Prerequisite Delivery Method and Academic Outcomes in a Physician Assistant Education Program.

PURPOSE: The Interservice Physician Assistant Program (IPAP) educates up to 169 matriculants per year. Each service branch sets the admission criteria, including all prerequisites, for their applicants. We hypothesized that prerequisites obtained online/virtual are less rigorous than coursework completed in-person. The purpose of this investigation was to evaluate whether online/virtual prerequisite courses were associated with academic deceleration or attrition at any point. METHODS: Student self-reported data were retrospectively analyzed to evaluate program scores of students who took prerequisites online/virtual or in-person. RESULTS: There were no statistically significant differences in foundational course performance between online/virtual and in-person coursework. In addition, students who took anatomy online performed better than students who completed the coursework in-person (140.6 ± 15.6 vs. 145.6 ± 14.7, P = .05). CONCLUSIONS: This analysis indicates that using the prerequisite source to predict academic difficulty may not be possible in IPAP students. Faculty will need to continue to search for other predictors of academic difficulty.

Tender Subcutaneous Nodule in a Prepubescent Boy.

Eligible for 1 MOC SA Credit From the ABD This Dermatopathology Diagnosis in our print edition is eligible for 1 self-assessment credit for Maintenance of Certification from the American Board of Dermatology (ABD). After completing this activity, diplomates can visit the ABD website (http://www.abderm.org) to self-report the credits under the activity title "Cutis Dermatopathology Diagnosis." You may report the credit after each activity is completed or after accumulating multiple credits.

Informing 21st-Century Risk Assessments with 21st-Century Science.

Understanding and preventing adverse impacts from chemicals in the environment is fundamental to protecting public health, and chemical risk assessments are used to inform public health decisions in the United States and around the world. Traditional chemical risk assessments focus on health effects of environmental contaminants on a chemical-by-chemical basis, largely based on data from animal models using exposures that are typically higher than those experienced by humans. Results from environmental epidemiology studies sometimes show effects that are not observed in animal studies at human exposure levels that are lower than those used in animal studies. In addition, new approaches such as Toxicology in the 21st Century (Tox21) and exposure forecasting (ExpoCast) are generating mechanistic data that provide broad coverage of chemical space, chemical mixtures, and potential associated health outcomes, along with improved exposure estimates. It is becoming clear that risk assessments in the future will need to use the full range of available mechanistic, animal, and human data to integrate multiple types of data and to consider nontraditional health outcomes and end points. This perspective was developed at the "Strengthening the Scientific Basis of Chemical Safety Assessments" workshop, which was cosponsored by the U.S. Environmental Protection Agency and the National Institute of Environmental Health Sciences, where gaps between the emerging science and traditional chemical risk assessments were explored, and approaches for bridging the gaps were considered.

Outcomes of diarrhea management in operations Iraqi Freedom and Enduring Freedom.

INTRODUCTION: Among deployed U.S. military personnel, a sub-population of international travelers, acute infectious diarrhea continues to be a leading cause of morbidity and a potential threat to military effectiveness. METHODS: To assess outcomes and satisfaction of diarrhea management in the field, a systematic survey was given to military personnel during mid- or post-deployment from Iraq or Afghanistan, from January through August 2004. RESULTS: Sixty-three percent of those surveyed reported at least one episode of diarrhea, while less than half sought care for their symptoms. Overall, trends of decreased post-treatment duration were noted as traveler's diarrhea therapy modalities grew more complex, controlling for severity of illness at presentation. Among those reporting diarrhea, the greatest level of satisfaction was seen in treatment with IV fluids (59%) followed by antibiotics (46%) and loperamide (40%). The greatest amount of dissatisfaction was seen in treatments with oral fluids only. CONCLUSION: While current standard of care is self-treatment of diarrhea in civilian travelers, the U.S. military lacks standards outlining self-treatment of personnel at the individual level. Further research is needed to develop treatment guidelines on diarrhea management during military deployment.

Self-reported combat stress indicators among troops deployed to Iraq and Afghanistan: an epidemiological study.

Evident mental health needs among combat veterans after their return from combat have been described, whereas available data describing the mental health status of military personnel during deployment are few. Data were collected from personnel systematically selected from current combat regions participating in a rest and recuperation program in Doha, Qatar. Overall, 40620 troops completed a clinic screening form between October 2003 and January 2005. Rates of self-reported depression among troops in Afghanistan were lower than those of Iraq (32.3 vs 69.7 per 10000, P < .0001). Feelings of depression and self-harm were inversely correlated with rank (4-level ordinal grouping) (beta(Coef) = -.21, P = .0006; beta(Coef) = -0.49, P < .00001, respectively). Distinct temporal trends found in reported combat stress and monthly mortality rates were noted. These data support previous reports of higher mental health problems among troops in Iraq as compared with troops in Afghanistan and lower health care-seeking behavior overall. In an effort to remove barriers to care and minimize combat stress effects, it is critical to recognize mental health needs and initiate services during combat deployments.

Age-dependent survival of the dengue vector Aedes aegypti (Diptera: Culicidae) demonstrated by simultaneous release-recapture of different age cohorts.

The assumption that mosquito survival remains constant and that it is independent of age was tested with free-ranging Aedes aegypti (L.) (Diptera: Culicidae) by using a "synthetic cohort" mark-release-recapture method. Mosquito age cohorts (1-2, 3-4, and 19-20 d) were released simultaneously in homes in rural Thai villages during dry and rainy seasons (2002). Significant age-dependent effects were detected during the dry and rainy seasons. More young than older mosquitoes were recaptured (1-4 versus 5-20 d). The best predictive fit for recaptures was obtained using a quadratic function of age. Our results provide the first field-based evidence for age-dependent Ae. aegypti mortality in which the death rate increases with advancing age and highlight the need for research on ecological and epidemiological aspects of this process.

Knowledge, attitudes, and practices regarding epidemiology and management of travelers' diarrhea: a survey of front-line providers in Iraq and Afghanistan.

To evaluate the relationship between medical knowledge and clinical practice, a survey on travelers' diarrhea was administered to military health care providers attending a professional development and trauma management conference. The survey was administered at the beginning of the conference and 58 of the 76 attendees participated by completing a questionnaire. Respondents were aware of the standard definition of travelers' diarrhea; however, their knowledge about the epidemiology and management of travelers' diarrhea was low. Less than one-third correctly answered questions on etiology and more than two-thirds made incorrect management choices in treatment of mild to moderate watery diarrhea and dysentery. Important knowledge gaps about gastroenteritis were identified and should serve as a basis to develop military-specific clinical guidelines and training programs.

Dispersal of the dengue vector Aedes aegypti within and between rural communities.

Knowledge of mosquito dispersal is critical for vector-borne disease control and prevention strategies and for understanding population structure and pathogen dissemination. We determined Aedes aegypti flight range and dispersal patterns from 21 mark-release-recapture experiments conducted over 11 years (1991-2002) in Puerto Rico and Thailand. Dispersal was compared by release location, sex, age, season, and village. For all experiments, the majority of mosquitoes were collected from their release house or adjacent house. Inter-village movement was detected rarely, with a few mosquitoes moving a maximum of 512 meters from one Thai village to the next. Average dispersal distances were similar for males and females and females released indoors versus outdoors. The movement of Ae. aegypti was not influenced by season or age, but differed by village. Results demonstrate that adult Ae. aegypti disperse relatively short distances, suggesting that people rather than mosquitoes are the primary mode of dengue virus dissemination within and among communities.

The epidemiology of self-reported diarrhea in operations Iraqi freedom and enduring freedom.

Diarrhea remains a potential cause of compromised military effectiveness. To assess diarrhea rates and mission impact in operations in Iraq and Afghanistan, a survey was administered to soldiers participating in the "Rest and Recuperation" program in Doha, Qatar. Between October and December 2003, 2,389 volunteers completed a questionnaire designed to assess the occurrence and impact of diarrhea. The median length of deployment was 7.2 months, 70% reported at least one episode, and 56% had multiple episodes of diarrhea. Overall, 43% reported decreased job performance for a median of 2 days, and 17% reported being on bed rest for a median of 2 days. While this survey showed high rates of diarrhea associated with decreased operational effectiveness, the results are consistent with prior military operations in this region. Further research is needed to develop better methods for illness prevention and its minimization on operational impact.

Measurement of cardiac output in man with a U.S. $150 plethysmograph

It has been found possible to adapt a simple battery-operated plethysmograph costing U.S.$150 for the measurement of cardiac output. Although the method is certainly less convenient and possibly less accurate than the computerized impedance cardiographs(costing $23 000) now often used in the United States, it provides a useful measurement of changes in cardiac output over a period of time. In developing countries, it can be recommended for the repeated assessment or monitoring of patients during surgery, in Critical Care Units and in the evaluation of patients during circulatory stress tests (AU)