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Different formats for a neurology clerkship do not influence written examination scores.

OBJECTIVE: Changes in health care delivery required substitution of a number of alternatives for the traditional inpatient clerkship used in the neurology education of fourth-year medical students at the Uniformed Services University of the Health Sciences and for third-year medical students from Georgetown University. METHODS: We retrospectively analyzed grades on a locally generated multiple-choice examination based on a student objective list. Scores from students rotating on ambulatory neurology, neurosurgery, child neurology, neurorehabilitation, and rotations at other military hospitals over a 2-year period were compared with those achieved by students in a traditional clerkship at Walter Reed Army Medical Center. RESULTS: There were no significant differences in the grades between any of the groups. CONCLUSIONS: Student acquisition of factual material was not influenced by the type of clinical experience or by whether the student is in the third or fourth year of medical school.

Clinical Clerkship↗

Paraoptometric education and training in the United States Air Force.

The authors describe military optometry clinic personnel problems prior to 1971 which led to the creation of the Air Force Optometry Specialist/Technician career field. The optometry Specialist, whose civilian counterpart is the optometric assistant/technician, receives a highly intensive 9 week resident course at the USAF School of Health Care Sciences. Additional mandatory training is received on the job and by a career development course specifically designed for the Optometry Specialist. An optional 2-year program is also offered through the Community College of the Air Force.

Aerospace Medicine↗

Embodiment and embodied engagement: central concerns for the nursing care of contemporary peacekeepers suffering from psychological trauma.

TOPIC: Little has been written about the importance of clinicians attending to embodiment and embodied engagement in traumatic clinical situations. By listening and responding to embodied sensations, perceptions, and feelings, embodiment and embodied engagement offer a way to understanding the experience of trauma. PURPOSE: To discuss the concepts of embodiment and embodied engagement as central concerns for the care of contemporary peacekeepers suffering from trauma. SOURCES: Review of the literature on embodiment and embodied engagement, and an exemplar case. CONCLUSIONS: Meanings associated with traumatic events can be understood through embodied approaches, such as interpretive and hermeneutic phenomenology, both for research as well as for reflective practice. The art and science of nursing needs to reinstate the embodied experiences of both the patient and the nurse providing care in order for healing to take place.

Adult↗

A short medical school course on responding to bioterrorism and other disasters.

The events of 9/11 highlighted the limitations of the United States health care system in responding to large-scale public health emergencies. The key for an effective response to any mass casualty event is preparedness; thus, the education of medical students has become a priority. The Association of American Medical Colleges (AAMC) recommended that the nation's medical schools should thoroughly educate students about the public health and emergency services systems to ensure coordinated responses to weapons of mass destruction or other public health threats. In response, The Texas A&M University System Health Science Center College of Medicine, partnering with the Defense Institute for Medical Operations (DIMO), developed a one-week block of required (but not graded) instruction, the "Leadership Course in Disaster Response," first given in 2003-04 to 72 second-year students and taught by six military experts from DIMO. The course goal is to (1) educate students on resources available for regional disaster response; (2) define principles of resource management in disaster response; (3) identify specific agents associated with bioterrorism; and (4) understand the psychosocial aspects of disasters. The course was well received, and the 2004-05 session was improved, based on student and faculty feedback. The authors describe the details of the course (specifically, how the course was tailored to fit the AAMC guidelines), changes in students' knowledge and attitudes, and how the course was improved.

Adult↗

[Hayrullah Efendi, a physician of the Reformation Period (Tanzimat): his life and works].

Hayrullah Efendi, one of the prominent officials of the Reformation Period (Tanzimat 1839) was born in Istanbul in 1817 and died in Tahran in the year 1866, when he was the ambassador of the Ottoman Empire there. He started his education as a student of theology (Islamic studies), later started to study medicine and was graduated from the Military Medical school, "Mekteb-i Tibbiye-i Adliye-i-Sahane", in 1844. Retiring from the military service, he served as a member of the Committee of Agriculture (Ziraat Meclisi), General Board of Education (Meclis-i Maarif-i Umumiye), Supreme Council of Justice (Meclis-i Vâlâ-yi Ahkâm-i Adliye), vice president of the Council for Education and Sciences called "Encümen-i Dâniş", Dean of the Medical School "Mekteb-i Tibbiye" and head of the Sixth Department of the Municipal Organization. In addition to his works on medicine, science, history and literature Hayrullah efendi is also the writer of the first play in Turkish. Hayrullah Efendi's life and activities were given in our previous essay. His works are covered in the present study and will be continued in the following article.

History, 19th Century↗

Overview: cause and prevention in biowarfare and bioterrorism.

Bioweaponry is rooted in the ancient past. It became a science in the early 20th century following the breakthrough discoveries in microbiology and immunology of the late 1800s. The 20th century, with its major and minor wars, saw the research and development of biological weapons capable of immense destruction of life, which were used both by nations in preparation for military warfare and by individuals who engage in asymmetric warfare. Treaties, international agreements, and political pursuits have not been able either to control or to rid the world of bioweapons. The tools for specific defense against bioweapons consist of vaccines against both viruses and bacteria, and of antibiotics and drugs against bacteria. Vaccines and antimicrobials are of limited usefulness because of the large number of possible microbes that can be used for weapons, because of antimicrobial resistance to drugs and antibiotics, and because of limitations in technical feasibility for developing vaccines and antibacterials against certain of the agents. Induction of non-specific innate immunity by immunostimulatory vaccines (at one time licensed) needs to be explored for possible immunoprophylactic-therapeutic activity when administered immediately following exposure to bioweapon pathogens. The ideal solution to the bioweapons problem lies in measures to end their development and application throughout the world. Emphasis was made at the recent World Economic Forum of the need to end poverty and hunger in the world as a means to reduce the incentive to engage in warfare. Added to this is betterment of health, focused mainly on preventable diseases. A further solution to the problem may lie in the development of modern robotic systems for rapid forensic detection of development and production of bioweapons by "rogue" nations and even by individuals. This review deals with the specifics of the development of bioweapons and their control by vaccines, by therapy with antibacterials, by non-specific immunostimulants, by advanced systems for detection of development and deployment of biological agents of destruction, and by political and health-giving initiatives.

Adjuvants, Immunologic↗

The 36th Harry G. Armstrong Lecture. The limits of human performance: a point of view.

The author describes his experience over the past 20 years in the Pentagon environment advocating greater understanding of the importance of human performance and its limits by military technologist. The human performance research community is a key player in the effort to reverse the present marginalization of the human in a technology-dominated world. The author suggests specific initiatives the community could take to strengthen this effort and reposition itself for a greater leadership role in science and technology of the 21st century.

Adaptation, Physiological↗

[The making of hygienic modernity in Meiji Japan, 1868-1905].

This article is based on conceptual and methodological understanding of hygienic modernity in the nineteenth-century Western countries: one is the concept of modern hygiene in the context of modern state and the other is methodological relation of modern hygiene to scientific theory of germ . While modern state calls for the institutionalization of medical police as an administrative tool for consolidating the governmentality what Michel Foucault calls, scientific 'invention' of germ may be considered as 'logical, philosophical and historiographical'. Furthermore, the Meiji medicine men preferred Koch's to Pasteur's laboratory framework, not because the former was scientific than the latter but because Koch's programs were more compatible with imperial needs. The objective of this paper is to investigate four ways in which hygienic modernity had been established in Meiji Japan; (i) how Meiji imperialists perceived and managed to control Japanese hygienic condition, (ii) how Meiji-leading doctors learned about the German modern system of hygiene to consolidate Meiji empire; (iii) how modern germ theory functioned as the formation of imperial bodies in Meiji period; and (iv) how modem military hygiene contributed to Japanese defeat of Russia. Although I try to contend that modern hygiene was adopted as one of the most significant strategies for intensifying and extending the Meiji empire, this paper has some limits in not identifying how Japanese perception of infectious diseases were culturally adaptive to science-based hygienic programs the Meiji administrators had installed.

Communicable Diseases↗

[Kyongsong Imperial University Medical College].

Japan annexed Korea in 1910 and with the promulgation of the Chosen Kyoyuk Ryong (the Korea Education Decree) in 1911, it began to conduct education for the Korean people. However, this was only a matter of formality and a policy for liquidating the spirit of the Korean people. It finally resulted in the uprising of March 1, 1919 of the Korean people that has a cultural tradition of a high level. This event served as a cause of widely spread censure among the Korean people as well as the people of the whole world. Even in Japan voice of criticism rose high. Such being the situation, Japan amended the Korean educational law under the pretext of shifting to a so-called civil-rule policy. The Japanese authorities adopted the same educational system as was practiced in Japan proper, for primary and middle school education. As for higher education, they placed under a strict control the educational facilities already established by Korean people and foreign missionaries, suppressing even minor expansions of existing facilities. However, the movement by some Korean educators to establish a private university and efforts by some missionaries to integrate the existing educational organizations into a university made it inevitable for the Japanese authorities to set up a university of their own in Korea. Thus, they hurriedly established the Kyonsong Imperial University in which was included a medical college that was an indispensable organization for colonial education. They professed that the medical college was established for the purpose of providing equal opportunities and privileges to Korean and Japanese students, but, on the contrary, the operation of the college was done strictly under their colonial policy. The system of the Kyongsong Imperial University was enforced acording to the Japanese Imperial University Law, and all the faculty members and the administratial officials were Japanese. As for Koreans, a few graduates of the university was named nonpaid deputy assistants, and graduates of other colleges were employed as nonpaid subdeputy assistants. In most cases, Koreans, finally handicapped compared with Japanese, could not continue their study and research. A few of them who could conduct continued study and research were placed under strict restraints and, accordingly, their opportunities to achieve academic and social promotion were quite limited. During the history of 20 years of the Kyongsong Imperial University Medical College Yun Il Son and Ko Yong Sun served as assistant professors for 13 months and three days respectively. In addition, there were 12 Koreans who worked as temporary assistants, the periods of their service varying from two days to 10 years. The rate of graduates for Koreans was less than 30% and the rate for Koreans who received a degree of doctor of medical science was only 25%. From 1940, the course of the medical college was shortened to three years and same months under the war-time system, and with Japan's unconditional surrender to the Allied Forces on August 15, 1945, the entire faculty of the medical college was discharged by the U.S. Military Government on November 5, 1945.

Colonialism↗

Overview of telemedicine applications for otolaryngology.

OBJECTIVE/HYPOTHESIS: As we evolve into the managed care era, telemedicine technologies can help to provide efficiencies for the entire health care system. Our practice is centered around a residency training program in a federal facility. Our goal was to lay the groundwork for an entire service being on-line. STUDY DESIGN: Prospective. METHODS: The stepwise process is as follows: needs assessment to examine what part of the practice would lend itself to telemedicine deployment; usability studies to select the best equipment; study in-house to normalize the technology to the current standard of care comparing control subjects with experimental subjects; and deploying remote units to study remote referral. RESULTS: Video-otoscopy captures the image of an eardrum that can be sent from a remote site in a store-forward mode. After normalizing the standard of care, the potential for diagnosing and treating certain ear conditions such as hearing loss is readily apparent. An audiogram, pertinent laboratory data, and history and physical performed by the referring primary care provider would allow the patient to be seen and triaged virtually. Time savings for the patient and the otolaryngologist would be gained. Initial data indicate a greater than 90% correlation with handheld otoscopy and binocular microscopy. In speech sciences, a need existed to evaluate and treat patients from remote sites where speech therapists are unavailable. The use of live video teleconferencing to evaluate and treat patients in-house has preliminary results that show no difference in outcomes. Studying the proctoring of remote surgeons is also a need, as one of our military missions. Initial data show no difference in outcomes when residents are proctored by attending physicians from a physically separated control room in the hospital. We also participate with the Internet Tumor Board, which links four remote sites with our medical center. Different sites scroll through the slides that are listed on a Web site while linking each site with audio teleconferencing. We are initiating Internet Grand Rounds using the same technology. CONCLUSION: These efforts performed in a stepwise approach will lead to an otolaryngology--head and neck surgery service that is on-line for the next millennium, with telemedicine advances normalized to the standard of care.

Hawaii↗

A systematic review of sleep hygiene interventions in physically and operationally demanding occupations.

Workers in physically and operationally demanding (POD) occupations (e.g. military personnel, emergency responders, law enforcement) experience disrupted sleep due to irregular schedules and high-stress work environments. Given the importance of sleep for physical and cognitive performance, interventions to improve sleep in POD occupations are crucial yet remain under-researched. To investigate the effectiveness of sleep hygiene interventions in improving sleep quality and quantity outcomes for POD occupations, a systematic review was conducted across five databases (PubMed, CINAHL, SPORTDiscus, PsycINFO, Web of Science) in September 2024. Eligible studies involved workers in POD occupations where a sleep hygiene intervention was compared against a waitlist or passive control. Ten studies were included, eight randomised controlled trials (RCTs) and two non-randomised controlled trials (NRCTs). Narrative synthesis identified Structured Training Programs (n = 7), Phone Assistance Programs (n = 2), and Single Lecture Interventions (n = 1). Evidence certainty ranged from Very Low to Moderate, converging towards Low quality due to imprecision, risk of bias, and indirectness. Structured Training Programs showed moderate improvements in sleep quality and small-to-moderate effects on sleep duration. Phone Assistance Programs had minimal effects, and Single Lecture Interventions had negligible impact. Higher-quality research is urgently needed to assess sleep hygiene interventions in POD occupations.

Humans↗

Mechanisms of biological effects of radiofrequency electromagnetic fields: an overview.

Manmade sources of electromagnetic (EM) fields, and therefore human exposures to them, continue to increase. Public concerns stem from the effects reported in the literature, the visibility of the sources, and somewhat from confusion between EM fields and ionizing radiation. Protecting humans from the real hazards and allaying groundless fears requires a self-consistent body of scientific data concerning effects of the fields, levels of exposures which cause those effects, and which effects are deleterious (or beneficial or neutral). With that knowledge, appropriate guidelines for safety can be devised, while preserving the beneficial uses of radiofrequency radiation (RFR) energy for military or civilian purposes. The task is monumental because of the large and growing number of biological endpoints and the infinite array of RFR exposure conditions under which those endpoints might be examined. The only way to reach this goal is to understand the mechanisms by which EM fields interact with tissues. As in other fields of science, a mechanistic understanding of RFR effects will enable scientists to generalize from a selected few experiments to derive the "laws" of RFR bioeffects. This article gives an overview of present knowledge of those mechanisms and the part that the USAF School of Aerospace Medicine has played in expanding that knowledge.

Aerospace Medicine↗

Therapeutic urogenital modalities during the last three years of the Iran and Iraq War (1985-1987).

OBJECTIVE: Research projects in the field of military medicine have a central role in medical logistical planning. Treatment of traumatic lesions (including urogenital system injuries) is an important aspect of military medicine. Triage for urogenital injuries has specific problems and points of concern. The purpose of this study was to evaluate the role and different types of therapeutic modalities in the treatment of urogenital injuries during the final 3 years of the Iran and Iraq War (1985-1987). METHODS: In a descriptive-analytical study, records of 1,094 patients with urogenital injuries hospitalized from 1985 to 1987 were studied. A checklist and the Statistical Program for the Social Sciences (version 6) were used for data collection and analysis, respectively. A chi 2 test interpreted part of the data. RESULTS: The highest incidence of urogenital injuries and the highest rate of surgical interventions for urogenital injuries were in 1986 and 1987, respectively. The total incidence of urogenital injuries was 0.51%. Among all surgical interventions, bladder repair was most frequent and ureteral repair was least frequent. Partial nephrectomy was the second most frequent surgical intervention and was performed more often than total nephrectomy. There was a significant difference between the urogenital surgery rate and the total surgery rate (chi 2 = 148, p = 0.000). CONCLUSION: The results suggest progress in the triage of patients with urogenital injuries. The lower incidence of urogenital injuries, however, should be interpreted cautiously because it may be attributable to different combat field conditions. Follow-up studies in this group of patients are necessary.

Cross-Sectional Studies↗

Biomedical applications of simulated environments.

Environmental physiology assumes great significance in our national context in view of the diverse climatic conditions prevailing in different regions. Troops have to operate in diverse environmental conditions guarding the frontiers. Hence, the research in this area has been focused on the usage of field studies in the natural environments or simulated environments in the laboratory. Besides, the application of the simulation chambers in the research on the physiological effects of diverse environments, these studies may have applications in the control and management of certain clinical disorders. Some simulation chambers and specialised set-ups have been designed and developed at the Defence Institute of Physiology and Allied Sciences to carry out simulation studies. This paper describes these developments and the potentials of these biomedical applications of simulated environments.

Acclimatization↗

Deployable teleradiology: Bosnia and beyond.

The United States military has been an effective proponent of digital imaging and teleradiology for the past 15 years [1]. A digital imaging network that eliminates the use of x-ray film makes military medicine requirements simpler. X-ray film requirements include storage of new, unexposed films, storage and use of chemicals and water for processing, and disposal of chemicals. In some deployed situations, the chemical discharge needs to be collected and shipped out of the area. Therefore, the ability to implement electronic imaging and eliminate or greatly reduce the dependence on film, chemicals, and water are intrinsically important to military medicine. In December 1995, the United States government began deployment of 20,000 United States troops to Bosnia-Herzegovina as part of NATO's peacekeeping implementation force (IFOR) operation. A full complement of military medical support facilities was established in Bosnia. An army base in Hungary was the location from which the deployment was staged. The project to deploy telemedicine and teleradiology capabilities to the medical treatment facilities (MTF) in Bosnia and Hungary became known as PrimeTime III [2]. This paper deals with the deployable teleradiology (DEPRAD) system that was installed by the Imaging Science and Information Systems (ISIS) Center, Department of Radiology, Georgetown Medical Center, Washington, DC, at a number of facilities to implement filmless radiology and teleradiology services in support of PrimeTime III.

Bosnia and Herzegovina↗

[Russian electrophysiotherapeutic apparatus. The problems of its design and production].

The topical organizational problems of design, production, and use of physiotherapeutical equipment (PTE) are discussed. PTE is considered to be basic tools employed in physiotherapy. The therapeutical effect of PTE on man is produced by currents of different frequency and shape by means of electrodes (which come in contact with a patient's body) or an electromagnetic field having different frequency-modulation characteristics via non-contact method by means of radiating elements. The devices which transform electromagnetic to mechanical energy may be subsumed under a separate group that includes ultrasonic therapeutical apparatuses, mechanical massage and mechanical stimulation equipment. The leading PTE designer is "VNNIMP-VITA Co. which has developed and launched about 20 varying = purpose PTE models into practice. The interest displayed by the conversed enterprises of the military industrial complex in the manufacture of medical equipment items and primarily PTE has recently caused unsystematic development of new PTE which have not been positively assessed and introduced into medical practice. New PTE models should be designed by strengthening the relations between those who design this type of medical equipment and the new structures of the Russian Academy of Medical Sciences.

Electric Stimulation Therapy↗