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1. The estimated mortality of Ebola infection in the US (with our modern health care facilities & aggressive supportive care) is about 20%. Of course with just a handful of cases and one death (in a case that was mishandled) that's still pretty much a WAG - but clearly the mortality is much less than overseas where modern care isn't available. That also doesn't factor in experimental drugs (there are a few being used when they are available) and transfusion of antibody-containing blood products from Ebola survivors when compatible type blood is available. It's thought that these treatments may be somewhat effective, but no one knows for sure. 2. What's required to care for Ebola patients is standard isolation, contact isolation & droplet isolation. Theoretically, any hospital can do this. As a practical matter, these patients get very sick with projectile vomiting, explosive diarrhea and lots of other unpleasantness. All of these fluids are quite infectious in Ebola patients. Hence the staff caring for them must wear a very complex ensemble of PPE when caring for the patient, and (this is really important) must be able to decontaminate and safely remove the PPE when they go off duty. And essentially, they have to do it right without error every time around the clock. This is really complex and exhausting for staff to do repeatedly, especially if they're not extensively trained and practice (drill) regularly. This is probably why the nurses at Texas Presbyterian were infected - caring for the patient (who eventually died) at the height of his illness with at best "rushed up" training, no practice or experience with Ebola or other high-level infectious diseases and (some media reports) incomplete PPE ensembles and incomplete training in use and safe removal. In short this hospital (Texas Presbyterian) decided they could care for this patient there - they quickly got in over their heads & got in deep trouble really fast. Hindsight being 20/20, this was a bad decision and those paying the price are the two front-line nurses who were doing the best they could to care for this patient in an environment that just wasn't up to speed. 3. You'll notice that there have been no occupational exposures at the three national biocontainment centers that have cared for Ebola patients - NIH, Emory and Nebraska Medical Center (the fourth biocontainment center at St. Patrick in Missoula, Montana hasn't yet cared for any Ebola patients). That's because the staff of these centers regularly train, teach and drill in caring for patients who require this strict isolation on an ongoing basis. Their staff is qualified & current in use of these PPE ensembles and other things necessary to care for these patients. Right now there are 11 such beds in all of the U.S (2 currently occupied). It seems to make sense to move these patients to one of these four centers although it makes sense to stand up additional resources to care for Ebola patients if more are encountered - there are other hospitals that with help of CDC experts can stand up to the same level of competence with some advance warning, and there are several that are working on that now. 4. If you're interested in the air transport of Ebola patients back to the U.S. check here http://abcnews.go.com/Health/video/ebola-us-walkthrough-inside-ebola-transport-jet-26226918 - it's pretty interesting. 5. I think the CDC has also made some missteps early in this event but they are rapidly correcting and I have confidence in what they are telling us. 6. What's been written that makes sense is that travel bans don't make sense, but screening & individualized monitoring does. Apparently there's a very small number (<200/day) persons who come into the US from the West African areas where the outbreak is centered - indirectly because there are no direct flights - and DHS knows in advance who these individuals are co they can be closely monitored. I think you'll see that this plus screening of overseas PAX will be effective at keeping this situation under control domestically while teh world humanitarian effort gets it under control overseas. 6. Am I overly worried? No. Do we need to take this very seriously - especially while we are still learning the nuances of this disease in the U.S.? Absolutely. I'm old enough to remember when HIV/AIDS was first discovered & not well understood (I was a medical student at the time). This seems very similar - except internet and 24 hour cable communication is more prevalant - and I'm sure we'll get a good handle on it quickly.

Expected (again, assuming what NYT published is true). In fact, AWC would have no other choice if they want to continue to be recognized as a legit academic institution. Today, Turnitin and similar systems are so good that it's pretty much impossible to get away with "copy-paste" plagiarism and it's really easy to check your work before you turn it in.

Yes - and although they (I think correctly) issue lots of disclaimers about validity problems with the comparison and problems doing a direct comparison, the civilian institutions they've chosen as comparator groups (Kaiser, Geisinger & Intermountain) are all really recognized as "above the median" in quality in the civilian healthcare world.

I live in Overlook Park, which is up past the Heights (on the other side of Cammack Village) near the Big Dam Bridge. It's a great neighborhood and I love living here. The Heights and Hillcrest are nice as well, but garage/parking space is at a premium. There are a few really cool places closer to downtown LR, but (with a couple of specific exceptions in an area called Quapaw Quarter) stay north of I-630 and definitely west of I-30 downtown. WLR and Maumelle are nice and newer, but they're a pretty good trek to the base. In fact, anyplace where you have to cross the river adds to your travel time to the base, although it's not so bad from downtown LR, the heights or Hillcrest. The best night spots for me are the Heights & Hillcrest because they aren't touristy, the RiverMarket (downtown) is OK as well but is a little touristy and can get a little wild on weekends. I know alot less about the NLR/Sherwood?Jax side than I do about the LR side. Specific questions ask or PM me I've lived here since 1989.

I read this in some detail when it first came out. The events noted are tragic and shouldn't happen anywhere. Unfortunately, they happen (I hope in very small numbers) in every health system. My current take on the military health system (short version, and from my viewpoint only): Largely world-class people doing exceptional professional work in an environment where there may be a serious risk of fundamental cultural clashes between the professional peer respect/peer review health professional system and the hierarchical rank-ordered military leadership system. Military health records are improving, but not yet where they should be. The gold standard for electronic health records now (civilian or government) is the VA. It seems that the DOD may be behind the curve in transparency in quality and safety systems. A lot could be gained by combining the DOD branches (and USPHS) into a combined system in that regard. Again, the VA is a world class leader in this regard. There is also a relatively new, but well functioning civilian model operating through the AHRQ. The model for patient safety reporting systems is the Aviation Safety Reporting System (ASRS) which was conceptualized by the FAA to collect safety threats in a "no harm, no foul" manner from (civilian) pilots to improve flight safety. But pilots were so distrustful of the FAA they wouldn't participate so it ended up that NASA actually runs the program and provides safety recommendations and data to the FAA so there is a barrier between reporters (pilots and air traffic controllers) and the FAA. it's a fascinating story if you ever choose to read into it. I guess if I were king of this particular world I would have the military/PHS run a confidential QA & patient safety reporting program for the VA, and the VA run a confidential QA & patient safety reporting program for the military/PHS system - so there is the same firewall between reporters and regulators. I'd agree the article is anecdote, not scientific rigor. It is what it is - a newspaper article. But the DOD health system (not just the Army) has chosen to hold itself to the same standards as civilian peers - as I think it well should**. It does need to be able to measure its performance. You can't improve something if you can't measure it. And I'd agree with you, there's a quality spread in DOD hospitals just as there is in the civilian world as well. **by DOD health system I mean routine health care, not deployed under combat/austere conditions. If you're meeting the Joint Commission standards taking care of people in the desert standing in a tent within a bunch of sandbags wearing a helmet and body armor, even more good on ya!

See how that worked out here

This. And while Crye was willing to sell DOD the license outright at a pretty good price, there was still going to be an "imprint fee" paid to Crye for every item made in multicam. So whenever you hear the army talk about the new pattern (scorpion), they will mention that is is similar to, but different than multicam. It was a pattern developed by the army & submitted in the original next generation camo competition, but eliminated in the first round because it was too close in appearance to multicam. Apparently they've pulled it off the shelf because they couldn't get the deal they needed to license multicam.

For anyone who isn't familiar with the .civ side, this is generally good advice pretty much everywhere. Most places will have an AME (or maybe a few) who are aviation friendly and will be very good about getting you smoothly through the process with your FAA medical, unless of course you have a no-kidding issue that makes it unsafe for you to fly or something that's a statutory DQ that can't be waived (there are a few of those). The FBO's & local flight instructors know who those AME's are.

Certainly not common, but one case where an imposter directed rescue efforts & commandeered a bunch of property for the rescue efforts. http://en.wikipedia.org/wiki/I-40_bridge_disaster http://www.armytimes.com/article/20100912/NEWS/9120303/Green-Beret-faker-wore-black-beret

I'm doing doctoral work now with a lot of writing in management and research methods- both common subjects for which there is a shit-ton of work already published. We are required to submit everything we write through Turnitin, which crosschecks for textual matches against a huge variety of other writing. I grant you I'm writing this stuff to demonstrate my mastery of common concepts, not to generate new ideas - but I'd suggest that would give me even more opportunity to plagiarize if I chose to. It turns out that nothing I've written so far has tripped an alarm for plagiarism. In fact, the only matching text in any of my papers are things you'd expect to match, such as if I've included (and referenced) a direct quote, or my citation list (which will, of course, be identical to the original citations). In fact, I'm pretty impressed at how good the system is at finding matching text, and not flagging text that I've written completely on my own. I was concerned that with the huge amount of literature out there something I've written all on my own must match something someone else has written, but that just hasn't happened. We can (and are strongly encouraged to) run our stuff through before turning it in to be sure we haven't inadvertently forgotten to reference something. And while Turnitin is a common system for this, there are others - including some you can subscribe to without any academic affiliation and are pretty cheap on a "per page" basis. What this tells me is that it's not hard at all to avoid plagiarism, even if you're writing on common topics and arrive at the same conclusions as others. it's also really easy to get caught if the academic institution is making even a minimal effort at checking. Writing on a topic that others have written on, doing your own thinking, research and writing, and using other sources (properly referenced) - and arriving at the same conclusion that others have - is not plagiarism or academic dishonesty. It may or may not be of academic value, may or may not qualify for publishing and may or may not meet the requirements for a thesis or dissertation, but it's just not academic dishonesty. With that said, if what the NYT reports about his work is true, it's pretty clearly academic dishonesty - at least it would be considered academic dishonesty in the mainstream academic world. I see that the AWC plans to run his paper through a plagiarism checker, that's a great idea that they should have done in 2007 (yes, they were available then). Better yet, require the student to run it through and submit an originality report with the paper. It takes about 0.69 seconds. Maybe it wasn't quite so easy in 2007, but I'm pretty sure it wasn't that hard. The only way I see that he gets a pass is if AWC is willing to 'fess up that they just didn't address this with their students in that time period (I've had it beaten into my head at each of the four academic institutions I've done work at since 2008). If the findings reported in the NYT are confirmed, he'd be screwed on an academic dishonesty violation at any major academic institution. Does that disqualify him from elected political office? I don't know about that one. You be the judge. (edits - spelling)

Today they are saying it was someone who was forcibly trying to get into a building and that it ended up being a "case of mistaken identity" There has to be more to the story - one I'm pretty sure they aren't proud of.

News media reported it was a real world issue that happened to coincide with the date of the exercise. The exercise was supposed to have minimal disruption of normal base activities. The base was locked down for about 5 hours, and some C-130's landed @ Adams to wait it out. One report I saw (but can't find now) says someone was seen on base wearing black clothing, a helmet & carrying an "assault rifle" - someone suggested he might have been - for whatever reason - dressed up in paintball gear. At any rate, they locked down & searched the base but couldn't find him. It was reported that those in the commissary at the time were taken to a back room to shelter in place & were told (initially) it was an active shooter situation. It was never an active shooter, just a report of a suspicious person that they couldn't find. More info is supposed to be released tomorrow (today, Thursday, 7/24/2014)

or Burpelson AFB

Just finishing up a VA loan refinance with them. Very helpful & efficient, everything handled by phone and/or internet. Quite impressed.

Paruresis is a real thing. The attached article published in 2011 in Military Medicine says it's present in up to 30% of males and 25% of females. Most who have severe cases can be trained out of it (cognitive behavioral therapy). Drinking some extra water within reason is OK, but as detailed in the article it's possible to get into severe - even life threatening - trouble with water intoxication by drinking too much water too fast. Military Medicine article.pdf

Unfortunately, not in my specialty and way too deep into ophthalmology for me to comment based on my general knowledge as a basic MD. Deaddebate may have some insight re: the PE standards. At any rate, when you find out, would you consider posting how it turned out for future board members? I've not heard of this condition before (granted, I'm not an eye doc).

I also had a thought on your use of flonase question - and this is just additive to the info that deaddebate has already given you. I would agree that based on the info you've given, a diagnosis of allergic rhinitis is incorrect. Allergy is a specific condition where the body has an exaggerated, IgE mediated inflammatory reaction to something that is otherwise harmless. For example, most people can eat food containing peanut products with no problem - because peanuts are a normal, harmless food product for most people. But a person with peanut allergy may have a life threatening inflammatory reaction (that is mediated by a specific body immune system protein called IgE) because they've been exposed to peanut product - something that's harmless to everyone else. Smoke from a wildfire is not a harmless substance, and it's likely that most normal people who are exposed to it will develop inflammation of their nasal passages. So the correct diagnosis is acute chemical rhinitis or acute irritant rhinitis, not allergic rhinitis. You are not allergic to wildfire smoke because it is an irritant to everyone, not just you. It is also acute, not chronic because (I am assuming) you've never had an episode that's lasted six weeks or longer. Even if you have this every fire season, it's still acute irritant rhinitis as long as any single episode doesn't last six weeks or longer. Nasal flonase is a recommended and approved treatment for acute irritant rhinitis. For the reasons you've alluded to and deaddebate has explained, having the exact correct diagnosis can be really important when you're undergoing a physical exam for a qualification or job, such as a flight physical. This is medical nitpicking, but it can be really important because of situations like yours where having a 'just about right" but not exactly right diagnosis can be a problem later on. And yes as deaddebate mentioned a doctor can change the diagnosis - we do it all the time for inpatients. He/she just needs to document the change and the reason in your medical records. It won't erase your prior records, but it's not unusual for us to find that a previous diagnosis was incorrect - usually because some part of the problem hadn't made it's appearance yet. We just document everything in the medical record so it's clear what we did & why, and move on.

Assuming you have no other symptoms of cardiac disease, and you had a few isolated single PVC's on a 24 hour Holter, I think you'll be fine. It turns out that almost no one has a 24 hour Holter without some ectopy (only 13% of aviators had a completely ectopy-free Holter in one study quoted in the USAF waiver guide). The relevant portion of the USAF Waiver guide is pp 323 - 326, I've made a pdf of just those pages & attached to this post to make it easier to look at the primary source information. It uses the term "ectopy", that's a general term for abnormal electrical activity of the heart that includes premature heart beats - Premature Atrial Contractions (PAC's) start in the upper chamber of the heart, Premature Junctional Contractions (PJC's) start in the junctional tissue between the upper and lower chamber of the heart and Premature Ventricular Contractions (PVC's) start in the lower chamber of the heart. All of these are heartbeats where - for a single beat - the heart beats in some way other than it's usual organized pattern. This is because there's an abnormality in the electrical signal for that beat that causes the heart muscle to squeeze out of sequence, causing the abnormal heart beat. PAC's and PJC's have similar origin and effects, so sometimes they are just lumped together as PAC's or Premature Supraventricular Contractions (PSVC's). PVC's (especially frequent or multiform) are more worrisome in critically ill patients and patients with severe underlying heart disease, because they can lead to more dangerous continuous heart rhythms or even cardiac arrest. Occasional PVC's in someone who is otherwise healthy and has no other heart issues is almost always benign and usually unnoticed unless you undergo an in-depth physical. Occasionally you can feel them as a "skipped beat" but even then if you are otherwise in good health and have no heart problems, it's very likely not a problem at all. Where this would usually be seen in a flight physical is on the EKG. For isolated PVC's, what the waiver guide says is if you have more than one PVC on a 12 lead EKG or a rhythm strip you then undergo a 24 hr Holter. If 10% or less of the total beats on the Holter are PAC's or PVC's, and there are less than 10 paired ectopic beats on the Holter, then you're still good to go. If you have more ectopy than this on the Holter, you'll get referred for more workup (Echo, treadmill) and a decision made based on that. You are in the unusual position of already having done a Holter study. I've never seen a physical exam before that required a Holter, but I could see where a physical for an extremely strenuous job such as you mentioned might require one. As always, when asked about it just tell the truth & be prepared, if you can, to have documentation of the holter and interpretation. Bottom line - if you are otherwise in good health with no heart disease and they did an appropriate interpretation of your Holter with a finding of isolated, few or infrequent PVC's (which is what I'm interpreting what you wrote) I think you'll be fine. USAF Waiver Guide - Ectopy.pdf

Acute pericarditis is not hereditary so there should be no increased risk of either of you having it because you are related to each other. You haven't given any specifics of your episode, but acute pericarditis usually makes one pretty sick & if you had some kind of chest pain that you "rode out" until it went away without seeing a doctor, it probably wasn't acute pericarditis. Also, acute pericarditis has some pretty obvious and specific EKG changes so if you saw a doctor during your episode and they did an EKG, they likely would have diagnosed it then. My guess is you didn't have it. Hope your Dad does well.

It could even be from something as simple as dehydration. Elevation change can result in an increase in your hemoglobin, but I would expect it to take at least a few weeks. I just mention this because you said you recently moved to a new base with a high elevation. If by recent you mean 2 - 3 months ago, then I'd agree very likely it's your body adjusting to the altitude change. If it's just a week or two, there may be another reason.

Did it when I was young, before med school. It was awesome.

And there are many very effective treatments. Many involve medication, but there are forms of treatment as well. Counseling, residential and exercise programs and other similar treatments are important, but aren't usually sufficient because depression is indeed a medical problem and requires medical treatment. Interestingly, electroconvulsive therapy (ECT) is still one of the safest and most effective treatments for severe depression there is. No one knows why, but it just works really well without the side effects of medications. And it's nothing like the movies - it's very humane. It's now done with the patient under a brief general anesthesia so there's no visible muscle movement or anything like that. Unfortunately, it still has an (undeserved IMO) stigma. About the letter from Daniel Somers - that's pretty humbling. I don't work at the VA now but I have for many years - It will be a really big challenge to meet the needs of Iraq/AFG veterans. I hope we're up to it.

Agree w/ deaddebate. I'm a general surgeon, but I know some orthopedics & I could certainly find out something from one of my ortho buds if needed. If if's a clinical question, you're welcome to PM me. If it's a flight physical Q, deaddebate's your guy.

Just finished watching the entire news conference by the post CG live. Four deceased including the shooter. Most seriously injured sent to Scott & White, which is a nearby Level I trauma center. Some are very critical. Others treated at the on post hospital. All casualties are military. The single shooter was a soldier who killed himself when engaged by MP's. Nothing to indicate any relation to terrorism. Post has been opened back up.

The app is super. Wish I could get rid of the iAds though. Posted from the NEW Baseops.net App!