Cardiothoracic Surgical Volume Within the Military Health System: Fiscal Years 2007 to 2017.

BACKGROUND: Cardiothoracic surgical services have been provided at 7 military treatment facilities over the past decade. Accurate case volume data for adult cardiac and general thoracic surgical service lines in the Military Health System is unknown. METHODS: We queried the Military Health System Data Repository for adult cardiac and general thoracic cases performed at military treatment facilities in the Military Health System and surrounding purchased care markets for fiscal years 2007 to 2017. Cases were filtered and classified into major cardiac and major general thoracic categories. Five military treatment facility markets had sufficient cardiac case data to perform cost analysis. RESULTS: Institutional major cardiac case volume was low across the Military Health System with less than 100 cardiopulmonary bypass cases per year (range, 17-151 cases per year) performed most years at each military treatment facility. Similarly, general thoracic surgical case volume was universally low, with less than 30 anatomic lung resections (range, 0-26) and fewer than 5 esophageal resections (range, 0-4) performed at each military treatment facility annually. Cost analysis revealed that provision of cardiac surgical services is significantly more expensive at most military treatment facilities compared with their surrounding purchased care markets. CONCLUSIONS: Adult cardiac and general thoracic surgical volume within the Military Health System is low across all institutions and inadequate to provide clinical readiness for active-duty surgeons. Recapture of major cases from the purchased care market is unlikely and would not significantly increase military treatment facility or individual surgeon case volume.

Military Prehospital Use of Low Titer Group O Whole Blood.

The military's use of whole-blood transfusions is not new but has recently received new emphasis by the Tactical Combat Casualty Care Committee. US Army units are implementing a systematic approach to obtain and use whole blood on the battlefield. This case report reviews the care of the first patient to receive low titer group O whole blood (LTOWB) transfusion, using a new protocol.

The Role of Datasets on Scientific Influence within Conflict Research.

We inductively tested if a coherent field of inquiry in human conflict research emerged in an analysis of published research involving "conflict" in the Web of Science (WoS) over a 66-year period (1945-2011). We created a citation network that linked the 62,504 WoS records and their cited literature. We performed a critical path analysis (CPA), a specialized social network analysis on this citation network (~1.5 million works), to highlight the main contributions in conflict research and to test if research on conflict has in fact evolved to represent a coherent field of inquiry. Out of this vast dataset, 49 academic works were highlighted by the CPA suggesting a coherent field of inquiry; which means that researchers in the field acknowledge seminal contributions and share a common knowledge base. Other conflict concepts that were also analyzed-such as interpersonal conflict or conflict among pharmaceuticals, for example, did not form their own CP. A single path formed, meaning that there was a cohesive set of ideas that built upon previous research. This is in contrast to a main path analysis of conflict from 1957-1971 where ideas didn't persist in that multiple paths existed and died or emerged reflecting lack of scientific coherence (Carley, Hummon, and Harty, 1993). The critical path consisted of a number of key features: 1) Concepts that built throughout include the notion that resource availability drives conflict, which emerged in the 1960s-1990s and continued on until 2011. More recent intrastate studies that focused on inequalities emerged from interstate studies on the democracy of peace earlier on the path. 2) Recent research on the path focused on forecasting conflict, which depends on well-developed metrics and theories to model. 3) We used keyword analysis to independently show how the CP was topically linked (i.e., through democracy, modeling, resources, and geography). Publically available conflict datasets developed early on helped shape the operationalization of conflict. In fact, 94% of the works on the CP that analyzed data either relied on publically available datasets, or they generated a dataset and made it public. These datasets appear to be important in the development of conflict research, allowing for cross-case comparisons, and comparisons to previous works.