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TheUnitedStatesArmyVeterinaryCorps JanuaryMarch2009 Perspective 1 ACorpsChallenged,Capable,andCommitted 5 FoodandWaterRiskAssessment:ADecisionToolfortheTacticalCommander 7 QualityAssurance,Networking,andCollaborationActionsbythe 12 DoDVeterinaryFoodAnalysisandDiagnosticLaboratory FoodandWaterborneDiseaseThreats 15 AVeterinaryServiceSquadDeploymentinSupportofOperationIraqiFreedom 21 VeterinaryCivilActionProgramsinAfghanistan:Pros,Cons,andHow 25 OverviewofCombatTraumainMilitaryWorkingDogsinIraqandAfghanistan 33 MilitaryWorkingAnimalChemical,Biological,Radiological,andNuclear 38 ProtectionandMedicalCountermeasures ValidationandOperationalApplicationofaRapidMethodforRabiesAntigenDetection 42 BVirus(CercopithecineHerpesvirus 1 )TherapyandPreventionRecommendations 46 DirectedEnergy(Laser)InducedRetinalInjury: 51 CurrentStatusofSafety,Triage,andTreatmentResearch OpportunitiesforMilitaryMedicalOfficers:TheEpidemicIntelligenceService 57 attheCentersforDiseaseControlandPrevention The3rdArmyRescueoftheLipizzaners 59 A LSOINTHIS ISSUE FreshFrozenPlasma 64 TotalIntravenousAnesthesiaontheBattlefield 68 ShouldWeTeachEverySoldierHowtoStartIntravenousFluids? 73 AbstractsfromtheUSArmy-BaylorDoctoralPrograminPhysicalTherapy 76
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LTGEricB.SchoomakerTheSurgeonGeneralCommander,USArmyMedicalCommandMGRussellJ.CzerwCommandingGeneralUSArmyMedicalDepartmentCenterandSchool JanuaryMarch2009TheArmyMedicalDepartmentCenter&SchoolPB8-09-1/2/3 0835304GEORGEW.CASEY,JRGeneral,UnitedStatesArmyChiefofStaff DISTRIBUTION:SpecialAdministrativeAssistanttotheSecretaryoftheArmyByOrderoftheSecretaryoftheArmy:Official: JOYCEE.MORROWOnlineissuesoftheAMEDDJournalareavailableathttp://www.cs.amedd.army.mil/references_publications.aspx AProfessionalPublicationoftheAMEDDCommunity TheArmyMedicalDepartmentJournal[ISSN1524-0436]ispublishedquarterlyforTheSurgeonGeneralbytheUSArmyMedicalDepartmentCenter&School,ATTN:MCCS-HSASte135,1750GreeleyRoad,FortSamHouston,TX78234-5078.CORRESPONDENCE:Manuscripts,photographs,officialunitrequeststoreceivecopies,andunitaddresschangesordeletionsshouldbesenttotheJournalattheaboveaddress.Telephone:(210)221-6301,DSN471-6301DISCLAIMER:TheJournalpresentsclinicalandnonclinicalprofessionalinformationtoexpandknowledgeofdomestic&internationalmilitarymedicalissuesandtechnologicaladvances;promotecollaborativepartnershipsamongServices,components,Corps,andspecialties;conveyclinicalandhealthservicesupportinformation;andprovideapeer-reviewed,highquality,printmediumtoencouragedialogueconcerninghealthcareinitiatives.Viewsexpressedarethoseoftheauthor(s)anddonotnecessarilyreflectofficialUSArmyorUSArmyMedicalDepartmentpositions,nordoesthecontentchangeorsupersedeinformationinotherArmyPublications.TheJournalreservestherighttoeditallmaterialsubmittedforpublication(seeinsidebackcover).CONTENT:Contentofthispublicationisnotcopyrightprotected.Materialmaybereprintedifcreditisgiventotheauthor(s).OFFICIALDISTRIBUTION:ThispublicationistargetedtoUSArmyMedicalDepartmentunitsandorganizations,andothermembersofthemedicalcommunityworldwide.
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JanuaryMarch2009 1 AMEDDJournal AMEDDJournal DepartmentofDefenseDirective6400.4 Perspective MajorGeneralRussellJ.Czerw
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2 www.cs.amedd.army.mil/references_publications.aspx Perspective
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JanuaryMarch2009 3 T HE A RMY M EDICAL D EPARTMENT J OURNAL AMEDDJournal
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4 www.cs.amedd.army.mil/references_publications.aspx Perspective R EFERENCE DepartmentofDefenseInstruction6400.4:DoD VeterinaryServicesProgram
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JanuaryMarch2009 5 ACorpsChallenged,Capable,and Committed BrigadierGeneralTimothyK.Adams BGAdamsisChiefoftheUSArmyVeterinary CorpandtheAssistantSurgeonGeneral,Force Projection.
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6 www.cs.amedd.army.mil/references_publications.aspx ACorpsChallenged,Capable,andCommitted
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JanuaryMarch2009 7 B ACKGROUND FoodandWaterRiskAssessment: ADecisionToolfortheTacticalCommander S CENARIO http://www.ngb.army.mil/ia/Tab2.aspx
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8 www.cs.amedd.army.mil/references_publications.aspx R ECEIVING T HE M ISSION Military Standard3006 TechnicalBulletinMED 530 FoodandWaterRiskAssessment:ADecisionToolfortheTacticalCommander
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JanuaryMarch2009 9 T HE A RMY M EDICAL D EPARTMENT J OURNAL E XECUTE T HE M ISSION MilitaryStandard3006 Recommendedminimumtestkitequipmentformember ofFWRAteam.
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10 www.cs.amedd.army.mil/references_publications.aspx TechnicalGuide248 R EPORTING C ONCLUSION TechnicalGuide248 FoodandWaterRiskAssessment:ADecisionToolfortheTacticalCommander Amanagementsystem,alsoknownasHACCP,bywhichfoodsafetyisaddressedthroughtheanalysisandcontrolof biological,chemical,andphysicalhazardsfromrawmaterialproduction,procurement,andhandling,tomanufacturing, distribution,andconsumptionofthefinishedproduct,namelythefarm-to-table-continuum.Source:http:// www.afdo.org/afdo/HACCP/ https://doehsportal.apgea.army.mil/doehrs-oehs/
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JanuaryMarch2009 11 T HE A RMY M EDICAL D EPARTMENT J OURNAL Thedeterminedprobabilityofagivenhazardmappedagainstthathazardsseverity definesthecorrespondingriskestimateforthatcombinationoffactors. HazardProbability HazardSeverity Frequent(A)Likely(B)Occasional(C)Seldom(D)Unlikely(E) [CorrespondingRiskEstimate] Catastrophic(I) Extremely High Extremely High High High Moderate Critical(II) Extremely High High High Moderate Low Marginal(III) High Moderate Moderate Low Low Negligible(IV) Moderate Low Low Low Low R EFERENCES Mil-Std-3006:SanitationRequirementsforFoodEstablishments TechnicalBulletinMED530:OccupationalandEnvironmentalHealthFoodSanitation TechnicalGuide248:GuideforDeployedPreventiveMedicinePersonnelonHealthRiskAssessment A UTHOR
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12 www.cs.amedd.army.mil/references_publications.aspx I NTRODUCTION Q UALITY A SSURANCE ISO/IEC17025:2005 /IEC17025 QualityAssurance,Networking,and CollaborationActionsbytheDoDVeterinary FoodAnalysisandDiagnosticLaboratory AssociationofAnalyticalCommunities.Informationavailableat:http://www.aoac.org/.AccessedJan23,2009.
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JanuaryMarch2009 13 L ABORATORY NETWORKINGAND C OLLABORATIONS Informationavailableat:http://www.usamriid.army.mil/ Informationavailableat:http://www.fernlab.org/ ElectronicLaboratoryExchangeNetwork(USDeptofAgricultureandtheFoodandDrugAdministration).Information availableat:http://www.boozallen.com/consulting/industries_article/658975.AccessedJanuary23,2009. USDeptofAgriculture,AnimalandPlantHealthInspectionService.Informationavailableat:http://www.aphis.usda. gov/animal_health/nahln/.AccessedJanuary23,2009.
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14 www.cs.amedd.army.mil/references_publications.aspx C ONCLUSION QualityAssurance,Networking,andCollaborationActionsbythe DoDVeterinaryFoodAnalysisandDiagnosticLaboratory R EFERENCES ANSI/ISO/IEC17025-2005AmericanNationalStandard:GeneralRequirementsfor theCompetenceofTestingandCalibrationLaboratories. A UTHOR
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JanuaryMarch2009 15 FoodandWaterborneDiseaseThreats TheOneHealthConcept,firstarticulatedbyearly scientistssuchasRudolphVirchow,recognizestheintimate relationshipbetweenhumanhealth,animalhealthandthe environment,andcallsforanintegrative,collaborative approachtohealthbyencouragingthecollaboration betweenexpertsofdiversefieldsofstudy. 3 Retail/ Serving The Consumer Transportation Distribution Preparation Production Processing Figure1.Thefoodchainconsistsofinterconnectedsteps fromfarmtofork,eachwithitsownuniquearrayofvulnerabilitiestounintentionalordeliberateadulteration.
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16 www.cs.amedd.army.mil/references_publications.aspx Campylobacter Proliferation:Threatand Response caveatemptor Figure2.Lossofconsumerconfidenceinthesafetyofthe foodchaincarriessignificantsocial,economic,andpoliticalimplications.Eventheperceptionofunsafefoodcan potentiallycauselarge-scaleperturbationsinglobal markets. FoodandWaterborneDiseaseThreats
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JanuaryMarch2009 17 T HE A RMY M EDICAL D EPARTMENT J OURNAL Salmonella Campylobacter Shigella S HIGA -T OXIN P RODUCING E SCHERICIACOLI E.coli E.coli NOROVIRUS
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18 www.cs.amedd.army.mil/references_publications.aspx C RYPTOCOCCUSNEOFORMANS Cryptococcusneoformans T RICHINOSIS Trichinellaspiralis Figure3.Anelectronmicrographof Cryptosporidiumparvum organisms withinanenterocyte. FoodandWaterborneDiseaseThreats
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JanuaryMarch2009 19 T HE A RMY M EDICAL D EPARTMENT J OURNAL Figure4.Aphotomicrographofmuscle tissuefromabear,demonstrating profilesof Trichinellaspiralis larvae. R EFERENCES EmergInfectDis. EmergInfect Dis. JAmVetMedAssoc IntJToxicol. EmergInfectDis. Proliferation:ThreatandResponse WashingtonPost PRNewswire Outbreakalert!ClosingthegapsinourFederalfood-safetynet.
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20 www.cs.amedd.army.mil/references_publications.aspx EmergInfectDis. MMWR.MorbMortalWklyRep. EmergInfect Dis. JAmerVetMedAssoc. MMWR.MorbMortalWklyRep. EmergInfectDis. ApplEnvironMicrobiol. EmergInfect Dis. MMWR.MorbMortalWklyRep. MMWR. MMWRMorbMortalWklyRep NewEngJMed EmergInfectDis. MMWR.MorbMortalWklyRep. QJM. CommunDisRepCDRRev MMWR.MorbMortalWklyRep JAmerVetMedAssoc. WorldwideDirectoryofSanitarilyApprovedFoodEstablishmentsforArmedForcesProcurement DefeatIntoVictory A UTHOR FoodandWaterborneDiseaseThreats
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JanuaryMarch2009 21 I NTRODUCTION F OOD M ISSION ReceiptInspections FoodTrends UnapprovedSources WorldwideDirectoryof SanitarilyApprovedFoodEstablishmentsfor ArmedForcesProcurement InsectInfestation AVeterinaryServiceSquadDeploymentIn SupportofOperationIraqiFreedom Militaryoccupationalspecialty ArmyandAirForceExchangeService
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22 www.cs.amedd.army.mil/references_publications.aspx TemperatureAbuse A NIMAL M ISSION MilitaryWorkingDogs PreventiveMedicine PhysicalExaminations SickCall/Emergency/SurgicalCare Asecureareaoutsideandawayfromtheentrancegate ofabasewhereguardsandbombdogssearchvehicles forexplosivesbeforeallowingthemtoenter. Figure1.Beetlesinpasta. AVeterinaryServiceSquadDeployment,OperationIraqiFreedom Figure2.Insectinunopened, sealedbottleofwater.
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JanuaryMarch2009 23 T HE A RMY M EDICAL D EPARTMENT J OURNAL MedicalEvacuation KennelInspections HandlerTraining MWDTrends. Otitisexterna Figure3.Beefwithfreezerburn.Some packageswerebrokenexposingraw meat. Figure4.Thawedandrefrozenchicken. Evidenceofpurge,frozenbloodand juicesoutsidethechicken. Figure5.Refrigerationunitfailedinthetrucktransportingfrozenmeatenroute (left).Theoutsideairtemperaturewas120F.Bloodfromthawedmeatflowedfrom thetruckwheninspectorsopenedthedoors(right).
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24 www.cs.amedd.army.mil/references_publications.aspx Dentaldisease StrayAnimalControl/RabiesBiteControlProgram HealthChecksonLocalAnimals C ONCLUSION R EFERENCES ArmyRegulation40-905:VeterinaryHealthServices ArmyRegulation40-657:Veterinary/MedicalFood InspectionandLaboratoryService WorldwideDirectoryofSanitarilyApprovedFood EstablishmentsforArmedForcesProcurement TheHandbookofVeterinaryCareandManagement oftheMilitaryWorkingDog ArmyPamphlet190-12:MilitaryWorkingDog Program A UTHOR AVeterinaryServiceSquadDeployment,OperationIraqiFreedom
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JanuaryMarch2009 25 I NTRODUCTION VeterinaryCivilActionProgramsin Afghanistan:Pros,Cons,andHow A BSTRACT
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26 www.cs.amedd.army.mil/references_publications.aspx M ETHODOLOGY VeterinaryCivilActionProgramsinAfghanistan:Pros,Cons,andHow
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JanuaryMarch2009 27 T HE A RMY M EDICAL D EPARTMENT J OURNAL R ESULTS Figure1.VeterinaryFieldUnitsinAfghanistan.(Source:AfghanVeterinaryAssociation)
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28 www.cs.amedd.army.mil/references_publications.aspx D ISCUSSION BiasesinDataCollection NumbersofanimalsseenatVETCAPsinAfghanistan,August2006throughFebruary 2007(minusthoseinKabul Ghazni ). Province BalkhBamianGardezKapisaNangarharPanjshirKandarhar Cattle 791472846169121051 Sheep/Goats 188169075931229246096 Donkeys 20337332621293 Horses 358 1190400 Dogs 201454 95 Camels 00 0045 00 %AccesstoVFU 0%0.75% Data Unreliable 66%100%21% Vaccination Rate 4%20% 13%7%4% TheprincipleinvestigatorwasabsentatthoseVETCAPs. Percentofherdsmenwhoreportedtheiranimalshadeverbeenvaccinated. NoData Figure2.Packhorsewithopenwoundcausedbypoorlyfittedpackandpoorbodycondition(Nangarhar).Owner complainedthatthelocalveterinarianwasineffective becausehecouldntfixthewoundwhileallowingthe animaltocontinuetowork.IfIdonttakegoodsoverthe passeverydaywithmyhorse,myfamilydoesnteat,was hisreplywhenIaskedhimtorestthehorse. VeterinaryCivilActionProgramsinAfghanistan:Pros,Cons,andHow
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JanuaryMarch2009 29 T HE A RMY M EDICAL D EPARTMENT J OURNAL GeneralStateofVeterinaryServicesinAfghanistan Figure3:Bloatwassurprisinglycommon.Thelocalsinthe smallvillageinGardezProvincehavediscoveredacure. Onedownercowalsopresentedatthissiteinwhichthe herdsmanhadputaknifethroughtheomasumandintothe lungs. Overthe3yearsforwhichdatawasavailable,withtheexceptionofPanjshirProvince,theCMAteamrevisitedanarea nearaprevioussiteonlyonce.During2006,therewere3missionstoPanjshir,morethananyotherprovince,andthere wassomepotentialoverlapinareaofeffect.Thiswasdoneattheinsistenceoftheprovincialgovernor.However,there werevirtuallynovisitspriorto2006.Aslongassitevisitstothesameareasdonotrepeatinsubsequentyears,the effectwillbenegligible. Therewasgenerallynocellphoneortaxiserviceintheareasinwhichweworked. Figure4.Chroniclaminitis(phototakeninGardez)may havecausedslipperfeetincows.Thiswasacommon findinginKandaharaswell.
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30 www.cs.amedd.army.mil/references_publications.aspx PresumptiveCompetition WaystoMeettheGoalsWithoutSacrificingthe VeterinaryCommunity VeterinaryCivilActionProgramsinAfghanistan:Pros,Cons,andHow
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JanuaryMarch2009 31 T HE A RMY M EDICAL D EPARTMENT J OURNAL O THER W AYSTO A SSIST C ONCLUSION Figure6.Horsewithhoofabscesswhichhasextendedinto coronetarea(Nangarhar). Figure5.Whitelineabscessinapack horseontheAfghanistan-Pakistan border. UnitedNationsEducation,Scientific,andCulturalOrganization InstudiesconductedamongthemigratingherdsmeninAfrica,theeconomicbenefitofkeepingathinanimalthatcould laterbefattenedoutweighedthepotentialbenefitofincreasedoffspringduetomoreorbetterforageperanimal. 3
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32 www.cs.amedd.army.mil/references_publications.aspx R EFERENCES Maasaiherding:Ananalysisofthelivestockproduction systemofMaasaipastoralistsineasternKajiadoDistrict,Kenya.ILCASystemsStudy4. A UTHOR VeterinaryCivilActionProgramsinAfghanistan:Pros,Cons,andHow
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JanuaryMarch2009 33 I NTRODUCTION D EPLOYED V ETERINARY P ERSONNEL OverviewofCombatTraumainMilitary WorkingDogsinIraqandAfghanistan Areaofconcentration
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34 www.cs.amedd.army.mil/references_publications.aspx I NJURIESAND W OUND D ISTRIBUTION Ananimalcarespecialist providespostoperative physicaltherapytoaworkingdogwhohadreceiveda gunshotwoundtotheshoulder.Thedogunderwent extendedphysicaltherapy attheDoDDogCenterat Lackland,AirForceBase, Texas,andreturnedtofull duty. Thismilitaryworkingdogincurredagunshotwoundtothe head.Followingintensivecareandtreatmentforskull fracture,detachedretina,andtraumaticbraininjury,he recoveredfullyandreturnedtoduty4monthsafterthe injury. OverviewofCombatTraumainMilitaryWorkingDogsinIraqandAfghanistan
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JanuaryMarch2009 35 T HE A RMY M EDICAL D EPARTMENT J OURNAL I NTEGRATIONOF V ETERINARY C AREINTOTHE H UMAN M EDICAL A SSETS I N T HEATER
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36 www.cs.amedd.army.mil/references_publications.aspx T ACTICAL C ANINE C OMBAT C ASUALTY C ARE: S TANDARDS B ASEDON E VIDENCEAND C OMBAT D ATA OverviewofCombatTraumainMilitaryWorkingDogsinIraqandAfghanistan AVeterinarianandhumantraumateamjoinforcestoperformlifesavingsurgeryonaworkingdoginjuredbyanexplosion.
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JanuaryMarch2009 37 T HE A RMY M EDICAL D EPARTMENT J OURNAL T HE W AY A HEAD R EFERENCES MilMed AnnSurg JTrauma DeploymentGuidelinesforMilitaryWorkingDogs JTrauma JSpecOperMed A UTHORS
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38 www.cs.amedd.army.mil/references_publications.aspx I NTRODUCTION P IGEONS H ORSESAND M ULES Inalmostanyconceivabletheaterofoperations, situationsarisewherethepresenceofhorse cavalry,inaratioofadivisiontoanarmy,willbe ofvitalmoment. Incontemplatedoperationsinmountainousterrain, plansshouldincludefacilitiesforsupplybypack train. MilitaryWorkingAnimalChemical, Biological,Radiological,andNuclear ProtectionandMedicalCountermeasures Figure1.PigeonBag,M4(E7R2),withPG103carrier, 1949.Notethehand-operatedbellowswithfilters.
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JanuaryMarch2009 39 D OGS Figure2.HorseGasMask, FlanneletteType,M1,1919. Figure3.HorseGasMask,Pack/Artillery,M4,witheyeprotection,1940.
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40 www.cs.amedd.army.mil/references_publications.aspx P RESENT D AY M EDICAL C OUNTERMEASURES MilitaryWorkingAnimalChemical,Biological,Radiological,and NuclearProtectionandMedicalCountermeasures Figure4.DogGasMask,FlanneletteType,M1,1918. Figure5.DogGasMask,M6,1944.
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JanuaryMarch2009 41 T HE A RMY M EDICAL D EPARTMENT J OURNAL FieldManual4-02.18 SupplyBulletinSB8-75-S7 SB8-75-S7 C ONCLUSION A CKNOWLEDGEMENTS R EFERENCES AmericainWWII HorsesandMulesandNationalDefense WarDogs:AHistoryofLoyaltyand Heroism FieldManual4-02.18:VeterinaryServiceTactics, Techniques,andProcedures DepartmentoftheArmySupplyBulletinSB8-75-S7 FieldManual3-0:Operations A UTHOR Noncontiguousareasofcombatoperationsdonotsharea commonboundary. 7
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42 www.cs.amedd.army.mil/references_publications.aspx I NTRODUCTION Rhabdovirus ValidationandOperationalApplicationofa RapidMethodforRabiesAntigenDetection A BSTRACT Figure1.Thepresenceofrabiesworldwide.Source:WorldHealthOrganization.Availableat:http://www.who.int/rabies/rabies_maps/en/index.html
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JanuaryMarch2009 43 R ABIES D IAGNOSTICSATTHE V ETERINARY L ABORATORY E UROPE E VOLUTION O F T HE D IRECT ,R APID I MMUNOHISTOCHEMICAL T EST 1 Table1.TotalnumberofsamplesfromIraqand Afghanistantestingpositiveforrabieswhichwere identifiedattheVeterinaryLaboratoryEuropeusing fluorescentantibodyidentification,from2004through October2008. IRAQ AFGHANISTAN YearSpeciesPositive Test YearSpeciesPositive Test 2005Canine12004Canine1 2007Canine32005Canine5 2007Mongoose12005Pig 1 2006Canine3 2008Canine1 Total 5Total 11 TheOneHealthConcept,firstarticulatedbyearly scientistssuchasRudolphVirchow,recognizesthe intimaterelationshipbetweenhumanhealth,animal health,andtheenvironment,andcallsforanintegrative, collaborativeapproachtohealthbyencouragingthe collaborationbetweenexpertsofdiversefieldsofstudy. 5
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44 www.cs.amedd.army.mil/references_publications.aspx P REDEPLOYMENT D EPLOYMENT R ESULTS Figure3.Resultsofadirectrapidimmunohistochemicaltest.Left:Negative braintouchimpression.Right:Positivereaction.Rabiesvirusantigenappearsas magentainclusionsagainstaneuronalhematoxylincounterstain Figure2.Arepresentationofthedirectrapidimmunohistochemicaltestwith10unknownsamplesandapositive andanegativecontrolslide. ValidationandOperationalApplicationofaRapidMethodforRabiesAntigenDetection
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JanuaryMarch2009 45 T HE A RMY M EDICAL D EPARTMENT J OURNAL C ONCLUSION R EFERENCES Rabies EmergInfectDis JAmVetMedAssoc A UTHORS Table2.AnimalstestedforrabiesinAfghanistanand Iraqusingthedirectrapidimmunohistochemicaltest, FebruarythroughJune2008. IRAQ AFGHANISTAN SpecimenTotal Tests PositiveSpecimenTotal Tests Positive Cat1470Cat490 Dog621Dog521 Fox170Jackal80 Jackal361 Monkey30 Rabbit20 Total1121 Cow44 Total2686
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46 www.cs.amedd.army.mil/references_publications.aspx I NTRODUCTION R ESERVOIRAND I NCIDENCEOF D ISEASEIN M ONKEYS Macaca M ODEOF T RANSMISSION BVirus(CercopithecineHerpesvirus1) TherapyandPreventionRecommendations
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JanuaryMarch2009 47 C LINICAL S IGNSIN H UMANS Figure1.Rhesusmacaque( M.mulatta )* Figure2.Japanesemacaque( M.fuscata )* Figure4.Stump-tailedmacaque( M.arctoides ) Figure3.Cynomolgusmacaque( M.fascicularis ) Figure5.Pig-tailedmacaque( M.nemestrina ) PhotosandgeographicdistributionmapscourtesyoftheNationalPrimateResearchCentersPrimateInfoNet.Available at:http://pin.primate.wisc.edu/factsheets
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48 www.cs.amedd.army.mil/references_publications.aspx D IAGNOSTIC C HALLENGES I NITIAL T REATMENT Figure6.Macaquemonkeywithalingual vesicleduetoBvirus. (PhotocourtesyofDrJ.K.Hilliard,ViralImmunologyCenter,GeorgiaStateUniversity, Atlanta,GA) BVirus(CercopithecineHerpesvirus 1 )TherapyandPreventionRecommendations
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JanuaryMarch2009 49 T HE A RMY M EDICAL D EPARTMENT J OURNAL T REATMENTOF V IRAL D ISEASE C ONCLUSION
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50 www.cs.amedd.army.mil/references_publications.aspx Macaca R EFERENCES LaboratoryAnimalMedicine Cercopithecine Herpesvirus ClinInfDis Cercopithecine herpesvirus CompMed Cercopithecineherpesvirus ThePictorialGuidetotheLivingPrimates EmergInfectDis OccupationalHealthand SafetyintheCareandUseofResearchAnimals CercopithecineHerpesvirus LaboratoryAnimalMedicine MorbMortalWklyRep Morb MortalWklyRep NonhumanPrimatesinBiomedicalResearch: BiologyandManagement Biosafetyin MicrobiologicalandBiomedicalLaboratories CercopithecineHerpesvirus JVirol A UTHOR BVirus(CercopithecineHerpesvirus 1 )TherapyandPreventionRecommendations
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JanuaryMarch2009 51 I NTRODUCTION DirectedEnergy(Laser)InducedRetinal Injury:CurrentStatusofSafety,Triage,and TreatmentResearch Figure1.Ocularhazarddistancesforcommonmilitarylasers extendtotacticallysignificantdistances.Thetoprowimages(left toright)showtheapproximateeffect(visualorresultingretinal injury)todistancerelationshipfortheGLLD.Thefourthimage indicatesthatthecollimatedlaserenergyisfocusedtoasmall spotonthesensoryretinaduetoimagingpropertiesoftheeye. Ocularexamsbyanophthalmologistareindicatedinsymptomatic exposurepatientseventhoughthepatientmaynothaveany concurrentovertphysicaltrauma.
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52 www.cs.amedd.army.mil/references_publications.aspx Figure2.AGHOSTgreenhandheldoptical surveillanceandtargetingdeviceisshown mountedonamachinegun.LaserilluminatorsaredeployedtoAfghanistanand Iraqforbothtargetdesignationand nonlethaldeterrentapplications. Figure3.Accidentalocularlaserexposurecase.Leftimage:Fourdayspostinjuryintherighteyeofapatientself exposedtoamilitarypulsedlaser.Thetwoblackarrowsindicatetwolargeareasoflesions.Rightimage:Two monthspostinjuryofthesamepatient.Theblackarrowindicatesbridgingofscarformationbetweendiscretelesions withinthefovea. DirectedEnergy(Laser)InducedRetinalInjury:CurrentStatusof Safety,Triage,andTreatmentResearch
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JanuaryMarch2009 53 T HE A RMY M EDICAL D EPARTMENT J OURNAL L ASER I NJURY M ECHANISMS C URRENT A RMY R ESEARCHON S AFETY ,T RIAGE AND T REATMENTS Figure4.Fundusphotoofmultipleexperimentally inducedlaserretinallesionsdemonstratingvariable visibleinjury.Lefttoright:Significantfoveallesionwith overthemorrhageintothevitreous;middlelesionwith redrimandwhitecenterisindicativeofretinalhemorrhage;upperrightcircularwhitelesionindicativeofa minimalvisiblelesion.Injuryvariabilityisafunctionof theexposuredoseanditslocationonretina,aswellas thevariablesofthelaser,includingwavelength,pulse duration,retinalirradiancediameterandpulserepetitionfrequency.
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54 www.cs.amedd.army.mil/references_publications.aspx DirectedEnergy(Laser)InducedRetinalInjury:CurrentStatusof Safety,Triage,andTreatmentResearch Figure5.Diagnosticimaging:Scanninglaserophthalmoscope(SLO)andopticalcoherencetomography(OCT)images ofexperimentallyinducedArgonlaserinjury.ThetoppanelindicatesnormalnoninjuredSLO/OCTscanwiththe verticalarrowontheSLO(left)imageindicatingsectionscannedtogeneratetheOCTimagetotherightofit.The whitearrowontheOCTimageindicatesthenormaldepressionofthefovealpit.Thebottompanelshowssamearea oftheretinascannedaftermultiplelesionswerecreated.The2whitearrowsindicate2lesionswithintheretinaon eithersideofthefovealpitthataredisruptionsofthephotoreceptorandretinalpigmentepitheliallayers.
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JanuaryMarch2009 55 T HE A RMY M EDICAL D EPARTMENT J OURNAL ANSI Z136.1 R ELEVANCEFOR P ATIENT C ARE FieldManual8-50 C ONCLUSION InformationavailablefromtheDefenseTechnicalInformationCenter:http://oai.dtic.mil/oai/oai?verb=getRecord metadataPrefix=html identifier=ADA232777 http://eyecareamerica.org/eyecare/conditions/macular-degeneration/amsler.cfm
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56 www.cs.amedd.army.mil/references_publications.aspx R EFERENCES ArchOphthalmol JOptSocAm JBiomedOpt SafetyWithLasersand OtherOpticalSources:AComprehensiveHandbook InvestOphthalmolVisSci PrinciplesandPracticeof Ophthalmology Retina Ophthalmology JBiomedOpt JBiomedOpt ANSIZ136.1:AmericanNationalStandardforSafe UseofLasers JLaser Appl Invest OphthalmolVisSci Ophthalmology HealthPhys FieldManual8-50:PreventionandMedical ManagementofLaserInjuries A UTHORS DirectedEnergy(Laser)InducedRetinalInjury:CurrentStatusof Safety,Triage,andTreatmentResearch
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JanuaryMarch2009 57 MorbidityMortalityWeekly Report OpportunitiesforMilitaryMedicalOfficers: TheEpidemicIntelligenceServiceatthe CentersforDiseaseControlandPrevention TheCDCusesthetermofficertodesignateaparticipantintheEIS(Source:http://www.cdc.gov/eis/about/ factsheet.htm).Consequently,inthisarticle,appearanceofthetermofficerdoesnotrefertomilitarypersonnel unlessitisusedassuchdirectlyincontext. TheEditor
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58 www.cs.amedd.army.mil/references_publications.aspx R EFERENCE FederalRegister A UTHOR TheAirForceVeterinaryCorpswasdisbandedin1980andthe272veterinariansweretransferredtotheBiomedical ScienceCorps.Theveterinarycareerfieldwaseliminatedinfiscalyear1983.(Source:http://airforcemedicine.afms .mil/sg_newswire/jan_05/BiomedicalSciencesCorpsCelebrates.htm) OpportunitiesforMilitaryMedicalOfficers:TheEpidemicIntelligenceServiceatthe CentersforDiseaseControlandPrevention
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JanuaryMarch2009 59 The3rdArmyRescueoftheLipizzaners
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60 www.cs.amedd.army.mil/references_publications.aspx COLCharlesHancockReed. (PhotocourtesyoftheLipizzan AssociationofNorthAmerica 4 ) ALipizzanermareinfrontofthestablesatHostau, Czechoslovakia,1945. (PhotocourtesyoftheLipizzanAssociationofNorthAmerica 4 ) The3rdArmyRescueoftheLipizzaners
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JanuaryMarch2009 61 T HE A RMY M EDICAL D EPARTMENT J OURNAL USArmySoldiersloadingLipizzanermaresandfoalsontotrucksfor transportfromHostau,CzechoslovakiatoSchwarzenburg,Germany, May12,1945. (PhotocourtesyoftheLipizzanAssociationofNorth America 4 ) LipizzanerhorsesintransporttoSchwarzenburg, Germany,May12,1945. (Photocourtesyofthe LipizzanAssociationofNorthAmerica 4 )
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62 www.cs.amedd.army.mil/references_publications.aspx R EFERENCES DasdeutscheHeeresveterinarwesenim ZweitenWeltkrieg UnitedStatesArmyVeterinaryServicein WorldWarII. PersonalMemoirs:AccountoftheRescueof theLipizzans Army OneofthegroupsofLipizzanerandotherhorsesmoving underUSArmycontrolfromHostau,Czechoslovakia,to Schwarzenburg,Germany,May12,1945. (Photocourtesy oftheLipizzanAssociationofNorthAmerica 4 ) GeneralPattonridingtheLipizzanerstallionFavoryAfrika inSalzburg,Austria,in1945.Thehorsehadbeenselected byAdolphHitlerhimselftobeagifttohisAxisally, EmperorHirohitoofJapan. 6 (PhotocourtesyofthePatton Museum) The3rdArmyRescueoftheLipizzaners
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JanuaryMarch2009 63 T HE A RMY M EDICAL D EPARTMENT J OURNAL MyDancingWhiteHorses GesprachemiteinemPferdemann,Dr. RudolfLessing WarasIknewit A UTHOR GeneralPattonandColonelAloisPodhajsky,CommandantoftheSpanishRidingSchool, May7,1945,inSt.Martin,Austria. 6 (PhotocourtesyoftheLipizzanAssociationofNorth America 4 )
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64 www.cs.amedd.army.mil/references_publications.aspx FreshFrozenPlasma I NTRODUCTION W HAT I S F RESH F ROZEN P LASMA ? C OAGULOPATHYAND D AMAGE C ONTROL S URGERY FreshFrozenPlasma
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JanuaryMarch2009 65 C OMBAT D ATA FFPS TORAGEAND P REPARATION T HAWED P LASMA labilefactors) U NIVERSAL F RESH F ROZEN P LASMA D ONOR 65% 34% 19% 0 10 20 30 40 50 60 70 FFP:pRBCRatioMortality(%)MortalitybyFFP:pRBCRatio.Ahighratioof1:1.4 wasassociatedwithalowermortalityrate comparedtomedium(1:2.5)andlowratios(1:8) (P<0.001). 13
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66 www.cs.amedd.army.mil/references_publications.aspx F UTURE C ONCLUSIONS R EFERENCES WorldJSurg Anesth Analg CritCareMed Anesthesiology AmJClinPathol AmJSurg BriefSciRep JTrauma CurrOpinCritCare JAm CollSurg FreshFrozenPlasma
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JanuaryMarch2009 67 T HE A RMY M EDICAL D EPARTMENT J OURNAL J Trauma JTrauma JTrauma StandardsforBloodBanksandTransfusionServices AnesthAnalg A UTHORS
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68 www.cs.amedd.army.mil/references_publications.aspx I NTRODUCTION C OMBAT A NESTHESIA :H ISTORICAL P ERSPECTIVE TotalIntravenousAnesthesiaonthe Battlefield
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JanuaryMarch2009 69 T OTAL I NTRAVENOUS A NESTHESIAVS G ENERAL t W HY TIVA IN C OMBAT
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70 www.cs.amedd.army.mil/references_publications.aspx F UTURE D IRECTION Figure1.NarkomedManesthesiaworkstationatthe399th CombatSupportHospitalinIraq. Figure2.ABaxtersyringeinfusionpump. TotalIntravenousAnesthesiaontheBattlefield
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JanuaryMarch2009 71 T HE A RMY M EDICAL D EPARTMENT J OURNAL C ONCLUSIONS R EFERENCES ABriefHistoryofMilitary Anesthesia:AnesthesiaandPerioperativeCareofthe CombatCasualty AnaesthIntensiveCare CPDAnaesthesia
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72 www.cs.amedd.army.mil/references_publications.aspx AnesthAnalg ASANewsletter AnesthAnalg AnesthAnalg EurJAnaesthesiol Anesthesiology JNeurosurg Anesthesiol Chest. ASANewsletter MilMedTech A UTHORS TotalIntravenousAnesthesiaontheBattlefield
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JanuaryMarch2009 73 ShouldWeTeachEverySoldierHowtoStart IntravenousFluids?
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74 www.cs.amedd.army.mil/references_publications.aspx thathasbeencontrolled and CLSCourseInstructorGuide ShouldWeTeachEverySoldierHowtoStartIntravenousFluids?
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JanuaryMarch2009 75 T HE A RMY M EDICAL D EPARTMENT J OURNAL R EFERENCES FieldManual4-02:ForceHealthProtectionina GlobalEnvironment JTrauma CritCare Med MilMed Mil Med BaltimoreSun JTrauma SurgClin NorthAm NewEnglJMed JTrauma JTrauma MilMed JTrauma J Trauma SubcourseIS0873,CombatLifesaverCourse: InstructorGuide JTrauma Mil Med ArchIntMed AnnEmergMed BrJHospMed A UTHORS
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76 www.cs.amedd.army.mil/references_publications.aspx TheInfluenceofSex,Height,andWeightonTrunkMuscleThicknessandEndurance (NCT00373009) Purpose/Hypothesis: Subjects: Materials/Methods: Results: AbstractsfromtheUSArmy-BaylorDoctoral PrograminPhysicalTherapy PromoteWarriorreadinessandhumanperformancethroughsystematicresearchand theadvancementofevidence-basedpracticerelatedtoneuromusculoskeletalconditions. USArmy-BaylorDoctoralPrograminPhysicalTherapy,SanAntonio,Texas TRUEResearchFoundation,SanAntonio,Texas BrooksCenterforRehabilitationStudies,DepartmentofPhysicalTherapy,UniversityofFlorida,Gainesville,Florida
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JanuaryMarch2009 77 Conclusion: Military/ClinicalRelevance: Supports: Acknowledgement: TheEffectsofTraditionalSit-UpTrainingVersusCoreStabilizationExercisesonSit-Up PerformanceinUSArmySoldiers:AClusterRandomizedTrial(NCT00373009) Purpose/Hypothesis: Subjects: Materials/Methods: Results: Conclusion: Military/ClinicalRelevance: Supports: Acknowledgement: USArmy-BaylorDoctoralPrograminPhysicalTherapy,SanAntonio,Texas BrooksCenterforRehabilitationStudies,DepartmentofPhysicalTherapy,UniversityofFlorida,Gainesville,Florida TRUEResearchFoundation,SanAntonio,Texas
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78 www.cs.amedd.army.mil/references_publications.aspx MedianandUlnarNeuropathiesinUSArmyDentalAssistants(MOS*68e) Pre-AndPosttrainingasPreventiveDentalSpecialists(MOS68e-X2) Purpose/Hypothesis: Subjects: Materials/Methods: Results: Conclusions: Military/ClinicalRelevance: Supports: Militaryoccupationalspecialty USArmy-BaylorDoctoralPrograminPhysicalTherapy,SanAntonio,Texas DynamicPlantarPressureParametersPredictiveOfStaticFootPosture Purpose/Hypothesis: Subjects: AbstractsfromtheUSArmy-BaylorDoctoralPrograminPhysicalTherapy
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JanuaryMarch2009 79 T HE A RMY M EDICAL D EPARTMENT J OURNAL Materials/Methods: Results: Conclusions: Military/ClinicalRelevance: Supports: Acknowledgement: USArmy-BaylorDoctoralPrograminPhysicalTherapy,SanAntonio,Texas DepartmentofPhysicalTherapy,NorthernArizonaUniversity,Flagstaff,Arizona DynamicPlantarPressureParametersPredictiveofStaticArchHeightIndex Purpose/Hypothesis: Subjects: Materials/Methods: USArmy-BaylorDoctoralPrograminPhysicalTherapy,SanAntonio,Texas DepartmentofPhysicalTherapy,NorthernArizonaUniversity,Flagstaff,Arizona
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80 www.cs.amedd.army.mil/references_publications.aspx Results: Conclusions: Military/ClinicalRelevance: Supports: Acknowledgement: DynamicPlantarPressureParametersPredictiveOfStaticFootPosture(continued) AbstractsfromtheUSArmy-BaylorDoctoralPrograminPhysicalTherapy
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SUBMISSIONOFMANUSCRIPTSTOTHEARMYMEDICALDEPARTMENTJOURNALTheUnitedStatesArmyMedicalDepartmentJournalispublishedquarterlytoexpandknowledgeofdomesticandinternationalmilitarymedicalissuesandtechnologicaladvances;promotecollaborativepartnershipsamongtheServices,components,Corps,andspecialties;conveyclinicalandhealthservicesupportinformation;andprovideaprofessional,highquality,peerreviewedprintmediumtoencouragedialogueconcerninghealthcareissuesandinitiatives.REVIEWPOLICYAllmanuscriptswillbereviewedbytheAMEDDJournalsEditorialReviewBoardand,ifrequired,forwardedtotheappropriatesubjectmatterexpertforfurtherreviewandassessment.IDENTIFICATIONOFPOTENTIALCONFLICTSOFINTEREST1.Relatedtoindividualauthorscommitments:Eachauthorisresponsibleforthefulldisclosureofallfinancialandpersonalrelationshipsthatmightbiastheworkorinformationpresentedinthemanuscript.Topreventambiguity,authorsmuststateexplicitlywhetherpotentialconflictsdoordonotexist.Authorsshoulddosointhemanuscriptonaconflict-of-interestnotificationsectiononthetitlepage,providingadditionaldetail,ifnecessary,inacoverletterthataccompaniesthemanuscript.2.Assistance:AuthorsshouldidentifyIndividualswhoprovidewritingorotherassistanceanddisclosethefundingsourceforthisassistance,ifany.3.Investigators:Potentialconflictsmustbedisclosedtostudyparticipants.Authorsmustclearlystatewhethertheyhavedonesointhemanuscript.4.Relatedtoprojectsupport:Authorsshoulddescribetheroleofthestudysponsor,ifany,instudydesign;collection,analysis,andinterpretationofdata;writingthereport;andthedecisiontosubmitthereportforpublication.Ifthesupportingsourcehadnosuchinvolvement,theauthorsshouldsostate.PROTECTIONOFHUMANSUBJECTSANDANIMALSINRESEARCHWhenreportingexperimentsonhumansubjects,authorsmustindicatewhethertheproceduresfollowedwereinaccordancewiththeethicalstandardsoftheresponsiblecommitteeonhumanexperimentation(institutionalandnational)andwiththeHelsinkiDeclarationof1975,asrevisedin2000.IfdoubtexistswhethertheresearchwasconductedinaccordancewiththeHelsinkiDeclaration,theauthorsmustexplaintherationalefortheirapproachanddemonstratethattheinstitutionalreviewbodyexplicitlyapprovedthedoubtfulaspectsofthestudy.Whenreportingexperimentsonanimals,authorsshouldindicatewhethertheinstitutionalandnationalguideforthecareanduseoflaboratoryanimalswasfollowed.GUIDELINESFORMANUSCRIPTSUBMISSIONS1.Articlesshouldbesubmittedindigitalformat,preferablyanMSWorddocument,eitherasanemailattachment(withillustrations,etc),orbymailonCDorfloppydiskaccompaniedbyoneprintedcopyofthemanuscript.Ideally,amanuscriptshouldbenolongerthan24double-spacedpages.However,exceptionswillalwaysbeconsideredonacase-by-casebasis.Ingeneral,4double-spacedMSWordpagesproduceasinglepageof2columntextintheAMEDDJournalproductionformat.2.TheAmericanMedicalAssociationManualofStylegovernsformattinginthepreparationoftextandreferences.Allarticlesshouldconformtothoseguidelinesascloselyaspossible.Abbreviations/acronymsshouldbelimitedasmuchaspossible.Inclusionofalistofarticleacronymsandabbreviationscanbeveryhelpfulinthereviewprocessandisstronglyencouraged.3.Acompletelistofreferencescitedinthearticlemust beprovidedwiththemanuscript.ThefollowingisasynopsisoftheAmericanMedicalAssociationreferenceformat:Referencecitationsofpublishedarticlesmustincludetheauthorssurnamesandinitials,articletitle,publicationtitle,yearofpublication,volume,andpagenumbers.Referencecitationsofbooksmustincludetheauthorssurnamesandinitials,booktitle,volumeand/oreditionifappropriate,placeofpublication,publisher,yearofcopyright,andspecificpagenumbersifcited.Referencecitationsforpresentations,unpublishedpapers,conferences,symposia,etc,mustincludeasmuchidentifyinginformationaspossible(location,dates,presenters,sponsors,titles).4.Eithercolororblackandwhitephotographsmaybesubmittedwiththemanuscript.Colorproducesthebestprintreproductionquality,butpleaseavoidexcessiveuseofmultiplecolorsandshading.Digitalgraphicformats(JPG,GIF,BMP)andMSWordphotofilesarepreferred.Printsofphotographsareacceptable.PleasedonotsendphotosembeddedinPowerPoint.Imagessubmittedonslides,negatives,orcopiesofX-rayfilmwillnotbepublished.Forclarity,pleasemarkthetopofeachphotographicprintontheback.Tapecaptionstothebackofphotosorsubmitthemonaseparatesheet.Ensurecaptionsandphotosareindexedtoeachother.Clearlyindicatethedesiredpositionofeachphotowithinthemanuscript.5.Theauthorsnames,ranksoracademic/certificationcredentials,titlesorpositions,currentunitofassignment,andcontactinformationmust beincludedonthetitlepageofthemanuscript.6.Submitmanuscriptsto:USARMYMEDICALDEPARTMENTCENTER&SCHOOLATTN:MCCSHSASTE1351750GREELEYROADFORTSAMHOUSTON,TX78234-5078 DSN471-6301Comm210-221-6301Fax:DSN471-2226Comm210-221-2226Email:amedd.journal@amedd.army.mil
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