United States Coast Guard

Recent studies have linked trauma patient outcomes to the plasma donor's sex, with premenopausal females associated with improved survival and lower organ failure. Currently, green-colored plasma (due to oral contraceptive use) is removed from the donor pool. We set out to evaluate the hemostatic potential of green plasma. We obtained 90 units of plasma from our regional blood center: 30 units of visible green plasma and 60 units of standard-color plasma divided between male and female donors. We collected clinical data such as age, sex, ethnicity, and number of pregnancies. We then assessed the hemostatic potential through thrombelastography (TEG), calibrated automated thrombography (CAT), and clotting factor levels. Green plasma unit donors were younger than standard-color female and male donor units (median age 27 vs. 58 vs. 54) and had fewer pregnancies than their non-green female counterparts (median 0 vs. 2); (both p < 0.001). All TEG values, as well as CAT lag time, thrombin potential, and peak thrombin were more hypercoagulable in the green plasma group compared to standard-color female and male donor units; all p < 0.05. In addition, the majority of factor levels (including II, VII, IX, X, and fibrinogen) were higher in green donor plasma; all p < 0.05. Based on our data, green plasma has superior hemostatic potential without any other aberrant characteristics, possibly justifying the use of green plasma in transfusion medicine. Reintroducing this product will help to expand on the plasma donor pool.

Musculoskeletal Injuries (MSKIs) have a longstanding deleterious impact on the health of service members (SMs) and the readiness of the armed services. Although active duty branches of the military have reported historical injury rates and descriptive statistics, less is known about other armed services populations. Cadets at service academies undergo similar initial military training (IMT) as their active duty counterparts, however, rates and risk factors for sustaining a MSKI during training and its impact on the cadet are less known. The purpose of this study, therefore, was to evaluate MSKI during IMT at the U.S. Coast Guard Academy (USCGA). Retrospective MSKI data from 2018 to 2023 was used to calculate descriptive statistics of MSKIs sustained during USCGA IMT, which is the 7-week introductory training before matriculation at the USCGA. Incidence rates were calculated as the number of exposed (injured) cadets divided by the total number of cadets and multiplied by the exposure period of interest (person-weeks). Incidence rate was assessed for each year of observation (7-week period) as well as for each week of IMT to identify trends in injury rate. Factors most frequently associated with MSKI were assessed for significance with multiple regression. Differences in injury risk between sex were assessed via risk ratio with confidence intervals. Descriptive statistics were provided for body region, mechanism of injury, and other available metrics. The cumulative incident rate was 65.98 MSKI per 1,000 person-weeks during IMT across 2018-2023, with 31.2% of all cadets sustaining an MSKI. Females had a 50% greater risk of injury than males for each year of observation (Risk Ratio (RR) = 1.49, 95% CI). The lower extremity was the most frequently injured body region (66.9%) and most MSKIs were sustained doing training-related activities. Factors significantly associated with the presence of MSKI included sex, history of prior injury, and medical waiver for admission. Rates of MSKI are similar among cadets at service academies as active duty SMs undergoing IMT. Further investigation is warranted to have a better understanding of risk factors for injury and long-term outcomes associated with early career MSKI. Cadets at service academies should also be considered for future injury prevention initiatives given the high rate of MSKI among this population.

Abstract With East Asia becoming highly digitalized, the security of submarine cables is increasingly essential to the stability of regional prosperity as well as national security. While East Asia is highly vulnerable to natural disasters such as earthquakes and volcanic activity, submarine cable security is also threatened by the region’s unique geopolitical situation, including the Taiwan Strait crisis, maritime disputes, and the intense U.S.–China rivalry in the region. Securing submarine cables against intentional damage or interference in the region is becoming more of a concern. In order to ensure the security of submarine cables, regional countries need to approach this issue in the spirit of protecting a commonly held good.

Purpose: From September 10-20, 2022, a central Pacific Ocean cyclone developed into Typhoon Merbok then transitioned into an extratropical post-typhoon where its remnants became stronger and impacted the 2100-kilometer (1300-mile) geographically isolated western coastline of Alaska. This research formally documented the immediate aftermath cascade disaster and what role Merbok played to exacerbate an ongoing cascading series of disasters by examining application of core emergency and recovery support function capabilities in both short- and long-term timeframes. Methodology: Descriptive research using a collective case study was used. Findings: While some successes were noted, the research found both the emergency and recovery support functions were overall ineffective and did not function which resulted in exacerbation of the cascading hazard event in short-term recovery and long-term resilience. Unique Contribution to Theory, Policy, and Practice: This research looked beyond just disaster impact to examine how a storm exposed broader ramifications questioning where Indigenous villages were established, access to these locations, what was considered infrastructure compared to other US locations, how the emergency and recovery support functions failed to adequately implement their respective core functions, decimation of the ability to maintain an Indigenous subsistence lifestyle, and what was needed for recovery versus resilience for the people involved. The findings impact both response to major disasters and preparedness considerations for remote and geographically isolated locations.

Marine structures and ships fight a constant battle against corrosion. Sacrificial anodes and impressed-current cathodic protection (ICCP) are two common protection techniques. Many structures employ a hybrid configuration of both, in the hope that the combination provides more protection than either does individually. Doing so, however, can create situations in which these techniques interfere with each other. It is essential to verify that protection extends adequately to all areas of the structure. This article describes instrumentation and measurement strategies to determine the corrosion potential and extent of ICCP protection in difficult-to-reach areas on ships. A case study is presented for these methods on a vessel that experienced severe galvanic corrosion damage in its stern tube. Operators of mission-critical marine structures can use these insights to tune and improve corrosion protection schemes before damage manifests.

To observe the cage subsidence after oblique lateral interbody fusion (OLIF) for lumbar spondylosis, summarize the characteristics of the cage subsidence, analyze causes, and propose preventive measures. The data of 144 patients of lumbar spine lesions admitted to our hospital from October 2015 to December 2018 were retrospectively analyzed. There were 43 males and 101 females, and the age ranged from 20 to 81 years old, with an average of (60.90±10.06) years old. Disease types:17 patients of lumbar intervertebral disc degenerative disease, 12 patients of giant lumbar disc herniation, 5 patients of discogenic low back pain, 33 patients of lumbar spinal stenosis, 26 patients of lumbar degenerative spondylolisthesis, 28 patients of lumbar spondylolisthesis with spondylolisthesis, 11 patients of adjacent vertebral disease after lumbar internal fixation, 7 patients of primary spondylitis in the inflammatory outcome stage, and 5 patients of lumbar degenerative scoliosis. Preoperative dual-energy X-ray bone mineral density examination showed 57 patients of osteopenia or osteoporosis, and 87 patients of normal bone density. The number of fusion segments:124 patients of single-segment, 11 patients of two-segment, 8 patients of three-segment, four-segment 1 patient. There were 40 patients treated by stand-alone OLIF, and 104 patients by OLIF combined with posterior pedicle screw. Observed the occurrence of fusion cage settlement after operation, conducted monofactor analysis on possible risk factors, and observed the influence of fusion cage settlement on clinical results. All operations were successfully completed, the median operation time was 99 min, and the median intraoperative blood loss was 106 ml. Intraoperative endplate injury occurred in 30 patients and vertebral fracture occurred in 5 patients. The mean follow-up was (14.57±7.14) months from 6 to 30 months. During the follow-up, except for the patients of primary lumbar interstitial inflammation and some patients of lumbar spondylolisthesis with spondylolisthesis, the others all had different degrees of cage subsidence. Cage subsidence classification:119 patients were normal subsidence, and 25 patients were abnormal subsidence (23 patients were gradeⅠ, and 2 patients were gradeⅡ). There was no loosening or rupture of the pedicle screw system. The height of the intervertebral space recovered from the preoperative average (9.48±1.84) mm to the postoperative average (12.65±2.03) mm, and the average (10.51±1.81) mm at the last follow-up. There were statistical differences between postoperative and preoperative, and between the last follow-up and postoperative. The interbody fusion rate was 94.4%. The low back pain VAS decreased from the preoperative average (6.55±2.2 9) to the last follow-up (1.40±0.82), and there was statistically significant different. The leg pain VAS decreased from the preoperative average (4.72±1.49) to the final follow-up (0.60±0.03), and the difference was statistically significant (t=9.13, P<0.000 1). The ODI index recovered from the preoperative average (38.50±6.98)% to the latest follow-up (11.30±3.27)%, and there was statistically significant different. The complication rate was 31.3%(45/144), and the reoperation rate was 9.72%(14/144). Among them, 8 patients were reoperated due to fusion cage subsidence or displacement, accounting for 57.14%(8/14) of reoperation. The fusion cage subsidence in this group had obvious characteristics. The monofactor analysis showed that the number of abnormal subsidence patients in the osteopenia or osteoporosis group, Stand-alone OLIF group, 2 or more segments fusion group, and endplate injury group was higher than that in the normal bone mass group, OLIF combined with pedicle screw fixation group, single segment fusion group, and no endplate injury group, and the comparison had statistical differences. Cage subsidence is a common phenomenon after OLIF surgery. Preoperative osteopenia or osteoporosis, Stand-alone OLIF, 2 or more segments of fusion and intraoperative endplate injury may be important factors for postoperative fusion cage subsidence. Although there is no significant correlation between the degree of cage subsidence and clinical symptoms, there is a risk of cage migration, and prevention needs to be strengthened to reduce serious complications caused by fusion of cage subsidence, including reoperation.

ABSTRACT The on-going reduction of sea-ice in the Arctic is now facilitating maritime activities in areas previously considered inaccessible. Numerous statistics indicate that fishing and tourism are clearly gaining momentum within the wider region under discussion. Furthermore, a certain number of private companies and state-affiliated actors are setting into motion plans for promoting the use of the so-called arctic passages, while certain interesting business projects are already underway; the Yamal LNG Project is for example clearly standing out. As human presence and operations are expected to intensify within that inherently risky region, the first aim of this paper is to qualitatively identify certain business opportunities associated with the Arctic and then highlight their interrelation with the prevailing patterns of maritime traffic. Additionally, on the basis of the report titled ‘Arctic Shipping Status Report – Heavy Fuel Oil (HFO) Use by Ships in the Arctic 2019' (ASSR #2) that was released during October 2020 by the Arctic Council's Working Group on the Protection of the Arctic Marine Environment (PAME), it explains the use of the various types of fuels in the region under discussion and highlights certain environmental risks. Finally, it briefly assesses the overall effectiveness of a (proposed) regulatory intervention of completely banning the use of HFO in the Arctic. This initiative can indeed have a positive contribution to protecting the region's pristine environment, but any regulations of this type must also consider the issue of fishing vessels, which are not covered under the scope of International Maritime Organization's (IMO) International Convention for the Safety of Life at Sea (SOLAS) and the International Convention for the Prevention of Pollution from Ships (MARPOL).

To fill a gap in understanding of the Generative Voluntary Safety Reporting Culture (GVSRC) in the Gulf of Mexico (GOM) Oil and Gas (O&amp;G) sector, perspectives of stakeholders based on their experiences were explored using attributes of a proposed Offshore Safety Action Program (OSAP) modeled after the Aviation Safety Action Program (ASAP). A phenomenological approach encompassing semi-structured interviews (n = 18) and five focus-group sessions (n = 18) was used to collect data from a cross-section of top management, supervisors, regulatory representatives, and subject-matter experts (SME). Four themes emerged from a Thematic Analysis: (1) Voluntary safety reporting culture, (2) Voluntary safety reporting bottlenecks, (3) Universality, and (4) Organizational review of safety events. Most respondents strongly supported the OSAP because it ensures a formalized adjudication of voluntary safety reports by an Event Review Committee (ERC) with representation from employees, management, and regulators. Most respondents supported the non-punitive and confidential attributes of the OSAP as a means to enhance GVSRC. However, there were varying perspectives on defining intentional disregard for safety under the OSAP. Due to the enumerated challenges of cost, respondents agreed that organizations use a scalable process commensurate with the complexity of their operations when adopting the OSAP. A veritable framework for data-driven corrective actions, organizational learning, and enhanced GVSRC in the offshore sector is a potential policy implication of adopting the OSAP.