Journal of Archives in Military Medicine Journal of Archives in Military Medicine J Arch Mil Med http://www.jammonline.com 2345-5071 2345-5063 10.5812/jamm en jalali 2017 6 24 gregorian 2017 6 24 2 2
en 10.5812/jamm.18224 The Human Element in Combat The Human Element in Combat discussion discussion

The dominancy in combat depends on several factors including objectives, strategies, weapons and materials, technology, numbers of soldiers, and of course, the human element. More specifically, cohesion, e.g. interpersonal bond of an organization in order to sustain their will and commitment to each other, their unit, and the mission, plays a major role in this regard. Importantly, defining the objectives and purposes of the battle, appropriate and timely logistic support, structural organization with regard to individual characteristics, and leadership would influence military cohesion. Furthermore, motivation and control, surveillance and conformity, commonality of values and societal factors play important role on the small unit cohesion. However, civic education is most effective in the soldiers’ contribution and resistance within and after a battle. Then commanders and leaders construct the bases of cohesion in their unit by assessing the individual psychological state, societal condition, and spiritual characteristics to obtain success during a confrontation. In this literature review, several psychological aspects of cohesion are outlined. JAMM International expects receiving expert opinions from military systems in respect of their own cultural and organization characteristics, and requirements for a discussion.

The dominancy in combat depends on several factors including objectives, strategies, weapons and materials, technology, numbers of soldiers, and of course, the human element. More specifically, cohesion, e.g. interpersonal bond of an organization in order to sustain their will and commitment to each other, their unit, and the mission, plays a major role in this regard. Importantly, defining the objectives and purposes of the battle, appropriate and timely logistic support, structural organization with regard to individual characteristics, and leadership would influence military cohesion. Furthermore, motivation and control, surveillance and conformity, commonality of values and societal factors play important role on the small unit cohesion. However, civic education is most effective in the soldiers’ contribution and resistance within and after a battle. Then commanders and leaders construct the bases of cohesion in their unit by assessing the individual psychological state, societal condition, and spiritual characteristics to obtain success during a confrontation. In this literature review, several psychological aspects of cohesion are outlined. JAMM International expects receiving expert opinions from military systems in respect of their own cultural and organization characteristics, and requirements for a discussion.

Combat Disorders;Psychology;Military Medicine;Cohesion Combat Disorders;Psychology;Military Medicine;Cohesion http://www.jammonline.com/index.php?page=article&article_id=18224 Farshad Najafipour Farshad Najafipour Department of Public Health, School of Medicine, Aja University of Medical Sciences, Tehran, IR Iran; Department of Public Health, School of Medicine, Aja University of Medical Sciences, Tehran, IR Iran. Tel/Fax: +98-2188337909 Department of Public Health, School of Medicine, Aja University of Medical Sciences, Tehran, IR Iran; Department of Public Health, School of Medicine, Aja University of Medical Sciences, Tehran, IR Iran. Tel/Fax: +98-2188337909
en 10.5812/jamm.18551 When They Return From Afghanistan/Iraq: Acceptance of Loss Due to War Injury When They Return From Afghanistan/Iraq: Acceptance of Loss Due to War Injury research-article research-article Background

Returning service members who are disabled due to war injury has risen substantially over the last decade due to increased use of body armor, extraordinary medical care and rapid return to the United Sates for medical care. This has resulted in a huge cohort of returning service members who need protracted care. Acceptance of disabling conditions requires that health care professionals have an understanding of the factors that impact injury acceptance.

Objectives

This study aimed to explicate the demographic and war-related factors that impact acceptance of war related disability.

Patients and Methods

The Acceptance of disability scale was used to assess factors related to acceptance of a war-related injury. Members of the Warrior Transition Brigade in two Department of Defense hospitals were surveyed (n = 157).

Results

Finding showed that the majority of participants accepted their disabling condition at the ‘medium’ level with nuances regarding demographic factors. There was no impact for age, deployment length and deployment frequencies on the findings. Additional findings highlight specific subscale areas impacting disability acceptance.

Conclusions

Health care professionals engaged in working with the combat related war injured need to be sensitive to the factors that impact adjustment to their disability. Findings point in specific directions to enable this level of care.

Background

Returning service members who are disabled due to war injury has risen substantially over the last decade due to increased use of body armor, extraordinary medical care and rapid return to the United Sates for medical care. This has resulted in a huge cohort of returning service members who need protracted care. Acceptance of disabling conditions requires that health care professionals have an understanding of the factors that impact injury acceptance.

Objectives

This study aimed to explicate the demographic and war-related factors that impact acceptance of war related disability.

Patients and Methods

The Acceptance of disability scale was used to assess factors related to acceptance of a war-related injury. Members of the Warrior Transition Brigade in two Department of Defense hospitals were surveyed (n = 157).

Results

Finding showed that the majority of participants accepted their disabling condition at the ‘medium’ level with nuances regarding demographic factors. There was no impact for age, deployment length and deployment frequencies on the findings. Additional findings highlight specific subscale areas impacting disability acceptance.

Conclusions

Health care professionals engaged in working with the combat related war injured need to be sensitive to the factors that impact adjustment to their disability. Findings point in specific directions to enable this level of care.

Veterans;Wounding;Injury Acceptance;Wartime Disability Veterans;Wounding;Injury Acceptance;Wartime Disability http://www.jammonline.com/index.php?page=article&article_id=18551 Joan Beder Joan Beder Wurzweiler School of Social Work, Yeshiva University, New York, USA; Wurzweiler School of Social Work, Yeshiva University, New York, NY, USA. Tel: +1-2129605229, Fax: +1-2129600821 Wurzweiler School of Social Work, Yeshiva University, New York, USA; Wurzweiler School of Social Work, Yeshiva University, New York, NY, USA. Tel: +1-2129605229, Fax: +1-2129600821
en 10.5812/jamm.19260 Welcome JAMM International! Welcome JAMM International! letter letter Letter;Military Medicine;Publications Letter;Military Medicine;Publications http://www.jammonline.com/index.php?page=article&article_id=19260 Mohammad Reza Safarinejad Mohammad Reza Safarinejad Department of Urology, Aja University of Medical Sciences, Tehran, IR Iran; Department of Urology, Aja University of Medical Sciences, Tehran, IR Iran. Tel-Fax: +98-88337909 Department of Urology, Aja University of Medical Sciences, Tehran, IR Iran; Department of Urology, Aja University of Medical Sciences, Tehran, IR Iran. Tel-Fax: +98-88337909
en 10.5812/jamm.18133 Machine Learning Techniques in Predicting Delayed Pneumothorax and Hemothorax Following Blunt Thoracic Trauma Machine Learning Techniques in Predicting Delayed Pneumothorax and Hemothorax Following Blunt Thoracic Trauma brief-report brief-report Background

Delayed pneumothorax and hemothorax are among the possible fatal complications of blunt thoracic trauma.

Objectives

Finding reliable criteria for timely diagnosis of high-risk patients has been an area of interest for researchers.

Material and methods

We gathered a database including 616 patients among which, 17 patients experienced the delayed complications. Employing four classification techniques, namely, linear regression, logistics regression, artificial neural network, and naïve Bayesian classifier, we tried to find a predictive pattern to recognize patients with positive results based on recorded clinical and radiological variables at the time of admission.

Results

First, without using machine learning techniques, we tried to predict the complications based only on a single variable. We recognized chest wall tenderness as the best single criterion that enables to classify all high-risk patients with 100% sensitivity (95% CI, 82-100). This criterion potentially excludes 57% (95% CI, 53-61) of low-risk patients from further observation. Then we used the machine learning techniques to assess the effect of all admission time variables together. According to our results, amongst the utilized techniques, logistics regression model enables not only to exclude 81% (95% CI, 77-84) of patients without complications from unnecessary observation, but also to recognize all patients with true positive results for pneumothorax and hemothorax (95% CI, 82-100).

Conclusions

Instead of serial chest X-ray, patients with blunt chest trauma could be initially evaluaed by a risk assessment model in order to avoid unnecessary work-up.

Background

Delayed pneumothorax and hemothorax are among the possible fatal complications of blunt thoracic trauma.

Objectives

Finding reliable criteria for timely diagnosis of high-risk patients has been an area of interest for researchers.

Material and methods

We gathered a database including 616 patients among which, 17 patients experienced the delayed complications. Employing four classification techniques, namely, linear regression, logistics regression, artificial neural network, and naïve Bayesian classifier, we tried to find a predictive pattern to recognize patients with positive results based on recorded clinical and radiological variables at the time of admission.

Results

First, without using machine learning techniques, we tried to predict the complications based only on a single variable. We recognized chest wall tenderness as the best single criterion that enables to classify all high-risk patients with 100% sensitivity (95% CI, 82-100). This criterion potentially excludes 57% (95% CI, 53-61) of low-risk patients from further observation. Then we used the machine learning techniques to assess the effect of all admission time variables together. According to our results, amongst the utilized techniques, logistics regression model enables not only to exclude 81% (95% CI, 77-84) of patients without complications from unnecessary observation, but also to recognize all patients with true positive results for pneumothorax and hemothorax (95% CI, 82-100).

Conclusions

Instead of serial chest X-ray, patients with blunt chest trauma could be initially evaluaed by a risk assessment model in order to avoid unnecessary work-up.

Thorax;Pneumothorax;Hemothorax;Linear Model;Logistic Models Thorax;Pneumothorax;Hemothorax;Linear Model;Logistic Models http://www.jammonline.com/index.php?page=article&article_id=18133 Ali Reza Khoshdel Ali Reza Khoshdel Department of Epidemiology, Aja University of Medical Sciences, Tehran, IR Iran Department of Epidemiology, Aja University of Medical Sciences, Tehran, IR Iran Hamidreza Bayati Hamidreza Bayati Department of Surgery, Isfahan University of Medical Sciences, Isfahan, IR Iran; Department of Surgery, Isfahan University of Medical Sciences, Isfahan, IR Iran. Tel: +98-9102008954 Department of Surgery, Isfahan University of Medical Sciences, Isfahan, IR Iran; Department of Surgery, Isfahan University of Medical Sciences, Isfahan, IR Iran. Tel: +98-9102008954 Babak Shekarchi Babak Shekarchi Department of Surgery, Isfahan University of Medical Sciences, Isfahan, IR Iran Department of Surgery, Isfahan University of Medical Sciences, Isfahan, IR Iran Seyyed Ehsan Toossi Seyyed Ehsan Toossi Department of Surgery, Isfahan University of Medical Sciences, Isfahan, IR Iran Department of Surgery, Isfahan University of Medical Sciences, Isfahan, IR Iran Behnam Sanei Behnam Sanei Department of Surgery, Isfahan University of Medical Sciences, Isfahan, IR Iran Department of Surgery, Isfahan University of Medical Sciences, Isfahan, IR Iran
en 10.5812/jamm.16516 The Effect of α-TCP Particle Size on Mechanical and Setting Properties of Calcium Phosphate Bone Cements The Effect of α-TCP Particle Size on Mechanical and Setting Properties of Calcium Phosphate Bone Cements research-article research-article Background

Calcium phosphate cements (CPCs) show several advantages over other materials, used for bone repair. For example, they are injectable, easily shapeable and remained localized. Therefore, they fill effectively bone defects with an irregular shape. Furthermore, CPCs are very bone compatible and also osteoconductive.

Objectives

This work aimed to investigate the effect of particle size on the mechanical and setting properties of α-tricalcium phosphate (α-TCP) based cements. The rate of conversion of reactants to nano-hydroxyapatite (nHA) in the medium of human blood plasma is also studied.

Materials and Methods

In this study, we prepared CPCs consisting of α-TCP (61%), dicalcium phosphate (DCP) (26%), calcium carbonate (CaCO3), hydroxyapatite (HA) (3%) as powder phase, in a solution of 3 wt% NaH2PO4 as liquid phase. In the next step, three different cements with the same formulation but different α-TCP particle sizes (4 μm, 10 μm, 22 μm) were prepared. Finally, we evaluated the setting time, compressive strength and the rate of conversion of reactants to apatite phase in blood plasma.

Results

Based on the results, the initial setting time decreased from 30 minutes for CPC with α-TCP particle size of 22 μm to 15 minutes for the cement with α-TCP particle size of 4 μm. Also, the cement prepared with the least α-TCP particle size exhibited the maximum compressive strength after setting. The results revealed that reduction of α-TCP particle size, the main component of the CPC, favors conversion of cement constituents to needle-like nano-apatite crystals when soaking in human blood plasma, and this leads to increment of mechanical strength.

Conclusions

In α-TCP based CPCs, reduction of α-TCP particle size favors the conversion of the cement constituents to nano-apatite crystals (when soaking in human blood plasma), which leads to reduction of setting time and increase in mechanical strength of CPCs.

Background

Calcium phosphate cements (CPCs) show several advantages over other materials, used for bone repair. For example, they are injectable, easily shapeable and remained localized. Therefore, they fill effectively bone defects with an irregular shape. Furthermore, CPCs are very bone compatible and also osteoconductive.

Objectives

This work aimed to investigate the effect of particle size on the mechanical and setting properties of α-tricalcium phosphate (α-TCP) based cements. The rate of conversion of reactants to nano-hydroxyapatite (nHA) in the medium of human blood plasma is also studied.

Materials and Methods

In this study, we prepared CPCs consisting of α-TCP (61%), dicalcium phosphate (DCP) (26%), calcium carbonate (CaCO3), hydroxyapatite (HA) (3%) as powder phase, in a solution of 3 wt% NaH2PO4 as liquid phase. In the next step, three different cements with the same formulation but different α-TCP particle sizes (4 μm, 10 μm, 22 μm) were prepared. Finally, we evaluated the setting time, compressive strength and the rate of conversion of reactants to apatite phase in blood plasma.

Results

Based on the results, the initial setting time decreased from 30 minutes for CPC with α-TCP particle size of 22 μm to 15 minutes for the cement with α-TCP particle size of 4 μm. Also, the cement prepared with the least α-TCP particle size exhibited the maximum compressive strength after setting. The results revealed that reduction of α-TCP particle size, the main component of the CPC, favors conversion of cement constituents to needle-like nano-apatite crystals when soaking in human blood plasma, and this leads to increment of mechanical strength.

Conclusions

In α-TCP based CPCs, reduction of α-TCP particle size favors the conversion of the cement constituents to nano-apatite crystals (when soaking in human blood plasma), which leads to reduction of setting time and increase in mechanical strength of CPCs.

Bone Cements;Hydroxyapatite;Particle Size Bone Cements;Hydroxyapatite;Particle Size http://www.jammonline.com/index.php?page=article&article_id=16516 Mostafa Shahrezaei Mostafa Shahrezaei Department of Orthopedic Surgery, AJA University of Medical Sciences, Tehran, IR Iran Department of Orthopedic Surgery, AJA University of Medical Sciences, Tehran, IR Iran Jalal Shahrouzi Jalal Shahrouzi Department of Nanotechnology and Advanced Materials, Materials and Energy Research Center, Karaj, IR Iran; Department of Nanotechnology and Advanced Materials, Materials and Energy Research Center, No. 364/2, 107 St. Shahrdari Blvd., Mehrshahr, Karaj, IR Iran. Tel: +98-9125842262, Fax: +98-2636201888 Department of Nanotechnology and Advanced Materials, Materials and Energy Research Center, Karaj, IR Iran; Department of Nanotechnology and Advanced Materials, Materials and Energy Research Center, No. 364/2, 107 St. Shahrdari Blvd., Mehrshahr, Karaj, IR Iran. Tel: +98-9125842262, Fax: +98-2636201888 Saeed Hesaraki Saeed Hesaraki Department of Nanotechnology and Advanced Materials, Materials and Energy Research Center, Karaj, IR Iran Department of Nanotechnology and Advanced Materials, Materials and Energy Research Center, Karaj, IR Iran Ali Zamanian Ali Zamanian Department of Nanotechnology and Advanced Materials, Materials and Energy Research Center, Karaj, IR Iran Department of Nanotechnology and Advanced Materials, Materials and Energy Research Center, Karaj, IR Iran
en 10.5812/jamm.18643 Epidemiology of Superficial Fungal Infections in Iran Army Personnel Epidemiology of Superficial Fungal Infections in Iran Army Personnel research-article research-article Conclusions

The overall trend of SFIs in recent years has been declining, but it is still a common problem of army personnel, especially in Naval Force and in warm and humid areas. Army health commanders must do their best to decrease the incidence by improving health knowledge and facilities, particularly in the most endemic areas.

Patients and Methods

This research was a retrospective study from 2005 to 2011. Data were collected from the regional surveillance system of Iran Army and double checked in the Deputy of Health of AJA University of Medical Sciences. Analysis was performed using appropriate statistical functions by Stata Software.

Objectives

The main objective of this study was to evaluate the epidemiologic features of SFIs in Iran Army personnel.

Background

Although there are different classifications for dermatomycosis or fungal infection of skin and its appendages, in this study, we consider only superficial type (tinea versicolor) and cutaneous one (dermatophytosis) under the common title of superficial fungal infections (SFIs). Tinea versicolor commonly affects the outermost skin layer of the young and manifests as reddish-brown or light skin spots. Dermatophytosis can affect deeper layers of skin and hair into the epidermis at the scalp, feet, and groin area. It is caused by only three types of dermatophytes: Epidermophyton, Trichophyton, and Microsporum. Previous studies have already shown the high prevalence of SFIs in military personnel. This is due to the many predisposing factors for these infections in any military system such as poor hygiene, frequent use of gummed shoes, and massive sweating during military maneuvers.

Results

During these 7 years, 9707 cases of SFIs were reported. Sixty percent of them were diagnosed during the warm months of spring and summer. About 58% of the cases were reported from four provinces, including Hormozgan, Guilan, Semnan and Khorasan Razavi and finally about half of reports (48%) were from Naval Force.

Conclusions

The overall trend of SFIs in recent years has been declining, but it is still a common problem of army personnel, especially in Naval Force and in warm and humid areas. Army health commanders must do their best to decrease the incidence by improving health knowledge and facilities, particularly in the most endemic areas.

Patients and Methods

This research was a retrospective study from 2005 to 2011. Data were collected from the regional surveillance system of Iran Army and double checked in the Deputy of Health of AJA University of Medical Sciences. Analysis was performed using appropriate statistical functions by Stata Software.

Objectives

The main objective of this study was to evaluate the epidemiologic features of SFIs in Iran Army personnel.

Background

Although there are different classifications for dermatomycosis or fungal infection of skin and its appendages, in this study, we consider only superficial type (tinea versicolor) and cutaneous one (dermatophytosis) under the common title of superficial fungal infections (SFIs). Tinea versicolor commonly affects the outermost skin layer of the young and manifests as reddish-brown or light skin spots. Dermatophytosis can affect deeper layers of skin and hair into the epidermis at the scalp, feet, and groin area. It is caused by only three types of dermatophytes: Epidermophyton, Trichophyton, and Microsporum. Previous studies have already shown the high prevalence of SFIs in military personnel. This is due to the many predisposing factors for these infections in any military system such as poor hygiene, frequent use of gummed shoes, and massive sweating during military maneuvers.

Results

During these 7 years, 9707 cases of SFIs were reported. Sixty percent of them were diagnosed during the warm months of spring and summer. About 58% of the cases were reported from four provinces, including Hormozgan, Guilan, Semnan and Khorasan Razavi and finally about half of reports (48%) were from Naval Force.

Army;Dermatomycosis;Epidemiology;Fungal Infection;Iran Army;Dermatomycosis;Epidemiology;Fungal Infection;Iran http://www.jammonline.com/index.php?page=article&article_id=18643 Shahram Rahimi Dehgolan Shahram Rahimi Dehgolan Faculty of Medicine, Tehran University of Medical Sciences, Tehran, IR Iran Faculty of Medicine, Tehran University of Medical Sciences, Tehran, IR Iran Seyyed Javad Hosseini Shokouh Seyyed Javad Hosseini Shokouh Infectious Diseases Department, AJA University of Medical Sciences, Tehran, IR Iran Infectious Diseases Department, AJA University of Medical Sciences, Tehran, IR Iran Mahtab Noorifard Mahtab Noorifard Infectious Diseases Department, AJA University of Medical Sciences, Tehran, IR Iran Infectious Diseases Department, AJA University of Medical Sciences, Tehran, IR Iran Arasb Dabbagh Moghaddam Arasb Dabbagh Moghaddam Deputy of Health, AJA University of Medical Sciences, Tehran, IR Iran Deputy of Health, AJA University of Medical Sciences, Tehran, IR Iran Elnaz Tabibian Elnaz Tabibian Faculty of Medicine, Tehran University of Medical Sciences, Tehran, IR Iran; Faculty of Medicine, Tehran University of Medical Sciences, Tehran, IR Iran. Tel/Fax: +98-2188002581 Faculty of Medicine, Tehran University of Medical Sciences, Tehran, IR Iran; Faculty of Medicine, Tehran University of Medical Sciences, Tehran, IR Iran. Tel/Fax: +98-2188002581
en 10.5812/jamm.20634 JAMM, Simurgh and Spiritual Symbol of Medicine JAMM, Simurgh and Spiritual Symbol of Medicine letter letter Spiritual Health;History of Medicine;Mythology Spiritual Health;History of Medicine;Mythology http://www.jammonline.com/index.php?page=article&article_id=20634 Alireza Zali Alireza Zali Functional Neurosurgery Research Center, Shahid Beheshti University of Medical Sciences, Tehran, IR Iran; Functional Neurosurgery Research Center, Shahid Beheshti University of Medical Sciences, Tehran, IR Iran. Tel: +98-2188945186, Fax: +98-2122749204 Functional Neurosurgery Research Center, Shahid Beheshti University of Medical Sciences, Tehran, IR Iran; Functional Neurosurgery Research Center, Shahid Beheshti University of Medical Sciences, Tehran, IR Iran. Tel: +98-2188945186, Fax: +98-2122749204