General Leonard Wood Army Community Hospital

» Scoliosis is common in patients with cerebral palsy, and its incidence increases with the severity of the cerebral palsy.» Although there are growing reports of improved outcomes with spinal arthrodesis for scoliosis in children with nonambulatory cerebral palsy, there is no evidence-based recommendation for the scoliosis treatment approach, either operative or nonoperative, that maximizes patient health-related quality of life (HRQoL) parameters in this subgroup.» Operative intervention for neuromuscular scoliosis improves patient and caregiver outcomes and satisfaction in children with nonambulatory cerebral palsy when compared with observational treatment.» There is insufficient evidence to suggest that spinal arthrodesis for scoliosis in children with nonambulatory cerebral palsy influences HRQoL parameters.

Increasing amounts of diabetes-focused content is being posted to YouTube with little regulation as to the quality of the content. Diabetic education has been shown to reduce the risk of ulceration and amputation. YouTube is a frequently visited site for instructional and demonstrational videos posted by individuals, advertisers, companies, and health-care organizations. We sought to evaluate the usefulness of diabetic foot care video information on YouTube. YouTube was queried using the keyword phrase diabetic foot care. Original videos in English, with audio, less than 10 min long within the first 100 video results were evaluated. Two reviewers classified each video as useful or nonuseful/misleading. A 14-point usefulness criteria checklist was used to further categorize videos as most useful, somewhat useful, or nonuseful/misleading. Video sources were categorized by user type, and additional video metrics were collected. Of 87 included videos, 56 (64.4%), were classified as useful and 31 (35.6%) as nonuseful/misleading. A significant difference in the mean length of useful videos vs nonuseful/misleading videos was observed (3.33 versus 1.73 min; P < .0001). There was no significant difference in terms of popularity metrics (likes, views, subscriptions, etc) between useful and nonuseful/misleading videos. This study demonstrates that although most diabetic foot care videos on YouTube are useful, many are still nonuseful/misleading. More concerning is the lack of difference in popularity between useful and nonuseful videos. Podiatric physicians should alert patients to possibly misleading information and offer a curated list of videos.

US Pacific Command's strategy includes assistance to United States government relief agencies and nongovernment organizations during humanitarian aid and disaster relief operations in the Asia-Pacific region. Situational awareness during these operations is enhanced by broad interagency access to unclassified commercial satellite imagery. The Remote Ground Terminal-a mobile satellite downlink ground station-has undergone several technology demonstrations and participated in an overseas deployment exercise focused on a natural disaster scenario. This ground station has received new commercial imagery within 20 minutes, hastening a normally days-long process. The Army Geospatial Center continues to manage technology development and product improvement for the Remote Ground Terminal. Furthermore, this ground station is now on a technology transition path into the Distributed Common Ground System-Army program of record.

Obstet Gynecol Surv 2016;71(4):197–198 The purpose of the current study was to examine the effect of elective induction of labor in nulliparous women with an unfavorable cervix at 39 weeks of gestation on cesarean delivery rates.

The Physical Training and Rehabilitation Program (PTRP) is a recovery and reintegration program for recruits in Initial Entry Training (IET) who are unable to continue training because of serious injury. This investigation examined PTRP admission incidence among recruits in IET at Forts Jackson, Leonard Wood, Benning, and Sill during Fiscal Year 2011 (FY11). PTRP admission data were collected from a spreadsheet completed monthly by PTRP commanders. Total number of recruits was obtained from each post's Directorate of Programs, Training, and Management. In FY11, 368 men and 268 women were admitted into PTRPs at all installations. For Forts Jackson, Leonard Wood, Benning, and Sill, male admission incidences (cases/1,000 recruits) were 2.6, 3.0, 6.2, and 5.4, respectively; female admission incidences for Forts Jackson, Leonard Wood, and Sill, were 11.1, 10.1, and 22.6, respectively. Most injuries sent to PTRP were bone stress injuries (65%) or fractures (21%). 76% of recruits were returned to duty. Differences in admission incidence between posts appear primarily related to different local policies regarding convalescent leave and admission criteria. PTRP admission rates are lower than in the past, presumably related to policy changes and injury-reduction efforts. A cost-benefit analysis would assist in determining the value of the PTRP.

Although leprosy is curable with drug treatment, the identification of biomarkers of infection, disease progression and treatment efficacy would greatly help to reduce the overall prevalence of the disease. Reliable biomarkers would also reduce the incidence of grade-2 disability by ensuring that those who are most at risk are diagnosed and treated early or offered repeated treatments in the case of relapse. In this study, we examined the reactivity of sera from lepromatous and tuberculoid leprosy patients (LPs) against a panel of 12 recombinant Mycobacterium leprae proteins and found that six proteins were strongly recognised by multibacillary (MB) patients, while only three were consistently recognised by paucibacillary patients. To better understand the dynamics of patient antibody responses during and after drug therapy, we measured antibody titres to four recombinant proteins, phenolic glycolipid-I and lipoarabinomannan at baseline and up to two years after diagnosis to investigate the temporal changes in the antibody titres. Reactivity patterns to individual antigens and decreases in antibody titres were patient-specific. Antibody titres to proteins declined more rapidly vs. those to carbohydrate and glycolipid antigens. Compared to baseline values, increases in antibody titres were observed during reactional episodes in one individual. Additionally, antibody responses against a subset of antigens that provided a good prognostic indicator of disease progression were analysed in 51 household contacts of MB index cases for up to two years. Although the majority of these contacts showed no change or exhibited decreases in antibody titres, seven individuals developed higher titres towards one or more of these antigens and one individual with progressively higher titres was diagnosed with borderline lepromatous leprosy 19 months after enrolment. The results of this study indicate that antibody titres to specific M. leprae antigens can be used to monitor treatment efficacy in LPs and assess disease progression in those most at risk for developing this disease.

The goal was to determine the prevalence of, and risk factors for, depression in an entry-level U.S. Army population. A cross-sectional survey of U.S. Army soldiers in advanced individual training was performed by using an anonymous self-report survey including demographic data, history (including abuse and psychiatric treatment), and the Patient Health Questionnaire-9. Soldiers in advanced individual training (n = 1,184) were approached, and 1,090 (91.2%; 955 male soldiers and 135 female soldiers) voluntarily chose to participate. Eleven percent reported a psychiatric history, 26% reported a history of abuse, and 15.9% endorsed moderate or more severe current depressive symptoms (male, 15.0%; female, 22.2%). A history of psychiatric treatment (odds ratio, 2.08; 95% confidence interval, 1.21-3.59; p = 0.009) and a history of verbal abuse (odds ratio, 4.11; 95% confidence interval, 2.45-6.90; p = 0.000) placed soldiers at higher risk for depression. Our study shows a higher than expected rate of depression in entry-level training soldiers and identifies some risk factors for depression. This indicates an important need for further study, effective screening, preventive counseling, and early intervention.

The Tactical Fire Fighting Truck (TFFT) is the U.S. Army replacement for the Military Adaptation of a Commercial Item (MACI) 2500L fire truck. The MACI 2500L is a commercial fire fighting vehicle adapted for tactical use. It lacks full cross country mobility, has a low reliability, insufficient water capacity, small crew capacity, and does not have a commonality of automotive parts with the rest of the Army's truck fleet. The TFFT is a modified Heavy Expanded Mobility Tactical Truck (HEMTT) M977 that provides improved mobility and reliability, a crew capacity of six, and has a reliable logistical support of parts because of the large number of HEMTTs in the Army inventory. The implementation of human factors engineering and system safety engineering during the acquisition process provided an improved and enhanced fire fighting system for the U.S Army.