Teleophthalmology in the United States Army: A Review From 2004 Through 2018

ABSTRACT Introduction We describe results of the U.S. Army Ocular Teleconsultation program from 2004 through 2018 as well as the current condition, benefits, barriers, and future opportunities for teleophthalmology in the clinical settings and disease areas specific to the U.S. Military. Materials and Methods This was a retrospective, noncomparative, consecutive case series. A total of 653 ocular teleconsultations were reviewed; 76 concerned general policy questions and underwent initial screening to determine the year each request was received, the average and median initial consultant response time, the number of participating consultants, the country from which the request originated, the military status and branch of each U.S. patient for which a request was submitted, and the nationality, age, and military status of foreign patients for whom consults were requested. The remaining 577 requests were further analyzed to determine the diagnostic category of the request, whether or not an evacuation recommendation was provided by a consultant, the relationship of the request to trauma, if and what type of nonocular specialty consultant(s) participated in the consultation request, and if and what type of ancillary imaging accompanied the request. Results The number of requests was 13 in 2004, compared to 80 in 2011 and 11 in 2018. The average response time in 2018 was 2.27 hours compared to 9. 73 hours in 2004. The number of participating ocular specialists was 5 in 2004, compared to 39 in 2013 and 13 in 2018. Requests originating from Iraq and Afghanistan comprised 61.1% (399/653) of requests. The U.S. Army personnel comprised the largest percentage of consults at 38.6% (252/653). Nonmilitary patients from the USA accounted for 18.5% (121/653) of consults. Non-U.S. patients including coalition forces, contractors, detainees, and noncombatants accounted for 14.4% (94/653) of consults, of which 22% (21/94) were children. Anterior segment consults accounted for 45.1% (260/577) of consults, with corneal surface disease being the largest subset within this diagnostic category. Evacuation was recommended in 22.7% (131/577) of overall cases and 41.1% (39/95) of trauma cases. Requests were associated with either combat-related or accidental trauma in 16.5% (95/577) of cases. Dermatology and neurology were the most commonly co-consulted specialties, representing 40.0% (32/80) and 33.75% (27/80) of consults, respectively. Photographs of suspected ocular pathology accompanied 37.4% of consults, with the likelihood requesters included photographs being greatest in cases involving pediatric ophthalmology (7/9, 77.8%) and oculoplastics (86/120, 71.7%). Conclusions Army teleophthalmology has been an indispensable resource in supporting and advancing military medicine, helping to optimize the quality, efficiency, and accessibility of ophthalmic care for U.S. Military personnel, beneficiaries, allied forces, and local nationals worldwide. A dedicated ophthalmic care and coordination system which utilizes new advances in teleconsultation technology could further enhance our current capability to care for the ophthalmic needs of patients abroad, with opportunity for improving domestic care as well.

Comparison of Defence Arts by Country in Law Enforcement Education

Law Enforcement Defence and Intervention Techniques (LEDIT) are the methods of defence and intervention applied to suspects, criminals, and individuals who threaten security and public order, by the authority granted by law to the gendarmerie personnel who have the duty of security, public order, and safety. The aim of this study is to analyse the martial arts used by law enforcement officers by country. In this study, which was designed for a descriptive purpose, the data were obtained from the websites of the Police and Gendarmerie Forces, from the replies to the defence techniques information request letter written to the embassies, and from the theses and articles published in the relevant field, by using the scanning method. According to the data obtained, it has been observed that many countries use more than one defence technique. As a result, all countries in the world either created their own fighting styles for close-range combat or took them from other countries and blended them within their own styles. The study group of the research consists of the police forces of 22 countries, including Turkey, and 6 countries affiliated to the International Gendarmerie and Law Enforcement Forces with Military Status (FIEP).

Compounding Effects of Traumatic Brain Injury, Military Status, and Other Factors on Pittsburgh Sleep Quality Index: A Meta-analysis

ABSTRACT Introduction Traumatic brain injury (TBI) or concussion is a known risk factor for multiple adverse health outcomes, including disturbed sleep. Although prior studies show adverse effects of TBI on sleep quality, its compounding effect with other factors on sleep is unknown. This meta-analysis aimed to quantify the effects of TBI on subjective sleep quality in the context of military status and other demographic factors. Materials and Methods A programmatic search of PubMed database from inception to June 2020 was conducted to identify studies that compared subjective sleep quality measured using Pittsburgh Sleep Quality Index (PSQI) in individuals with TBI relative to a control group. The meta-analysis included group-wise standard mean difference (SMD) and 95% CI. Pooled means and SDs were obtained for TBI and non-TBI groups with and without military service, and meta-regression was conducted to test for group effects. Exploratory analysis was performed to test for the effect of TBI, non-head injury, military status, sex, and age on sleep quality across studies. Results Twenty-six articles were included, resulting in a combined total of 5,366 individuals (2,387 TBI and 2,979 controls). Overall, individuals with TBI self-reported poorer sleep quality compared to controls (SMD = 0.63, 95% CI: 0.45 to 0.80). Subgroup analysis revealed differences in the overall effect of TBI on PSQI, with a large effect observed in the civilian subgroup (SMD: 0.80, 95% CI: 0.57 to 1.03) and a medium effect in the civilian subgroup with orthopedic injuries (SMD: 0.40, 95% CI: 0.13 to 0.65) and military/veteran subgroup (SMD: 0.43, 95% CI: 0.14 to 0.71). Exploratory analysis revealed that age and history of military service significantly impacted global PSQI scores. Conclusions Poor sleep quality in TBI cohorts may be due to the influence of multiple factors. Military/veteran samples had poorer sleep quality compared to civilians even in the absence of TBI, possibly reflecting unique stressors associated with prior military experiences and the sequelae of these stressors or other physical and/or psychological traumas that combine to heightened vulnerability. These findings suggest that military service members and veterans with TBI are particularly at a higher risk of poor sleep and its associated adverse health outcomes. Additional research is needed to identify potential exposures that may further heighten vulnerability toward poorer sleep quality in those with TBI across both civilian and military/veteran populations.

Care and Compensation for Civilian Victims of War

Lacking bed space, Coalition military hospitals in Iraq and Afghanistan declined to admit any civilian except those injured by multinational forces. There are, however, no firm moral grounds for granting collateral casualties a special right to medical attention. Military necessity justifies preferential care for civilians who can contribute to a counterinsurgency, not those suffering collateral damage. Money, not medicine, is a better vehicle to assuage resentment among wounded civilians. Considering the rights of compatriots, allies, civilians, and detainees, five ethical principles govern the distribution of medical care during war: military-medical necessity, associative duties, liability for collateral or accidental harm, beneficence, and urgent medical need. Judging by the number of patients each principle reaches, the cost of care, and the feasibility of implementation, necessity and associative duties best serve military medicine. Once patients assemble by identity and military status, urgent medical need governs care within each group.

Combat Casualty Care

To deliver combat casualty care to warfighters, multinational forces deploy medical units to provide immediate front-line treatment, transfer the injured to in-theater combat hospitals, and evacuate the critically wounded to Europe and the United States. With bed space limited, Coalition medical facilities developed medical rules of eligibility to regulate the flow of multinational patients, host-nation allies, detainees, and local civilians. While multinational patients received unreserved medical attention, local nationals were, at best, only eligible for emergency care before transfer to poorly equipped local facilities. Despite legal provisions that stipulate impartial care based solely on urgent medical need, medical personnel attended to patients based on national identity and military status. Military necessity sometimes permits treating moderately injured warfighters before the critically ill to return the former to duty. Appealing to associative duties, however, allows military medical providers to deliver preferential care to compatriots despite urgent medical need elsewhere.

ABKHAZ-GEORGIAN ETHNOPOLITICAL CONFLICT AS A COMPLEX CONFLICT AND PROSPECTS FOR ITS SETTLEMENT

The paper addresses the issue of Abkhaz-Georgian ethnopolitical conflict treating it as not a single process but as the complex case that consists of several consecutive self-sufficient conflicts or sub-conflicts during which different parties had various goals and escalated the situation trying to achieve miscellaneous aims. Although each of these sub-conflicts are looking like historical phases of one conflict, each of them has its own logic and, therefore, requires to be analyzed separately. The first sub-conflict of 1991-1994 can be quite accurately explained from the structuralist perspective as an attempt of the Abkhaz to reconsider their status and break the discriminative social structures developed during imperial and Soviet rule. The second phase 1994-2008 was the period of nationalist mobilization and the new clashes and atrocities were the result of the Georgian and Abkhaz elites’ intention to strengthen their legitimacy and power. Russia's role in this case fits well with the concept of "humanitarian intervention" and does not correspond to the Roger Brubaker’s famous “triadic nexus” (1996). Finally, the last phase of conflict since 2008 can be hardly called an ethnopolitical conflict itself since peace and the military status quo were established after the war of 2008 which neither side can challenge. Therefore, after 2008, it is more appropriate to speak about the need of post-conflict reconciliation instead of Abkhaz-Georgian ethnopolitical conflict. However, none of the parties has taken steps towards this reconciliation yet because the settlement of the conflict is impossible while it continues to be used for nationalist mobilization.

Experience of Members of the International Association of Gendarmeries and Police Forces with Military Status (FIEP) in Performing Military Police Functions

The article examines the principles of functioning of the military justice bodies of foreign countries. The development of military justice in Ukraine through the creation of military police has been updated. The analysis of the military police's organizational structure of the countries belonging to the International Association of Gendarmeries and Police Forces with Military Status (FIEP) is carried out. The corresponding theoretical and legal basis for forming proposals for the development of military justice in Ukraine has been substantiated and consolidated.