Parlaying digital imaging and communications in medicine and open architecture to our advantage: the new Department of Defense picture archiving and communications system.
(1/12)
The Department of Defense (DoD) undertook a major systems specification, acquisition, and implementation project of multivendor picture archiving and communications system (PACS) and teleradiology systems during 1997 with deployment of the first systems in 1998. These systems differ from their DoD predecessor system in being multivendor in origin, specifying adherence to the developing Digital Imaging and Communications in Medicine (DICOM) 3.0 standard and all of its service classes, emphasizing open architecture, using personal computer (PC) and web-based image viewing access, having radiologic telepresence over large geographic areas as a primary focus of implementation, and requiring bidirectional interfacing with the DoD hospital information system (HIS). The benefits and advantages to the military health-care system accrue through the enabling of a seamless implementation of a virtual radiology operational environment throughout this vast healthcare organization providing efficient general and subspecialty radiologic interpretive and consultative services for our medical beneficiaries to any healthcare provider, anywhere and at any time of the night or day. (+info)
Virtual management of radiology examinations in the virtual radiology environment using common object request broker architecture services.
(2/12)
In the Department of Defense (DoD), US Army Medical Command is now embarking on an extremely exciting new project--creating a virtual radiology environment (VRE) for the management of radiology examinations. The business of radiology in the military is therefore being reengineered on several fronts by the VRE Project. In the VRE Project, a set of intelligent agent algorithms determine where examinations are to routed for reading bases on a knowledge base of the entire VRE. The set of algorithms, called the Meta-Manager, is hierarchical and uses object-based communications between medical treatment facilities (MTFs) and medical centers that have digital imaging network picture archiving and communications systems (DIN-PACS) networks. The communications is based on use of common object request broker architecture (CORBA) objects and services to send patient demographics and examination images from DIN-PACS networks in the MTFs to the DIN-PACS networks at the medical centers for diagnosis. The Meta-Manager is also responsible for updating the diagnosis at the originating MTF. CORBA services are used to perform secure message communications between DIN-PACS nodes in the VRE network. The Meta-Manager has a fail-safe architecture that allows the master Meta-Manager function to float to regional Meta-Manager sites in case of server failure. A prototype of the CORBA-based Meta-Manager is being developed by the University of Arizona's Computer Engineering Research Laboratory using the unified modeling language (UML) as a design tool. The prototype will implement the main functions described in the Meta-Manager design specification. The results of this project are expected to reengineer the process of radiology in the military and have extensions to commercial radiology environments. (+info)
Simulation-based training of medical teams to manage chemical warfare casualties.
(3/12)
With chemical warfare becoming an imminent threat, medical systems need to be prepared to treat the resultant mass casualties. Medical preparedness should not be limited to the triage and logistics of mass casualties and first-line treatment, but should include knowledge and training covering the whole medical spectrum. In view of the unique characteristics of chemical warfare casualties the use of simulation-assisted medical training is highly appropriate. Our objective was to explore the potential of simulator-based teaching to train medical teams in the treatment of chemical warfare casualties. The training concept integrates several types of skill-training simulators, including high tech and low tech simulators as well as standardized simulated patients in a specialized simulated setting. The combined use of multistimulation modalities makes this maverick program an excellent solution for the challenge of multidisciplinary training in the face of the looming chemical warfare threat. (+info)
Training Israeli medical personnel to treat casualties of nuclear, biologic and chemical warfare.
(4/12)
Recent events have significantly increased concern about the use of biologic and chemical weapons by terrorists and other countries. Since weapons of mass destruction could result in a huge number of casualties, optimizing our diagnostic and therapeutic skills may help to minimize the morbidity and mortality. The national demands for training in medical aspects of nuclear, biologic and chemical warfare have increased dramatically. While Israeli medical preparedness for non-conventional warfare has improved substantially in recent years especially due to extensive training programs, a standardized course and course materials were not available until recently. We have developed a core curriculum and teaching materials for a 1 or 2 day modular course, including printed materials. (+info)
Lessons learned from non-medical industries: the tragedy of the USS Greeneville.
(5/12)
In February 200l the nuclear powered submarine USS Greeneville collided with the Japanese fishing trawler Ehime Maru, killing nine passengers. A series of small failures and hurried actions escalated into tragedy. This incident provides lessons learned that can be used by healthcare organizations to improve patient safety. Expertise, training, equipment, and procedures appeared to be adequate protection, yet the presence of multiple defences obscured their faulty functioning, just as they often do in medical settings. A number of other problems occurred aboard Greeneville which we also see in health care. The problem was the total breakdown of communication. The Greeneville team also failed to move from a rigid hierarchical structure to a more flexible adaptive structure. Communication often breaks down in healthcare settings, which are organized to maximize status and hierarchical differences, thus often impeding information flow needed to make decisions. Redundancy failed aboard Greeneville as it often does in medicine. Finally, the Captain of the Greeneville established an artificially hurried situation. Time constrained situations happen all the time in health care. We recommend strategies to mitigate the development of these kinds of processes. (+info)
Teratogenicity of depleted uranium aerosols: a review from an epidemiological perspective.
(6/12)
BACKGROUND: Depleted uranium is being used increasingly often as a component of munitions in military conflicts. Military personnel, civilians and the DU munitions producers are being exposed to the DU aerosols that are generated. METHODS: We reviewed toxicological data on both natural and depleted uranium. We included peer reviewed studies and gray literature on birth malformations due to natural and depleted uranium. Our approach was to assess the "weight of evidence" with respect to teratogenicity of depleted uranium. RESULTS: Animal studies firmly support the possibility that DU is a teratogen. While the detailed pathways by which environmental DU can be internalized and reach reproductive cells are not yet fully elucidated, again, the evidence supports plausibility. To date, human epidemiological data include case examples, disease registry records, a case-control study and prospective longitudinal studies. DISCUSSION: The two most significant challenges to establishing a causal pathway between (human) parental DU exposure and the birth of offspring with defects are: i) distinguishing the role of DU from that of exposure to other potential teratogens; ii) documentation on the individual level of extent of parental DU exposure. Studies that use biomarkers, none yet reported, can help address the latter challenge. Thoughtful triangulation of the results of multiple studies (epidemiological and other) of DU teratogenicity contributes to disentangling the roles of various potentially teratogenic parental exposures. This paper is just such an endeavor. CONCLUSION: In aggregate the human epidemiological evidence is consistent with increased risk of birth defects in offspring of persons exposed to DU. (+info)
Time domain detection of shocks and impacts in whole-body vibration.
(7/12)
A method for detecting shocks and impacts in whole-body vibration time histories has been developed that is suitable for implementation as a computer algorithm. The procedure consists of comparing the magnitudes of a higher-order mean value and the impulsiveness calculated for successive time segments of the acceleration-time history. The indicators were the ratio of the 12th-order root mean value to the root mean square RMT/RMS, and the impulsiveness corresponding to a cumulative probability value of 0.97, I(0.97) (i.e., the magnitude of the positive and negative excursions exceeded 3% of the time divided by 2RMS). Both indicators have a value of 2.16 for random vibration with a Gaussian amplitude distribution, and deviate from this value when the motion possesses other characteristics. For seat motion in the Z-direction analyzed using frequency weighting W(b), and time segments of ~20 s, shocks and impacts could be identified when RMT/RMS >/= 2.5, and I(0.97) +info)
Armor and anesthesia: exposure, feeling, and the soldier's body.
(8/12)
For many civilians, the high-tech weapons, armor, and military medicine with which U.S. soldiers are equipped present an image of lethal capacity and physical invulnerability. But, as this article explores, soldiers themselves just as often associate the life-sustaining technology of modern warfare with feelings that range from a pragmatic ambivalence about exposure to harm all the way to profoundly unsettling vulnerability. This article, based on fieldwork among soldiers and military families at the U.S. Army's Ft. Hood, examines sensory and affective dimensions of soldiers' intimate bodily relationships with the technologies that alternately or even simultaneously keep them alive and expose them to harm. I argue that modern military discipline and technology conspire to cultivate soldiers as highly durable, capable, unfeeling, interchangeable bodies, or what might be called, after Susan Buck-Morss (1992), anesthetic subjects. But for soldiers themselves, their training, combat environment, protective gear, and weapons are a rich font of both emotional and bodily feeling that exists in complex tension with the also deeply felt military imperative to carry on in the face of extreme discomfort and danger. (+info)