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Letter From The Chief Executive Officer Dr. John Cho. 首席执行官 John Cho 博士的信。
IF 1.2 4区 医学 Q2 MEDICINE, GENERAL & INTERNAL Pub Date : 2024-11-05 DOI: 10.1093/milmed/usae462
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引用次数: 0
The Successful Use of Bilateral 2-Level Ultrasound-Guided Stellate Ganglion Block to Improve Traumatic Brain Injury Symptoms: A Retrospective Analysis of 23 Patients. 成功使用双侧 2 层超声引导星状神经节阻滞改善创伤性脑损伤症状:对 23 名患者的回顾性分析。
IF 1.2 4区 医学 Q2 MEDICINE, GENERAL & INTERNAL Pub Date : 2024-11-05 DOI: 10.1093/milmed/usae193
Sean W Mulvaney, James H Lynch, Kristine L Rae Olmsted, Sanjay Mahadevan, Kyle J Dineen

Purpose: The purpose of the study was to determine whether performing ultrasound-guided, bilateral stellate ganglion blocks (SGBs; performed on subsequent days) improved traumatic brain injury (TBI) symptoms.

Methods: A retrospective chart review was conducted for the time period between August 2022 and February 2023 to identify patients who received bilateral, 2-level (C6 and C4) SGBs for PTSD symptoms but who also had a history of TBI. Neurobehavioral Symptoms Inventory (NSI) scores were collected at baseline, 1 week, and 1 month post-treatment in 14 males and 9 females.

Results: Out of 23 patients, 22 showed improvement in their NSI scores. NSI baseline average score was 42.7; the average score at 1 week post-treatment was 18.8; 1 month post-treatment was 20.1. This represents a 53% improvement in the NSI score between baseline and 1 month.

Conclusion: The use of bilateral, 2-level SGBs may be indicated in treating patients with PTSD symptoms with concomitant diagnoses of mild-to-moderate TBI.

目的:该研究旨在确定在超声引导下进行双侧星状神经节阻滞(SGB,在随后几天进行)是否能改善创伤性脑损伤(TBI)症状:方法: 我们对2022年8月至2023年2月期间的病历进行了回顾性分析,以确定因创伤后应激障碍症状而接受双侧2级(C6和C4)星状神经节阻滞治疗的患者,这些患者也有创伤性脑损伤病史。在基线、治疗后1周和1个月收集了14名男性和9名女性的神经行为症状量表(NSI)评分:在 23 名患者中,22 人的 NSI 分数有所改善。NSI 基线平均分为 42.7 分;治疗后 1 周的平均分为 18.8 分;治疗后 1 个月的平均分为 20.1 分。这表明,从基线到治疗后 1 个月,NSI 分数提高了 53%:结论:在治疗伴有创伤后应激障碍症状并同时被诊断为轻度至中度创伤性脑损伤的患者时,可以使用双侧 2 级 SGB。
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引用次数: 0
A Scoping Review of Military Culture, Military Identity, and Mental Health Outcomes in Military Personnel. 军事文化、军人身份和军人心理健康结果的范围研究。
IF 1.2 4区 医学 Q2 MEDICINE, GENERAL & INTERNAL Pub Date : 2024-11-05 DOI: 10.1093/milmed/usae276
Carolyn Heward, Wendy Li, Ylona Chun Tie, Pippa Waterworth

Introduction: The military is a unique cultural institution that significantly influences its members, contributing to the development and transformation of their identities. Despite growing interest in identity research in the military, challenges persist in the conceptualization of military identity, including understanding how it forms, assessing the influence of military culture on identity development, and evaluating the implications for mental health. The primary objective of this scoping review was to map the complexities of military culture's impact on military identity and its effects on mental health.

Materials and methods: A scoping review of the literature was conducted using the Joanna Briggs Institute Scoping Review Methodology. Studies were included if they described military culture, military identity, and mental health, resulting in 65 eligible studies. The extracted data were thematically analyzed to identify how military culture impacts military identity and mental health and well-being.

Results: Multiple identities were evident within the military population, with 2 overarching identities, loyalty and military, overall conferring positive mental health outcomes. Where these identities were hidden or disrupted, poorer mental health outcomes were observed.

Conclusions: The scoping review conducted in this study challenges the notion of military identity as a singular concept promoting positive mental health outcomes. It highlights its multifaceted nature, revealing that individuals may face identity concealment and disruptions during periods of transition or adjustment, resulting in adverse mental health outcomes. To capture the complexity of military identity, the authors developed the Military Identity Model (MIM). Military leaders, policymakers, and health care professionals are encouraged to recognize the complex nature of military identity and its impact on mental health and well-being. We recommend using the Military Identity Model to explore military identity and adjustment-related difficulties.

导言:军队是一个独特的文化机构,对其成员产生了重大影响,促进了他们身份认同的发展和转变。尽管对军队身份认同研究的兴趣与日俱增,但在军队身份认同的概念化方面仍然存在挑战,包括了解其形成过程、评估军事文化对身份认同发展的影响以及评估其对心理健康的影响。本次范围界定综述的主要目的是了解军事文化对军人身份认同的复杂影响及其对心理健康的影响:采用乔安娜-布里格斯研究所的范围界定综述方法对文献进行了范围界定综述。符合条件的研究共有 65 项。我们对提取的数据进行了专题分析,以确定军事文化如何影响军人身份以及心理健康和幸福感:在军人群体中,多重身份是显而易见的,而忠诚和军人这两种最重要的身份总体上会带来积极的心理健康结果。在这些身份被隐藏或破坏的地方,心理健康结果较差:本研究进行的范围界定审查对把军人身份认同作为促进积极心理健康结果的单一概念提出了质疑。它强调了身份认同的多面性,揭示了个人在过渡期或适应期可能会面临身份认同的隐藏和中断,从而导致不良的心理健康结果。为了把握军人身份认同的复杂性,作者开发了军人身份认同模型(MIM)。我们鼓励军队领导、政策制定者和医疗保健专业人员认识到军人身份的复杂性及其对心理健康和幸福感的影响。我们建议使用军人身份模型来探讨军人身份和与适应相关的困难。
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引用次数: 0
Response to Letter to the Editor Regarding: Preparing Future Military Medical Officers to Conduct Emergency Fresh Whole Blood Transfusions in Austere Environments: A Novel Training Curriculum. 回应致编辑的信,内容涉及让未来的军医做好在恶劣环境下进行紧急新鲜全血输注的准备:新颖的培训课程。
IF 1.2 4区 医学 Q2 MEDICINE, GENERAL & INTERNAL Pub Date : 2024-11-05 DOI: 10.1093/milmed/usae386
Kevin J Matthews
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引用次数: 0
Role of Pain Catastrophizing in the Effects of Cognitive Behavioral Therapy for Chronic Pain in Different Subgroups: An Exploratory Secondary Data Analysis Using Finite Mixture Models. 疼痛灾难化在不同亚群慢性疼痛认知行为疗法效果中的作用:使用有限混合模型的探索性二次数据分析》。
IF 1.2 4区 医学 Q2 MEDICINE, GENERAL & INTERNAL Pub Date : 2024-11-05 DOI: 10.1093/milmed/usae288
Dahee Wi, Jeffrey C Ransom, Diane M Flynn, Alana D Steffen, Chang Park, Larisa A Burke, Ardith Z Doorenbos

Introduction: Providing effective treatment for debilitating chronic pain is a challenge among many populations including military service members. Cognitive behavioral therapy for chronic pain (CBT-CP) is a leading psychological pain treatment. Pain catastrophizing is a pivotal mediator of pain-related outcomes. The purpose of this study was (1) to identify patient subgroups who differ in response to CBT-CP and (2) to explore the characteristics that define these patient subgroups. The overall goal was to obtain a better understanding of factors that may influence response to CBT-CP.

Materials and methods: This study was a secondary analysis of data from a clinical trial of 149 U.S. active duty service members with chronic pain. Participants underwent group-based CBT-CP for 6 weeks and completed pre- and posttreatment assessments. Finite mixture models were employed to identify subgroups in treatment response, with pain impact score as the primary outcome measure.

Results: We identified two classes of nearly equal size with distinct pain impact responses. One class reported improved pain impact scores following CBT-CP. This improvement was significantly associated with lower (better) baseline depression scores and greater improvement in posttreatment pain catastrophizing. In contrast, the other class reported slightly worse mean pain impact scores following CBT-CP treatment; this response was not related to baseline depression or change in pain catastrophizing.

Conclusions: Our findings demonstrate that a sizable proportion of individuals with chronic pain may not respond to group-based CBT-CP and may require a more individualized treatment approach.

导言:在包括军人在内的许多人群中,为使人衰弱的慢性疼痛提供有效治疗是一项挑战。慢性疼痛认知行为疗法(CBT-CP)是一种主要的疼痛心理治疗方法。疼痛灾难化是疼痛相关结果的关键中介因素。本研究的目的是:(1)识别对 CBT-CP 反应不同的患者亚群;(2)探索定义这些患者亚群的特征。总体目标是更好地了解可能影响 CBT-CP 反应的因素:本研究是对 149 名患有慢性疼痛的美国现役军人的临床试验数据进行的二次分析。参与者接受了为期 6 周的 CBT-CP 团体治疗,并完成了治疗前后的评估。我们采用有限混合物模型来识别治疗反应亚组,并以疼痛影响评分作为主要结果测量指标:结果:我们确定了两个规模几乎相等的组别,它们对疼痛的影响反应各不相同。其中一类患者在接受 CBT-CP 治疗后,疼痛影响评分有所改善。这种改善与较低的(较好的)基线抑郁评分和治疗后疼痛灾难化的较大改善明显相关。与此相反,另一类患者在接受 CBT-CP 治疗后,平均疼痛影响评分略有下降;这种反应与基线抑郁或疼痛灾难化的变化无关:我们的研究结果表明,有相当一部分慢性疼痛患者可能对以小组为基础的 CBT-CP 治疗无效,可能需要更个性化的治疗方法。
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引用次数: 0
The Exploration of the GWOT Combat Amputee's Experience With Longitudinal Care: A Qualitative Study. 探索 GWOT 战斗截肢者的纵向护理经验:定性研究。
IF 1.2 4区 医学 Q2 MEDICINE, GENERAL & INTERNAL Pub Date : 2024-11-05 DOI: 10.1093/milmed/usad490
Alexander Pursel, Ryoma Nichols, Dan Evans, Kristina Lindquist

Introduction: Contemporary advances in combat medicine have allowed greater numbers of wounded service members to survive their injuries. An estimated 1,705 combat veterans sustained major lower or upper extremity amputations between 2001 and 2017 during the Global War on Terror. This study intends to answer the following question utilizing a qualitative study design: What were the common and abnormal experiences of the Global War on Terror combat amputees relative to their mechanism of injury, perception of injury, and systems of care utilized during their recovery and rehabilitation process?.

Methods: During the months of December 2022 and January 2023, individual semi-structured interviews were conducted with U.S. Marines that served in the Global War on Terror (total n = 10). Deductive and inductive approaches were employed to identify codes, themes, and meta-themes in the data.

Results: All participants deployed to Afghanistan between the years 2010 and 2014 and were assigned to the following military occupational specialties: Explosive Ordnance Disposal technicians (total n = 2); combat engineers (total n = 2); and infantrymen (total n = 6). Analysis of data collected from interviews highlighted these key observations: (1) Themes in the combat amputee experience include support, systems of care, and mindset and (2) the themes synergistically contribute to the meta-themes mental health and pain and vice versa. As all participants were subjected to a blast mechanism of injury, it is difficult to determine if this played a role in deviating rehabilitation and recovery processes. Perception of injury and how well participants adapted to their new lifestyle, meaning how optimistic they were, appeared to play a significant role in recovery. Participants had mixed feelings about the care they had received but generally spoke favorably of military hospitals and were frustrated with the Veteran Affairs, and there was no clear consensus on their relationship with civilian health care, though most participants chose to seek most of their care through the Veteran Affairs.

Conclusion: Based on the research question, this study found an intricate relationship between mental health, pain, and the experiences of the participants regarding their care and rehabilitation. However, the nature of qualitative research makes it impossible to determine generalizations that can be used to create meaningful change to address improving combat amputee veteran care. Further research into long-term health outcomes based on hypotheses not evaluated in existing literature would further improve the ability of health care providers to care for this unique patient population.

导言:当代作战医学的进步使更多的伤员得以幸存。在 2001 年至 2017 年的全球反恐战争期间,估计有 1 705 名退伍军人的下肢或上肢截肢。本研究旨在利用定性研究设计回答以下问题:全球反恐战争中截肢者在受伤机制、受伤感知以及恢复和康复过程中使用的护理系统方面有哪些常见和异常经历?在 2022 年 12 月和 2023 年 1 月期间,对参加过全球反恐战争的美国海军陆战队员(总人数 = 10 人)进行了个人半结构化访谈。采用演绎法和归纳法确定数据中的代码、主题和元主题:所有参与者均在 2010 年至 2014 年期间部署到阿富汗,并被分配到以下军事职业专业:爆炸物处理技术员(共 2 人)、战斗工兵(共 2 人)和步兵(共 6 人)。对访谈中收集到的数据进行分析后,我们得出了以下重要结论:(1) 战斗截肢者经历的主题包括支持、护理系统和心态;(2) 这些主题协同作用,共同促成了心理健康和疼痛这两个元主题,反之亦然。由于所有参与者都遭受了爆炸伤害,因此很难确定这是否在偏离的康复和恢复过程中起了作用。对受伤的看法以及参与者对新生活方式的适应程度,即他们的乐观程度,似乎对康复起着重要作用。虽然大多数参与者选择通过退伍军人事务部寻求大部分医疗服务,但他们与民间医疗服务的关系并没有明确的共识:根据研究问题,本研究发现心理健康、疼痛以及参与者在护理和康复方面的经历之间存在着错综复杂的关系。然而,由于定性研究的性质,我们无法确定可用于创造有意义的变革以改善战斗截肢退伍军人护理的概括性结论。根据现有文献中未评估的假设对长期健康结果进行进一步研究,将进一步提高医疗服务提供者护理这一特殊患者群体的能力。
{"title":"The Exploration of the GWOT Combat Amputee's Experience With Longitudinal Care: A Qualitative Study.","authors":"Alexander Pursel, Ryoma Nichols, Dan Evans, Kristina Lindquist","doi":"10.1093/milmed/usad490","DOIUrl":"10.1093/milmed/usad490","url":null,"abstract":"<p><strong>Introduction: </strong>Contemporary advances in combat medicine have allowed greater numbers of wounded service members to survive their injuries. An estimated 1,705 combat veterans sustained major lower or upper extremity amputations between 2001 and 2017 during the Global War on Terror. This study intends to answer the following question utilizing a qualitative study design: What were the common and abnormal experiences of the Global War on Terror combat amputees relative to their mechanism of injury, perception of injury, and systems of care utilized during their recovery and rehabilitation process?.</p><p><strong>Methods: </strong>During the months of December 2022 and January 2023, individual semi-structured interviews were conducted with U.S. Marines that served in the Global War on Terror (total n = 10). Deductive and inductive approaches were employed to identify codes, themes, and meta-themes in the data.</p><p><strong>Results: </strong>All participants deployed to Afghanistan between the years 2010 and 2014 and were assigned to the following military occupational specialties: Explosive Ordnance Disposal technicians (total n = 2); combat engineers (total n = 2); and infantrymen (total n = 6). Analysis of data collected from interviews highlighted these key observations: (1) Themes in the combat amputee experience include support, systems of care, and mindset and (2) the themes synergistically contribute to the meta-themes mental health and pain and vice versa. As all participants were subjected to a blast mechanism of injury, it is difficult to determine if this played a role in deviating rehabilitation and recovery processes. Perception of injury and how well participants adapted to their new lifestyle, meaning how optimistic they were, appeared to play a significant role in recovery. Participants had mixed feelings about the care they had received but generally spoke favorably of military hospitals and were frustrated with the Veteran Affairs, and there was no clear consensus on their relationship with civilian health care, though most participants chose to seek most of their care through the Veteran Affairs.</p><p><strong>Conclusion: </strong>Based on the research question, this study found an intricate relationship between mental health, pain, and the experiences of the participants regarding their care and rehabilitation. However, the nature of qualitative research makes it impossible to determine generalizations that can be used to create meaningful change to address improving combat amputee veteran care. Further research into long-term health outcomes based on hypotheses not evaluated in existing literature would further improve the ability of health care providers to care for this unique patient population.</p>","PeriodicalId":18638,"journal":{"name":"Military Medicine","volume":null,"pages":null},"PeriodicalIF":1.2,"publicationDate":"2024-11-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139048940","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Refractory Osteomyelitis in a Military Service Member Resolved With Adjunctive Hyperbaric Oxygen Therapy. 辅助高压氧疗法治疗一名军人的难治性骨髓炎
IF 1.2 4区 医学 Q2 MEDICINE, GENERAL & INTERNAL Pub Date : 2024-11-05 DOI: 10.1093/milmed/usad505
Jeffrey Spiro, Michael Gedestad, Piotr Wisniewski

Refractory osteomyelitis is typically defined as a chronic infection that persists or recurs despite definitive surgical management and antibiotic therapy. Cases often involve complex wounds or fractures and can be challenging to treat, resulting in multiple courses of broad-spectrum antibiotic therapy and numerous surgeries over periods of months to years. Adjuncts to improve resolution of these complicated infections are sorely needed. Here, we describe the case of a 47-year-old active duty military member who sustained an open right ankle fracture during a skydiving accident that was subsequently complicated by refractory osteomyelitis. The patient failed more than three courses of combined medical and surgical management over a 9-month period before undergoing adjunctive hyperbaric oxygen therapy (HBOT), ultimately resulting in resolution of the infection. Adjunctive HBOT for treatment of conditions such as refractory osteomyelitis may be an underutilized resource in part because of a general paucity of high-quality data in the literature supporting its use, as well as a relative lack of availability of this resource. Nonetheless, the overall accumulating body of evidence indicates that the use of adjunctive HBOT in select patients with refractory osteomyelitis is safe and effective and further research may be warranted given its relevance and potential impact to military populations.

难治性骨髓炎通常是指在接受明确的手术治疗和抗生素治疗后仍持续存在或复发的慢性感染。病例往往涉及复杂的伤口或骨折,治疗起来极具挑战性,患者需要接受多个疗程的广谱抗生素治疗,并在数月至数年的时间里进行多次手术。我们亟需辅助药物来改善这些复杂感染的治疗效果。在这里,我们描述了一名 47 岁现役军人的病例,他在一次跳伞事故中右脚踝关节开放性骨折,随后并发了难治性骨髓炎。患者在接受辅助高压氧治疗(HBOT)9 个月后,经过三个多疗程的内外科综合治疗无效,最终导致感染缓解。用于治疗难治性骨髓炎等疾病的辅助高压氧疗法可能是一种未充分利用的资源,部分原因是支持其使用的高质量文献数据普遍较少,而且这种资源相对缺乏。尽管如此,不断积累的证据表明,对部分难治性骨髓炎患者辅助使用 HBOT 是安全有效的。
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引用次数: 0
Correction To: Spinal Pathology and Muscle Morphologies With Chronic Low Back Pain and Lower Limb Amputation. Correction To:脊柱病理和肌肉形态与慢性腰背痛和下肢截肢的关系
IF 1.2 4区 医学 Q2 MEDICINE, GENERAL & INTERNAL Pub Date : 2024-11-05 DOI: 10.1093/milmed/usae448
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引用次数: 0
World War I and the Origins of Blood Transfusion for the Trauma Patient. 第一次世界大战与创伤患者输血的起源。
IF 1.2 4区 医学 Q2 MEDICINE, GENERAL & INTERNAL Pub Date : 2024-11-05 DOI: 10.1093/milmed/usad483
Joseph R Danford

The use of blood transfusion to treat hemorrhagic shock is a relatively new treatment with its origins in World War I. Due to the severity and nature of injuries seen, World War I provided the stimulus to propel medicine forward and accept whole blood transfusion for the trauma patient.

输血治疗失血性休克是一种相对较新的治疗方法,起源于第一次世界大战。由于创伤的严重程度和性质,第一次世界大战推动了医学的发展,并接受为创伤患者输注全血。
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引用次数: 0
Disguised Among the Sea: The Implications of Artificial Islands on Casualty Care in the Indo-Pacific. 伪装在海洋之中:人工岛对印度洋-太平洋地区伤员护理的影响》。
IF 1.2 4区 医学 Q2 MEDICINE, GENERAL & INTERNAL Pub Date : 2024-11-05 DOI: 10.1093/milmed/usae002
Ryan M Leone, Mason H Remondelli, Jason B Brill, Jay B Baker

As reported in the 2022 Biden-Harris National Security Strategy, China is perceived as the primary U.S. competitor with the intent and means to become the world's greatest superpower. China's efforts, which are at odds with America's ambition to maintain its global influence, are complemented by ostensibly harmless "gray zone tactics," defined as coercive geopolitical, economic, military, and cyber activities below the use of kinetic military force. Such tactics may be utilized with seemingly innocuous intentions, but in reality, they can complicate U.S. combat casualty care in the event of an Indo-Pacific conflict. One tactic of particular impact is China's development of artificial islands throughout the South China Sea. By creating these islands, China is expanding its reach beyond its continental borders. These islands, alongside China's well-developed naval and missile capabilities, will cause disruptions to U.S. casualty care staging, medical resupply, and aeromedical evacuations. To mitigate those threats, the USA should implement a robust regional Combatant Command Trauma System, improve global health security cooperation with local partner nations, and implement irregular or guerilla trauma systems that meet medical needs in impromptu, clandestine settings. Operational recommendations based on these efforts could include pre-positioning tactical combat casualty care and damage control resuscitation supplies and developing with nearby host-nation evacuation platforms such as small boat operators. These solutions, among others, require years of training, relationship-building, and capability development to institute successfully. As a result, U.S. Military leaders should act now to incorporate these strategies into their irregular warfare, low-intensity conflict, and large-scale combat operation toolkits.

正如 2022 年拜登-哈里斯国家安全战略报告所述,中国被视为美国的主要竞争对手,其意图和手段都是成为世界上最大的超级大国。中国的努力与美国保持其全球影响力的野心相悖,而表面上无害的 "灰色地带战术 "则是对中国的补充。"灰色地带战术 "的定义是在动武之下的地缘政治、经济、军事和网络胁迫活动。使用此类战术的意图看似无害,但实际上,一旦发生印太冲突,它们会使美国的战斗伤亡护理工作复杂化。其中一个影响特别大的战术是中国在整个南中国海开发人工岛屿。通过建造这些岛屿,中国正在将其势力范围扩展到大陆边界之外。这些岛屿以及中国发达的海军和导弹能力将对美国的伤员救护中转、医疗补给和航空医疗后送造成干扰。为减轻这些威胁,美国应实施强大的地区作战司令部创伤系统,改善与当地伙伴国的全球卫生安全合作,并实施非正规或游击创伤系统,以满足临时、秘密环境下的医疗需求。在这些努力的基础上提出的行动建议可包括预先部署战术战斗伤员救护和损害控制复苏物资,并与附近的东道国后送平台(如小船运营商)合作开发。除其他外,这些解决方案需要多年的培训、关系建立和能力发展才能成功实施。因此,美国军事领导人应立即采取行动,将这些战略纳入其非正规战争、低强度冲突和大规模作战行动工具包。
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引用次数: 0
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Military Medicine
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