medical and rescue support for the first six Space Shuttle flights. In 1986, Dr. Bagian served as an investigator for the Space Shuttle Challenger accident. A veteran of two space flights (STS-29 in 1989 and STS-40 in 1991), Dr. Bagian has logged more than 337 hours in space. Dr. Bagian is currently an adjunct assistant professor of military and emergency medicine at the Uniformed Services University of Health Sciences at F. Edward Herbert School of Medicine and also a clinical assistant professor of preventive medicine and community health at the University of Texas Medical Branch. He is a Colonel in the U.S. Air Force Reserve where he is a pararescue flight surgeon with the 920th Air Rescue Group. He has received the American Medical Association's Nathan S. Davis Award for outstanding public service in the advancement of public health. The NCPS received the 2001 Innovations in American Government Award given by the Institute for Government Innovation at the John F. Kennedy School of Government of Harvard University. The NCPS was the only federal organization to be so identified in 2001.

Hospitals, Veterans↗
PubMed2002

Clinical and laboratory features of systemic lupus erythematosus (SLE) in Pakistani patients.

OBJECTIVES: To study the clinico-pathological features of systemic lupus erythematosus (SLE) in Pakistani patients at the time of presentation in the four teaching hospitals of Rawalpindi-Islamabad area. SETTINGS: Department of Immunology, Armed Forces Institute of Pathology (AFIP), Rawalpindi, Military Hospital (MH), Rawalpindi, Armed Forces Institute of Urology (AFIU), Rawalpindi, Combined Military Hospital (CMH), Rawalpindi, Department of Rheumatology, Pakistan Institute of Medical Sciences (PIMS), Islamabad. SUBJECTS: Patients suffering from SLE, diagnosed on the basis of the ARA criteria. MAIN OUTCOME MEASURES: Clinico-pathological features at the time of presentation. RESULTS: Twelve male patients in age range 5-30 years (mean 21.6 years) and 38 female patients in age range 8-37 years (mean 22.2 years) were included in the study, showing a female to male ratio of 3:1. Fever was the most common presenting feature (100%), followed by arthralgias/arthritis (98%), malar rash (64%) and oral ulcers (58%). Laboratory results showed antinuclear antibody to be positive in all patients followed by anti double stranded DNA antibodies (anti DNA antibodies: 64%), anti extractable nuclear antigen antibodies (anti ENA antibodies: 64%) and evidence of complement consumption in 64% of the patients. Erythrocyte Sedimentation Rate (ESR) was found to be increased with a mean of 64 mm first hour fall in males and a mean of 87 mm first hour fall in the female patients. The C reactive protein was detected to be normal or marginally increased inspite of the increased ESR with mean of 7 mg/l for male patients and 5 mg/1 for the females. CONCLUSION: The subject patient population presented almost universally with fever and arthralgias or arthritis in combination with malar rash or oral ulcers and in some patients a combination of all of the above was observed. A combination of positive anti nuclear antibody test, evidence for consumption of the complement in form of low C4 and C3, increased ESR and low C reactive protein were found to be a sensitive and cost effective set of laboratory findings for the diagnosis of patients suffering from SLE. The above mentioned set of clinical and laboratory features would help in the correct and early diagnosis of patients suffering from SLE, a relatively rare disease, in the busy medical out patient departments in our set up.

Adult↗
PubMed2005

Science and the French Empire.

Scholarly interest in French colonial science, interpreted to include colonial medical and scientific institutions as well as personages and other "actors" in France serving colonial agendas, has been robust for some two decades. This essay characterizes the complex and interlinked historical relationships between French metropolitan and colonial science as one of asymmetric coevolution. In analyzing scholarship on diverse topics from physics and military technology to colonial botany, medicine, geography, and racial theory, it interrogates the concepts of French nation and French empire and questions the historiographical and explanatory utility of the core-periphery model. Special scrutiny falls on a trope common to historigraphical studies of the postrevolutionary era, that of a firm French nationalism enabling largely rational colonial agendas and the promotion of these agendas by highly centralized Parisian bureaucracies. The essay calls for a reading of French history inclusive of regional colonialist activities and argues for the prevalence of municipal and regional maritime, technological, scientific, and military interests in constructing the modern French empire.

Colonialism↗
PubMed2002

The Great War, the Russian Civil War, and the invention of big science.

The revolutionary transformation in Russian science toward the Soviet model of research started even before the revolution of 1917. It was triggered by the crisis of World War I, in response to which Russian academics proposed radical changes in the goals and infrastructure of the country's scientific effort. Their drafts envisioned the recognition of science as a profession separate from teaching, the creation of research institutes, and the turn toward practical, applied research linked to the military and industrial needs of the nation. The political revolution and especially the Bolshevik government that shared or appropriated many of the same views on science, helped these reforms materialize during the subsequent Civil War. By 1921, the foundation of a novel system of research and development became established, which in its most essential characteristics was similar to the U. S. later phenomenon known as "big science."

History, 20th Century↗
PubMed1998

Perceptions of current and recent military internal medicine residents on operational medicine, managed care, graduate medical education, and continued military service.

Current and recent internal medicine residents were surveyed on their level of confidence in practicing operational medicine, satisfaction with graduate medical education, the impact of TRICARE, the military managed care plan, on their patients and education, and intentions on remaining in uniformed service. Their sentiments were recorded on a five-point Likert scale (1 = strongly agree, 3 = neutral, 5 = strongly disagree). Two hundred twenty-one of the 294 surveys were returned (75.2%). Most physicians felt unprepared to perform duties in a nuclear, biological, or chemical warfare environment, or handle administrative aspects of operational medicine (mean scores, 3.2-3.7). A majority of respondents felt satisfied with the quality of their residency experience (mean score, 1.9). Although more than half of those surveyed (53.6%) listed the opportunity to teach residents as a top factor influencing their retention decision, most felt skeptical that graduate medical education would remain important in the future (mean score, 3.6). Most physicians agreed that restriction of TRICARE to patients less than 65 years old may degrade the quality of military internal medicine residencies (mean score, 1.6). Previous service, Reserve Officer Training Corps experience, and graduation from the Uniformed Services University of the Health Sciences were factors associated with increased physician intention to remain beyond their obligated service. The most common factors inducing physicians to leave the military included frequent deployments, relocations, and financial compensation. Factors cited most frequently as influencing physicians to stay on active duty included high-quality colleagues, opportunities for teaching residents, and freedom from malpractice and office management details.

Adult↗
PubMed2001

From logical neurons to poetic embodiments of mind: Warren S. McCulloch's project in neuroscience.

After more than half a century of eclipse, the mind (in contradistinction to brain and behavior) emerged in the 1950s as a legitimate object of experimental and quantitative research in natural science. This paper argues that the neural nets project of Warren S. McCulloch, in frequent collaboration with Walter Pitts, spearheaded this cognitivist turn in the 1940s. Viewing the project as a spiritual and poetic quest for the transcendental logos, as well as culturally situated epistemology, the paper focuses on McCulloch's and Pitts' efforts of logical modeling of the mind and on the social conditions that shaped that mission. From McCulloch's "experimental epistemology," the mind - purposes that ideas - emerged out of the regularities of neuronal interactions, or nets. That science of mind thus became a science of signals based on binary logic with clearly defined units of perception and precise rules of formation and transformation for representing mental states. Aimed at bridging the gulf between body and mind (matter and form) and the technical gulf between things man-made and things begotten, neural nets also laid the foundation for the field of artificial intelligence. Thus this paper also situates McCulloch;'s work within a larger historical trend, when cybernetics, information theory, systems theories, and electronic computers were coalescing into a new science of communication and control with enormous potential for industrial automation and military power in the Cold War era. McCulloch's modeling the mind as a system of command and control contributed to the actualization of this potential.

Brain↗