Graduate survey of the South Carolina Area Health Education Consortium family practice residency programs.

The results of this study demonstrate several interesting characteristics of the graduates of the SC AHEC associated family medicine residency programs: 45 percent practice in South Carolina, 63 percent live further than 120 miles from their residency program, 96 percent are satisfied with their specialty choice, and 56 percent are involved in teaching medical students and residents. Furthermore, these graduates have the following tendencies: to practice in the traditional solo or group practice; to practice in a suburban community, town or rural community and a setting size less than a population of 100,000 persons; to care for the aging adult and geriatric population; to provide nursing home care; and to utilize house calls to provide patient care). As the current health care system continues to be redesigned, this information will be essential for assessment and planning purposes.

Surmounting the engineering challenges of Everglades restoration.

The South Florida Water Management District, in partnership with other agencies and stakeholders, is undertaking one of the world's largest ecosystem restoration programs. The foundation of the nutrient control program for the Everglades is a set of six large constructed wetlands, referred to as Stormwater Treatment Areas (STAs). The initial treatment goal is to reduce phosphorus entering the Everglades to 50 parts per billion. The STAs comprise almost 17,000 hectares, with a capital cost of approximately $700 million. Approximately 4,720 hectares are currently operational, another 2,600 hectares are in the start-up phase, and construction is just getting under way on the remaining areas. Throughout the design process, engineers and scientists collaborated to capture the best available information on wetland treatment systems, and to develop the most appropriate design criteria. Some of the more challenging issues included characterizing stormwater inflows and phosphorus loads, determining appropriate nutrient removal performance characteristics, and estimating hydraulic design parameters relating to densely vegetated systems. The design process combined in-house staff with engineering consultants, construction contractors, external review groups and independent peer-review. This paper summarizes major design aspects and key assumptions, and sets the stage for addressing future challenges associated with achieving long-term water quality goals of Everglades restoration.

Environmental impacts to the Everglades ecosystem: a historical perspective and restoration strategies.

The Everglades is a vast subtropical wetland that dominates the landscape of south Florida and is widely recognized as an ecosystem of great ecological importance. As a result of anthropogenic disturbances over the past 100 years (i.e., agricultural and urban development, eutrophication resulting from stormwater runoff, changes in hydrology and invasion of exotic species), the biotic integrity of the entire Everglades is now threatened. To protect this valuable resource, the state of Florida and the Federal Government, in cooperation with other interested parties, have developed a comprehensive restoration strategy that addresses controlling excess nutrient loading and reestablishment of a more natural hydrology. These efforts include building approximately 17,000 ha of treatment wetlands, referred to as Stormwater Treatment Areas, to treat surface runoff before it is discharged into the Everglades. We briefly discuss the history of the Everglades in the context of environmental disturbance and outline the steps being taken to ensure its survival for future generations.

Emergency medical training in the 82d Airborne Division. The Gulf War experience.

The 82d Airborne Division, as the Army's worldwide contingency division, places unique demands on its medical personnel. This was true particularly during Operations Desert Shield and Desert Storm in 1990-1991. An unprecedented emergency medical training program was carried out in preparation for the Gulf War. All levels of expertise were involved: non-medical Combat Lifesavers, medics, physician assistants, and physicians. Courses provided included Combat Lifesaver provider and refresher training, Basic Trauma Life Support (BTLS) provider and instructor training, Chemical Casualty courses, and a Combat Surgical Skills course. Approximately 736 personnel, including 80 Saudi and allied physicians and medics, participated in these courses. Confidence and competence in handling war casualties at all levels was enhanced greatly. Prepackaged courses such as BTLS enabled the rapid training of large numbers of medical personnel under challenging conditions.

Mesenteric cysts in pregnancy. A case report.

Mesenteric cysts are rare. These large, often asymptomatic growths may be misinterpreted easily by the clinician as representing either benign or malignant ovarian tumors, renal masses, or hepatic tumors or cysts. We treated a women for a mesenteric cyst complicating her second pregnancy. Because of the increasing use of ultrasound in a wide variety of pregnancy complications, and because of the mesenteric cysts's unique sonographic appearance (resembling that of a benign ovarian tumor), such a cyst must be included in the differential diagnosis of large, cystic abdominal masses in pregnancy.

A blitz of bends: decompression sickness in four students after hypobaric chamber training.

This paper reports three cases of type II and one case of type I decompression sickness occurring in a group of nine vigorously active US Army parachutists who took a hypobaric chamber HALO (high altitude-low opening) training flight to a maximum altitude of 9,908.5 m (32,500 ft). After the cases of decompression sickness were diagnosed and treated, the aviator mask regulators were checked and found to be functioning properly; the oxygen supply was analyzed and found to be pure. All cases fully recovered after treatment on US Navy Diving Table 6 and have returned to full military duty. This HALO training profile is not in use with either the US Navy or the US Air Force and should probably be considered unsafe for future use in training.