The Impact of Operation Bushmaster on Medical Student Decision-making in a High-Stress, Operational Environment.

INTRODUCTION: Operation Bushmaster is a high-fidelity military medical field practicum for fourth-year medical students at the Uniformed Services University. During Operation Bushmaster, students treat live-actor and mannequin-based simulated patients in wartime scenarios throughout the five-day practicum. This study explored the impact of participating in Operation Bushmaster on students\u27 decision-making in a high-stress, operational environment, a crucial aspect of their future role as military medical officers. MATERIALS AND METHODS: A panel of emergency medicine physician experts used a modified Delphi technique to develop a rubric to evaluate the participants\u27 decision-making abilities under stress. The participants\u27 decision-making was assessed before and after participating in either Operation Bushmaster (control group) or completing asynchronous coursework (experimental group). A paired-samples t-test was conducted to detect any differences between the means of the participants\u27 pre- and posttest scores. This study was approved by the Institutional Review Board at Uniformed Services University #21-13079. RESULTS: A significant difference was detected in the pre- and posttest scores of students who attended Operation Bushmaster (P \u3c .001), while there was no significant difference in the pre- and posttest scores of students who completed online, asynchronous coursework (P = .554). CONCLUSION: Participating in Operation Bushmaster significantly improved the control group participants\u27 medical decision-making under stress. The results of this study confirm the effectiveness of high-fidelity simulation-based education for teaching decision-making skills to military medical students

Defining a research agenda for layperson prehospital hemorrhage control: A consensus statement

Importance: Trauma is the leading cause of death for US individuals younger than 45 years, and uncontrolled hemorrhage is a major cause of trauma mortality. The US military\u27s medical advancements in the field of prehospital hemorrhage control have reduced battlefield mortality by 44%. However, despite support from many national health care organizations, no integrated approach to research has been made regarding implementation, epidemiology, education, and logistics of prehospital hemorrhage control by layperson immediate responders in the civilian sector.Objective: To create a national research agenda to help guide future work for prehospital hemorrhage control by laypersons.Evidence review: The 2-day, in-person, National Stop the Bleed (STB) Research Consensus Conference was conducted on February 27 to 28, 2019, to identify and achieve consensus on research gaps. Participants included (1) subject matter experts, (2) professional society-designated leaders, (3) representatives from the federal government, and (4) representatives from private foundations. Before the conference, participants were provided a scoping review on layperson prehospital hemorrhage control. A 3-round modified Delphi consensus process was conducted to determine high-priority research questions. The top items, with median rating of 8 or more on a Likert scale of 1 to 9 points, were identified and became part of the national STB research agenda.Findings: Forty-five participants attended the conference. In round 1, participants submitted 487 research questions. After deduplication and sorting, 162 questions remained across 5 a priori-defined themes. Two subsequent rounds of rating generated consensus on 113 high-priority, 27 uncertain-priority, and 22 low-priority questions. The final prioritized research agenda included the top 24 questions, including 8 for epidemiology and effectiveness, 4 for materials, 9 for education, 2 for global health, and 1 for health policy.Conclusions and relevance: The National STB Research Consensus Conference identified and prioritized a national research agenda to support laypersons in reducing preventable deaths due to life-threatening hemorrhage. Investigators and funding agencies can use this agenda to guide their future work and funding priorities

Agronomic and Economic Performance Characteristics of Conventional and Low-External-Input Cropping Systems in the Central Corn Belt

We conducted a 9-ha field experiment near Boone, IA, to test the hypothesis that yield, weed suppression, and profit characteristics of low-external-input (LEI) cropping systems can match or exceed those of conventional systems. Over a 4-yr period, we compared a conventionally managed 2-yr rotation system {corn (Zea mays L.)/soybean [Glycine max (L.) Merr.]} with two LEI systems: a 3-yr corn/soybean/small grain + red clover (Trifolium pratense L.) rotation, and a 4-yr corn/soybean/small grain + alfalfa (Medicago sativa L.)/alfalfa rotation. Synthetic N fertilizer use was 59 and 74% lower in the 3- and 4-yr systems, respectively, than in the 2-yr system; similarly, herbicide use was reduced 76 and 82% in the 3- and 4-yr systems. Corn and soybean yields were as high or higher in the LEI systems as in the conventional system, and weed biomass in corn and soybean was low (≤4.2 g m−2) in all systems. Experimentally supplemented giant foxtail (Setaria faberi Herrm.) seed densities in the surface 20 cm of soil declined in all systems; supplemented velvetleaf (Abutilon theophrasti Medik.) seed densities declined in the 2- and 4-yr systems and remained unchanged in the 3-yr system. Without subsidy payments, net returns were highest for the 4-yr system ($540 ha−1 yr−1), lowest for the 3-yr system ($475 ha−1 yr−1), and intermediate for the 2-yr system ($504 ha−1 yr−1). With subsidies, differences among systems in net returns were smaller, as subsidies favored the 2-yr system, but rank order of the systems was maintained

Innovations for Tomorrow: Summary of the 2016 Disaster Health Education Symposium.

AbstractIn an effort to enhance education, training, and learning in the disaster health community, the National Center for Disaster Medicine and Public Health (NCDMPH) gathered experts from around the nation in Bethesda, Maryland, on September 8, 2016, for the 2016 Disaster Health Education Symposium: Innovations for Tomorrow. This article summarizes key themes presented during the disaster health symposium including innovations in the following areas: training and education that saves lives, practice, teaching, sharing knowledge, and our communities. This summary article provides thematic content for those unable to attend. Please visit http://ncdmph.usuhs.edu/ for more information. (Disaster Med Public Health Preparedness. 2017;11:160–162)</jats:p