Military personnel who see combat are exposed to traumatic experiences beyond what most civilians ever see. These events pose significant and imminent danger of physical injury and death; those lucky enough to survive combat risk developing mental and physical health issues upon their return. Problems common to veterans include depression, substance abuse, and heart disease, but the most pervasive is post-traumatic stress disorder (PTSD). This paper will examine the internal and external factors that influence the development of PTSD, discuss current evidence-based practices, and address the stigma of mental health care. A discussion of the ethical questions that face many clinicians treating veteran populations follows. Finally, this paper will address life-long learning opportunities and suggest advocacy strategies to reduce the stigma associated with mental health care.

The work aims to understand the blast induced injury mechanism and facilitate the development of protection and treatment. Novel multi-scale and multi-physics computational models of coupled blast physics, whole body biodynamics and injury biomechanics are presented. Modeling components include blast wave threat characterization, anatomy-based high-fidelity human model, human body blast loading, biodynamics and body/brain biomechanics leading to primary injury, as well as the multi-physics solver suitable for high-performance computing. The coupled gas dynamics and biomechanics solutions were validated against shock tube test data. The parametric simulations of human body exposed to blasts were conducted to find biomechanical responses and brain injury mechanism.

Aim of study: To demonstrate clinical and radiological effectiveness of intramedullary fixation of closed diaphyseal humeral fractures in adults using the elastic stable intramedullary nail (ESIN).
Patients and methods: Between May 2011 and December 2013, twenty-eight patients (19 males) with closed diaphyseal humeral fractures treated with closed reduction and percutaneous fixation with 2 elastic stable nails. Age from 18 to 56 years (mean, 29 years). Patients with open or pathological fractures, those less than 18 years and medically unfit patients were excluded. Causative injury was pedestrian vehicular accident in 15, fall from height 9 and sport-related activity 4 patients. The time of surgical intervention varied from 24 to 72 hours post-injury.
Results: Patients were followed up 12-31 months with an average of 20 months. X-ray films showed that twentysix fractures united completely at a range 14-20 week (mean, 13.1 weeks). Twenty-Six cases healed in good alignment at a median time of 13.1 weeks (range 14–20 weeks). One case developed delayed union where bone marrow injection and longer immobilization till full healing done. One case developed non-union which was treated by bone grafting and plating. There were no intraoperative complications. One patient with preoperative radial nerve injury recovered spontaneously by eight weeks. Patients followed and assessed using Disabilities of the Arm, Shoulder and Hand score (DASH). At last follow-up, the average DASH score was 90.5 (range 60–100). Final clinical evaluation showed 17 cases Excellent, 8 cases Good, 2 cases fair and one case Poor according to previous score.
Conclusion: Elastic stable nail fixation is a good procedure for treating adult humeral shaft fractures in which stabilization is indicated as it provides stable fixation, with minimal soft tissue stripping at the fracture site and allows early mobilization of the extremity.

This article seeks to decrease discrepancies on the disputes about quantitative, qualitative, and mixed method research, using clear explanations and drawing on well-evidenced examples. All in the hope that it might do justice to a better understanding of the act of research as the sole approach available to any scholar for the protection of their preferentiality and authoritativeness.

The objective of this study was to investigate the effectiveness of nutrition support teams (NSTs) for oral injuries in patients with mandible fracture treated by intermaxillary fixation (IMF). The participants included 25 patients who were treated for mandibular fracture by IMF with NST intervention, who were used as the primary study group, and 25 patients treated without NST intervention, who were used prospectively as a control group. Decrease of body weight of these groups was compared. During the NST intervention, the patients in the study group were encouraged to freely engage in mild exercise. In the primary study group, nutrition sufficiency ratios, body weight, serum markers (albumin Alb, hemoglobin Hb, C-reactive protein CRP), grip strength and body composition parameters (triceps skinfold thickness, mid-arm muscle circumference, body fat, subcutaneous fat, skeletal muscle) were then measured. The study group was then subdivided into two groups based on whether their grip strength increased or decreased during the NST intervention, and the data were compared between sub-groups. The body weight loss (kg and %) of patients with NST intervention was significantly lower than that of patients without NST intervention. In the primary study group, significant decrease of Alb and CRP, and significant increase of energy sufficiency was found. The body weight loss was significantly higher during the NST waiting period than during the weekly NST active period. Furthermore, the body weight loss of patients with increased grip strength was significantly lower than that of patients with decreased grip strength.

Objective: The aim of this study was to investigate the effects of Eye Movement Desensitization and Reprocessing (EMDR) on the residual symptoms of bipolar disorder through a single case AB design.
Method: A single-case experimental AB design was carried out using an EMDR intervention with a patient with bipolar I disorder.
Result: Beck Depression Inventory and Young Mania Rating Scale scores for the single patient with bipolar I disorder decreased rapidly during the intervention (A phase), but slightly increased during the intervention withdrawal (B phase).
Conclusion: The single-case experimental design results demonstrated that EMDR reduced residual depressive and manic symptoms in a patient with bipolar I disorder.

A major problem during a disaster relates to people requiring assistance. Very few studies have investigated the difficulties people requiring assistance during an actual disaster experience. We examined the situations and behavior of those with intellectual, developmental, and psychiatric disorders during the Great East Japan Earthquake through semi-structured interviews of eight supporters. In essence, the study aimed to elucidate crisis perceptibility of people who require assistance and special care during disaster evacuation. Results revealed that immediately after the disaster occurred, people requiring assistance and special care during evacuation did not exhibit any signs of panic or unexpected reactions. We assumed that the factor that accounted for the finding was the presence of supporters who understood them. There was also the possibility that different cognitive function profiles of people requiring assistance and special care affected their behavior during a disaster.

Sexual abuse toward children and adolescents is a global public health and human rights concern. Despite being a crime in most countries, and with well-known physical and mental health consequences, the majority of sexual offences are not reported. Child and adolescents sexual abuse is a maltreatment form characterized by contact or noncontact acts perpetrated by adults or older children toward younger children who have little power to resist. This overview aims to understand the social context of child sexual abuse, and the perceived roles of parents, community, and key professionals in handling such incidents of children and adolescents with a migration background.

Over the last 50 years a great variety of etiologic factors for gynecomastia have been investigated and discussed. However, the possible role of the chronic and acute tissue trauma still remains unclear. The authors report on and discussed the possible role of a single episode of acute trauma as a trigger mechanism for the onset of breast enlargement.

Several published reviews and recommendations exist for the use of negative pressure wound therapy (NPWT) with instillation and a dwell time (NPWTi-d) in acute and chronic wounds. Specific dressings for use with NPWTi-d have also been developed, including a reticulated open cell foam dressing with through holes (ROCF-CC) that assists in removing thick wound exudate and infectious materials. ROCF-CC is especially helpful for wound cleansing when debridement is not possible or appropriate in patients.

We report our initial experiences in using NPWTi-d with ROCF-CC in patients with pressure ulcers. An algorithmic approach was used to determine appropriate treatment to reach the goals of therapy (i.e., wound bed preparation, granulation tissue formation, and removal of infectious materials). Previous therapies included honey and gauze soaked in Dakin’s solution. All patients received antibiotics and debridement when possible.

Five patients (3 females and 2 males) received NPWTi-d with ROCF-CC (instillation of saline or a hypochlorous solution with a dwell time of 10 minutes, followed by 2-3 hours of -125 mmHg NPWT). Patient comorbidities included obesity, diabetes mellitus, hypertension, and peripheral artery disease. Mean age of patients was 65.2 years (range: 50-82 years). After an average of 6 days of therapy (range 2-9 days), all wounds treated with NPWTi-d with ROCFCC showed rapid granulation tissue formation.

We also noted improved removal of devitalized tissue and subsequent granulation tissue formation in patients receiving hypochlorous solution compared to patients receiving saline during NPWTi-d with ROCF-CC. All patients were eventually transferred to a skilled nursing facility. In our clinical practice, NPWTi-d with ROCF-CC provided effective and rapid removal of the thick exudate and infectious materials and promoted excellent development of underlying granulation tissue.