ABSTRACT
Military nurses have been placed in the forefront of clinical and leadership roles during the COVID-19 pandemic. Serving in critical roles, military nurses have spearheaded innovations in ...clinical practice, conducted research, and implemented evidence-based practice projects that have advanced the capabilities of the Armed Forces Nurse Corps. This collection captures and highlights many of these military nursing contributions combating the COVID-19 pandemic.
IMPORTANCE: The US Preventive Services Task Force recommends annual lung cancer screening (LCS) with low-dose computed tomography for current and former heavy smokers aged 55 to 80 years. There is ...little published experience regarding implementing this recommendation in clinical practice. OBJECTIVES: To describe organizational- and patient-level experiences with implementing an LCS program in selected Veterans Health Administration (VHA) hospitals and to estimate the number of VHA patients who may be candidates for LCS. DESIGN, SETTING, AND PARTICIPANTS: This clinical demonstration project was conducted at 8 academic VHA hospitals among 93 033 primary care patients who were assessed on screening criteria; 2106 patients underwent LCS between July 1, 2013, and June 30, 2015. INTERVENTIONS: Implementation Guide and support, full-time LCS coordinators, electronic tools, tracking database, patient education materials, and radiologic and nodule follow-up guidelines. MAIN OUTCOMES AND MEASURES: Description of implementation processes; percentages of patients who agreed to undergo LCS, had positive findings on results of low-dose computed tomographic scans (nodules to be tracked or suspicious findings), were found to have lung cancer, or had incidental findings; and estimated number of VHA patients who met the criteria for LCS. RESULTS: Of the 4246 patients who met the criteria for LCS, 2452 (57.7%) agreed to undergo screening and 2106 (2028 men and 78 women; mean SD age, 64.9 5.1 years) underwent LCS. Wide variation in processes and patient experiences occurred among the 8 sites. Of the 2106 patients screened, 1257 (59.7%) had nodules; 1184 of these patients (56.2%) required tracking, 42 (2.0%) required further evaluation but the findings were not cancer, and 31 (1.5%) had lung cancer. A variety of incidental findings, such as emphysema, other pulmonary abnormalities, and coronary artery calcification, were noted on the scans of 857 patients (40.7%). CONCLUSIONS AND RELEVANCE: It is estimated that nearly 900 000 of a population of 6.7 million VHA patients met the criteria for LCS. Implementation of LCS in the VHA will likely lead to large numbers of patients eligible for LCS and will require substantial clinical effort for both patients and staff.
BRG1, the central ATPase of the human SWI/SNF complex, is critical for biological functions, including nuclear receptor (NR)-regulated transcription. Analysis of BRG1 mutants demonstrated that ...functional motifs outside the ATPase domain are important for transcriptional activity. In the course of experiments examining protein interactions mediated through these domains, Ku70 (XRCC6) was found to associate with a BRG1 fragment encompassing the conserved helicase-SANT-associated (HSA) and BRK domains of BRG1. Subsequent transcriptional activation assays and chromatin immunoprecipitation studies showed that Ku70/86 and components of the topoisomerase IIβ (TOP2β)/poly(ADP ribose) polymerase 1 (PARP1) complex are necessary for NR-mediated SWI/SNF-dependent transcriptional activation from endogenous promoters. In addition to establishing Ku-BRG1 binding and TOP2β/PARP1 recruitment by nuclear receptor transactivation, we demonstrate that the transient appearance of glucocorticoid receptor (GR)/BRG1-dependent, TOP2β-mediated double-strand DNA breaks is required for efficient GR-stimulated transcription. Taken together, these results suggest that a direct interaction between Ku70/86 and BRG1 brings together SWI/SNF remodeling capabilities and TOP2β activity to enhance the transcriptional response to hormone stimulation.
During the coronavirus disease of 2019 (COVID-19) pandemic, overseas military bases faced unique challenges to preserve force health protection while simultaneously caring for military beneficiaries. ...The response to the rapidly evolving challenges surrounding transmission of the severe acute respiratory syndrome coronavirus 2 in Okinawa, Japan, required innovative solutions. One innovative solution was the COVID-19 Operational Response Cell established at Camp Courtney, Marine Corps Base Camp Smedley D. Butler. This interview describes the COVID-19 Response Cell operations and essential lessons learned by a Navy Nurse Corps officer working with III Marine Expeditionary Force, a forward-deployed force in the U.S. Indo-Pacific Command.
Tetrapods evolved from sarcopterygian fishes in the Devonian and were the first vertebrates to colonize land. The locomotor component of this transition can be divided into four major events: ...terrestriality, the origins of digited limbs, solid substrate-based locomotion, and alternating gaits that use pelvic appendages as major propulsors. As the sister group to tetrapods, lungfish are a morphologically and phylogenetically relevant sarcopterygian taxon for understanding the order in which these events occurred. We found that a species of African lungfish (Protopterus annectens) uses a range of pelvic fin-driven, tetrapod-like gaits, including walking and bounding, in an aquatic environment, despite having a derived limb endoskeleton and primitively small, muscularly supported pelvis. Surprisingly, given these morphological traits, P. annectens also lifts its body clear of the substrate using its pelvic fins, an ability thought to be a tetrapod innovation. Our findings suggest that some fundamental features of tetrapod locomotion, including pelvic limb gait patterns and substrate association, probably arose in sarcopterygians before the origin of digited limbs or terrestriality. It follows that the attribution of some of the nondigited Devonian fossil trackways to limbed tetrapods may need to be revisited.
ABSTRACT
Background
Evidence-based practice (EBP) is an innovative systematic problem-solving methodology that incorporates the best research evidence into clinical practice to improve patient ...outcomes, job satisfaction, and reduced healthcare costs. Although there are significant advances to implement EBP into military healthcare and operational settings, many barriers and challenges still exist. Civilian healthcare organizations have examined barriers and solutions to integrate EBP into clinical practice, but limited data exists to identify barriers and solutions to integrate EBP into military healthcare settings. Advancing the implementation of EBPs within military healthcare settings has the power to transform the administrative processes of healthcare management and most importantly, the delivery of healthcare for service members and beneficiaries. The purpose of this article is to present findings from a qualitative descriptive research study which analyzed data obtained during an EBP military summit.
Methods
A qualitative descriptive research study was used to examine EBP barriers and solutions to implement EBP in military healthcare settings. Participants attended a virtual 1-day military EBP summit (n = 182). As part of the summit, participants were invited to voluntarily participate in focus groups. Focus groups were conducted to gain an understanding of EBP barriers and solutions from military and civilian nurses and medics with interest and experience conducting EBP within military healthcare settings (n = 42). Focus group discussions were transcribed and analyzed by the study team.
Results
The study analysis identified six themes: leadership, command culture, EBP barriers (specific to MTF/operational environments), communication, infrastructure support, and outcome measures. Sub-themes identified additional dimensions military-specific barriers and solutions within the six identified themes.
Conclusions
The results of this research study identify actionable tasks and recommendations to advance EBP within the military healthcare system. EBP is currently underutilized in the military healthcare system, and supportive implementation of EBP can be accomplished through enhanced leadership engagement, changing command culture, addressing EBP barriers, infrastructure, communication planning, and integration of existing national clinical and financial outcome measures. Given the critical need to further transition of military healthcare to evidence-based data driven decisions, the knowledge gained from this study can optimize readiness and advance healthcare delivered to service members and beneficiaries within the military healthcare system.
The Indo-Asia-Pacific region has the highest incidence of natural disasters world-wide. Since 2000, approximately 1.6 billion people in this region have been affected by earthquakes, volcanos, ...tsunamis, typhoons, cyclones, and large-scale floods. The aftermath of disasters can quickly overwhelm available resources, resulting in loss of basic infrastructure, shelter, health care, food and water, and ultimately, loss of life.Over the last 12 years, US military forces have collaborated with countries throughout the Indo-Asia-Pacific region to enhance disaster preparedness and management during shipboard global health engagement missions. Military health care personnel are integral in this effort and have planned subject-matter expert exchanges, multidisciplinary conferences, courses, and hyper realistic simulated military-to-military training exercises related to disaster preparedness.Military health care providers are essential not only to providing international education and training, but also to ensuring optimal readiness to respond to future disasters in the Indo-Asia-Pacific region and worldwide. The ability to effectively respond to disasters and collaborate with other nations promotes international stability. Yet, few studies have examined disaster preparedness among US military health care personnel. This study aimed to assess knowledge, skills, and preparedness for disaster management among US military health care personnel preparing to deploy on a global health engagement mission.
A descriptive, cross-sectional study utilizing the Disaster Preparedness Evaluation Tool (DPET) examined self-reported perceptions of disaster preparedness among US military health care personnel preparing to deploy on a shipboard global health engagement mission. The DPET assessed perceived knowledge of disaster preparedness, disaster mitigation and response, and disaster recovery. Three hundred Hospital Corpsmen/Medics and officers in the Nurse Corps, Medical Corps, Medical Service Corps, and Dental Corps were invited to participate. One hundred fifty-four surveys were completed (response rate, 51%). Nineteen surveys were excluded from the analysis due to incomplete responses. Participants rated responses to 46 Likert items (scale of 1-6) and responded to 23 descriptive items. The study protocol was approved by the Naval Medical Center San Diego Institutional Review Board, protocol number NMCSD.2017.0061, in compliance with all applicable federal regulations governing the protection of human subject research.
All item mean scores on each of the three DPET subscales resulted in moderate levels of perceived disaster preparedness among military healthcare personnel (disaster preparedness means ranged from 3.04 to 4.67, disaster response means ranged from 3.76 to 4.29, and disaster recovery means ranged from 3.47 to 4.29). The final regression model had 6 significant variables that predicted DPET scores: previous disaster drills (p = 0.00), experiencing a real disaster (p = 0.002), bioterrorism training (p = 0.02), education level (p = 0.025), years in specialty (p = 0.019), and previous global health engagement missions (p = 0.016), with R2 = 0.39, R2adj = 0.36, F (7, 127) = 12.04.
Disaster preparedness among military healthcare personnel could be improved to function optimally for future global health engagement missions. This study expands current understandings of disaster preparedness among US military health care providers and identifies ways to improve and enhance training.
Background
There is little guidance about to how select dose parameter values when designing behavioral interventions.
Purpose
The purpose of this study is to present approaches to inform ...intervention duration, frequency, and amount when (1) the investigator has no a priori expectation and is seeking a descriptive approach for identifying and narrowing the universe of dose values or (2) the investigator has an a priori expectation and is seeking validation of this expectation using an inferential approach.
Methods
Strengths and weaknesses of various approaches are described and illustrated with examples.
Results
Descriptive approaches include retrospective analysis of data from randomized trials, assessment of perceived optimal dose via prospective surveys or interviews of key stakeholders, and assessment of target patient behavior via prospective, longitudinal, observational studies. Inferential approaches include nonrandomized, early-phase trials and randomized designs.
Conclusions
By utilizing these approaches, researchers may more efficiently apply resources to identify the optimal values of dose parameters for behavioral interventions.
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