The use of deployable military hospitals after hurricanes: lessons from the Hurricane Marilyn response.

Deployable military hospitals are frequently requested to supplement surviving local health care capabilities after disasters. Although some authors have advocated their use after mass casualty events such as earthquakes, previous reports have questioned the appropriateness of deploying these hospitals after destructive storms. These hospitals are relatively slow moving, expensive, and may require the diversion of local resources to support. After Hurricane Marilyn in 1995, a military hospital was deployed to the U.S. Virgin Islands. For a variety of reasons, the local health care community declined to use the facility once it was operational. This report is based on interviews with disaster managers and local health officials involved in the Hurricane Marilyn response. Recommendations include improving communications while requesting resources, broadening the range of available health assets to increase flexibility, positioning resources regionally or in the civilian sector, and creating clear indications for full-scale deployable hospitals when they are required.

Utilization of military support in the response to hurricane Marilyn: implications for future military-civilian cooperation.

INTRODUCTION: The past decade has been a period of evolution for the Federal disaster response system within the United States. Two domestic hurricanes were pivotal events that influenced the methods used for organizing Federal disaster assistance. The lessons of Hurricane Hugo (1989) and Hurricane Andrew (1992) were incorporated into the successful response to Hurricane Marilyn in the U.S. Virgin Islands in 1995. Following each of these storms, the Department of Defense was a major component of the response by the health sector. Despite progress in many areas, lack of clear communication between military and civilian managers and confusion among those requesting Department of Defense health resources may remain as obstacles to rapid response. METHODS: This discussion is based on an unpublished case report utilizing interviews with military and civilian managers involved in the Hurricane Marilyn response. RESULTS: The findings suggest that out-of-channel pathways normally utilized in the warning and emergency phase of the response remained operational after more formal civilian-military communication pathways and local assessment capability had been established. CONCLUSION: It is concluded that delays may be avoided if the system in place was to make all active pathways for the request and validation of military resources visible to the designated Federal managers located within the area of operations.

Working women at risk. Results from a survey of Hispanic injury patients.

Women experience lower rates of occupational injury than do men in general, but subgroups are at increased risk. Based on the medical records of 2572 injury patients requesting treatment in a Washington, DC, emergency department during a 1991 survey of injured Hispanics, we found that whereas women in general had a low risk of occupational injury. Hispanic women did not realize this protection. All Hispanics were at increased risk of occupational injury, but the relative risk attributable to ethnicity for Hispanic women (3.83; 95% confidence interval, 2.85,5.14) was nearly twice that of the corresponding relative risk suffered by working Hispanic men (2.07; 95% confidence interval, 1.72,2.48). It was also found that whereas, overall, women had a lower risk of assault than did men, relative risks of assault based on sex were the same in the workplace.

Cost effectiveness and accuracy of renal scans in the management of patients undergoing renal transplantation.

Following renal allograft transplantation, renal scans are frequently performed to evaluate anatomical and functional causes for allograft dysfunction. In our retrospective study of 20 patients, renal scans were found to be more expensive compared to renal biopsies $68,688 vs $7,421, and, in only one patient was aggressive anti-rejection therapy instituted based solely on the renal scan results. The 95% confidence interval for the proportion of correct diagnosis by renal scan was 0.16 to 0.62.

Modulation of the metabolism and cytotoxicity of iododeoxyuridine by 5'-amino-5'-deoxythymidine.

In HeLa and Vero cells the antiproliferative effects of iododeoxyuridine (IdUrd) were modulated in a biphasic manner by 5'-amino-5'-deoxythymidine (5'-AdThd). Low concentrations of 5'-AdThd increased the cytotoxicity of IdUrd whereas high concentrations of 5'-AdThd were antagonistic. Opposing effects on two enzymes, thymidine kinase (EC 2.7.1.21) and thymidylate kinase (EC 2.7.4.9), account for this unusual biphasic interaction. In the case of thymidine kinase, 5'-AdThd was found to antagonize the feedback inhibition which is normally exerted by the 5'-triphosphates of thymidine and IdUrd. Consequently, 5'-AdThd increased the rate of IdUrd phosphorylation. This stimulation (deinhibition) of enzyme activity was demonstrable in cell-free extracts and with a purified preparation of thymidine kinase provided that the 5'-triphosphates of IdUrd or thymidine were present. In their absence only enzyme inhibition was detected. In intact cells this stimulatory effect of 5'-AdThd was seen as a rapidly apparent, sustained increase in the steady-state levels of the phosphorylated IdUrd metabolites. As a result, IdUrd cytotoxicity was increased. Under these conditions, 5'-AdThd did not alter the relative abundance of the mono-, di-, and triphosphates of IdUrd. However, as the concentration of 5'-AdThd was raised, the percentage of IdUrd nucleotides present as iododeoxyuridylate increased dramatically. Corresponding reductions in the incorporation of IdUrd into cellular DNA and the associated cytotoxic effects were seen. These data suggested a second site of interaction, thymidylate kinase, the enzyme responsible for the conversion of iododeoxyuridylate to the diphosphate. In experiments measuring thymidylate kinase activity in cell-free extracts, 5'-AdThd effectively inhibited the phosphorylation of iododeoxyuridylate but not that of thymidylate. Additionally, 5'-AdThd did not produce an accumulation of thymidylate in intact cells. Thus, the ability of high concentrations of 5'-AdThd to antagonize the cytotoxicity produced by IdUrd without concomitantly inhibiting the phosphorylation of thymidylate and, thereby, reducing DNA synthesis was explained. Although the modulation of IdUrd metabolism produced by 5'-AdThd was qualitatively similar in Vero and HeLa cells, key quantitative differences were evident. Thus, 100 microM 5'-AdThd stimulated the uptake of 3 microM IdUrd in Vero cells but it was inhibitory in HeLa cells. Perturbation of nucleoside metabolism by agents such as 5'-AdThd may provide an important new way to achieve selective toxicity in cancer chemotherapy.

Schizophrenia and prostaglandins: theories and therapeutic implications.

Prostaglandin E1 (PGE1) which has characteristic pharmacological effects on the central nervous system has been implicated in the etiology of schizophrenia. In connection with the postulated involvement of PGE1 in the pathogenesis of schizophrenic symptoms, two contrasting hypotheses have been proposed. Neither theory has been supported by adequate clinical studies; they, may, however, have important therapeutic implications. Determination of PGE1 in the cerebrospinal fluid and the use of PGE1 antagonists and agonists in schizophrenic patients may provide some framework for future research.