Enduring engagement yes, episodic engagement no: lessons for SOF from Mali

This thesis examines SOFs recent experience in Mali and determines whereor to what extentit should be considered a failure. In addition to analyzing these encounters, a second aim of this thesis is to make recommendations for how SOF might better build partner capacity and capability in the future. The argument made is that enduring engagement is of enduring value; episodic engagement, on its own, is not. Examples of both types of engagement can be found in United States Special Operations Forces recent interactions with the Malian military.http://archive.org/details/enduringengageme1094538996Outstanding ThesisMajor, United States ArmyApproved for public release; distribution is unlimited

Radiologic Assessment of Muscle and Fat Stores in Long-Term Type I Diabetics Referred for Pancreas Transplant Compared to Healthy Controls

Type 1 diabetes (DM1) is associated with loss of skeletal muscle and bone mass and may affect body fat stores. This study employs computed tomography (CT) scans to assess the body composition of DM1 patients referred for pancreas transplant compared to healthy controls. A 1:1 case–control design matched study patients with otherwise healthy patients from the trauma database. Matching criteria included age ± 5 years, gender, and body mass index (BMI) ± 2kg/m2. Nutrition variables included serum albumin and protein levels, BMI, and CT measures of muscle mass and fat stores. There were 22 subjects and 22 controls (median DM1 duration 24 years). DM1 patients had less muscle mass and less subcutaneous fat but no difference in visceral fat. Patients with the greatest muscle deficit were those with DM1 greater than 20 years and those younger than age 40. DM1 patients maintain similar BMI and protein levels compared to healthy controls but have marked deficits of muscle and subcutaneous fat. These results inform the nutritional management of DM1 patients and quantify the muscle and fat deficits present in these patients. At highest risk are young patients and those with duration of DM1 over 20 years

Use of ward closure to control outbreaks among hospitalized patients in acute care settings: a systematic review

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Impact of Recipient Age in Combined Liver-Kidney Transplantation: Caution Is Needed for Patients ≥70 Years

Background. Elderly recipients (≥70 y) account for 2.6% of all liver transplants (LTs) in the United States and have similar outcomes as younger recipients. Although the rate of elderly recipients in combined liver-kidney transplant (CLKT) is similar, limited data are available on how elderly recipients perform after CLKT. Methods. We have previously shown excellent outcomes in CLKT using delayed kidney transplant (Indiana) Approach (mean kidney cold ischemia time = 53 ± 14 h). Between 2007 and 2018, 98 CLKTs were performed using the Indiana Approach at Indiana University (IU) and the data were retrospectively analyzed. Recipients were subgrouped based on their age: 18–45 (n = 16), 46–59 (n = 34), 60–69 (n = 40), and ≥70 years (n = 8). Results. Overall, more elderly patients received LT at IU (5.2%) when compared nationally (2.6%). The rate of elderly recipients in CLKT at IU was 8.2% (versus 2% Scientific Registry of Transplant Recipient). Recipient and donor characteristics were comparable between all age groups except recipient age and duration of dialysis. Patient survival at 1 and 3 years was similar among younger age groups, whereas patient survival was significantly lower in elderly recipients at 1 (60%) and 3 years (40%) (P = 0.0077). Control analyses (replicating Scientific Registry of Transplant Recipient’s survival stratification: 18–45, 46–64, ≥65 y) showed similar patient survival in all age groups. Conclusions. Although LT can be safely performed in elderly recipients, extreme caution is needed in CLKT due to the magnitude of operation

Modeling the release of Escherichia coli from soil into overland flow under raindrop impact

Pathogen transport through the environment is complicated, involving a variety of physical, chemical, and biological processes. This study considered the transfer of microorganisms from soil into overland flow under rain-splash conditions. Although microorganisms are colloidal particles, they are commonly quantified as colony-forming units (CFUs) per volume rather than as a mass or number of particles per volume, which poses a modeling challenge. However, for very small particles that essentially remain suspended after being ejected into ponded water and for which diffusion can be neglected, the Gao model, originally derived for solute transfer from soil, describes particle transfer into suspension and is identical to the Hairsine–Rose particle erosion model for this special application. Small-scale rainfall experiments were conducted in which an Escherichia coli (E. coli) suspension was mixed with a simple soil (9:1 sand-to-clay mass ratio). The model fit the experimental E. coli data. Although re-conceptualizing the Gao solute model as a particle suspension model was convenient for accommodating the unfortunate units of CFU ml−1, the Hairsine–Rose model is insensitive to assumptions about E. coli per CFU as long as the assumed initial mass concentration of E. coli is very small compared to that of the soil particle classes. Although they undoubtedly actively interact with their environment, this study shows that transport of microorganisms from soil into overland storm flows can be reasonably modeled using the same principles that have been applied to small mineral particles in previous studies