Wilderness & Environmental Medicine最新文献

{"title":"Development of Progressively Earth-Independent Medical Operations to Enable NASA Exploration Missions.","authors":"Arian Anderson, Emily Stratton, Ariana Nelson, Jay Lemery, Kurt Berens, David Hilmers, Kris Lehnhardt","doi":"10.1177/10806032241310386","DOIUrl":"https://doi.org/10.1177/10806032241310386","url":null,"abstract":"<p><p><b>Introduction</b> -The National Aeronautics and Space Administration's (NASA's) transition from operations in low-Earth orbit to long-duration missions to the Moon and Mars necessitates the development of progressively Earth-independent medical operations (EIMO) to support crews and reduce overall mission risk. Previous work has defined and laid the foundation for EIMO, but further development of the concept is required to prepare for future exploration missions. <b>Methods</b> -NASA's Exploration Medical Capability element organized a series of 5 technical interchange meetings from 2023 to 2024, which included internal (NASA) and external subject-matter experts in human spaceflight, health technology, and austere medicine to create a framework for developing the technologies and procedures necessary to maintain human health and performance in a progressively Earth-independent fashion. <b>Results</b> -The EIMO technical interchange meetings provided a forum for a field of experts and stakeholders to better understand gaps between current approaches to medical care in low-Earth orbit and the innovations needed to maintain the health and performance of astronauts on long-duration deep-space missions. These discussions were recorded, analyzed, and collated into reports that can inform the maturation of EIMO concepts. <b>Conclusions</b> -Multidisciplinary input from experts with experience in human spaceflight, health technology, and austere medicine is critical when planning for long-duration exploration missions. Innovations such as probabilistic risk assessment tools, extended reality devices, and advanced clinical artificial intelligence capabilities have been identified as high-value targets that can enhance inflight medical autonomy while maintaining appropriate workload balance and crew safety. By further developing the EIMO paradigm, NASA aims to identify areas of future work, research, and collaboration to reduce overall risk on future human spaceflight missions into deep space.</p>","PeriodicalId":49360,"journal":{"name":"Wilderness & Environmental Medicine","volume":" ","pages":"10806032241310386"},"PeriodicalIF":1.4,"publicationDate":"2025-01-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143048110","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Suspected Stonefish Envenomation in Reunion Island: 15 Years Later.","authors":"Louis Renson, François Maillet, Corentin Bonnet","doi":"10.1177/10806032241308477","DOIUrl":"https://doi.org/10.1177/10806032241308477","url":null,"abstract":"<p><strong>Introduction: </strong>Although marine envenomations are a reason for consultation in tropical emergency departments, stonefish stings are particularly feared. Immediate management focuses on pain control, whereas late management addresses cutaneous complications. This study presents a new series and compares the management of these patients and their outcomes at our center over the past 20 years.</p><p><strong>Methods: </strong>This study presents a new series of 53 patients treated between 2016 and 2020 at the South Hospital of the University Hospital Center of Réunion following a sting attributed to the stonefish. We compared this new series with a previous series of patients treated at the same center for the same reason between 2001 and 2005.</p><p><strong>Results: </strong>The series are comparable. Regarding early management, the use of regional anesthesia was more frequent (47 vs 3.5%). Half the patients received a strong opioid. Prescription of nonsteroidal anti-inflammatory drugs and corticosteroids persisted. Exposure to a heat source remained common. Prophylactic antibiotics were prescribed more frequently (64 vs 35%) and more uniformly with amoxicillin/clavulanate. Regarding late management, the average duration of hospitalization decreased (1.8 vs 2.6 d). Cutaneous complications were less frequent (9 vs 25%). No patient managed with regional anesthesia presented cutaneous complications.</p><p><strong>Conclusions: </strong>The management of patients in Réunion following Scorpaenidae stings has evolved over time. Regional anesthesia has become more widespread, and the prescription of probabilistic preventive antibiotic therapy is more homogeneous. These changes are associated with a shorter hospital stay and fewer cutaneous complications.</p>","PeriodicalId":49360,"journal":{"name":"Wilderness & Environmental Medicine","volume":" ","pages":"10806032241308477"},"PeriodicalIF":1.4,"publicationDate":"2025-01-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143014701","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Attacks on Humans by Neotropical Otters.","authors":"D Nataly Castelblanco-Martínez, Alex A González-Vargas, Gustavo González, M Fabiola Corona-Figueroa, Carlos A Lasso","doi":"10.1177/10806032241304736","DOIUrl":"https://doi.org/10.1177/10806032241304736","url":null,"abstract":"<p><p>Neotropical otters <i>Lontra annectens</i> (Carnivora, Mustelidae) are widely distributed in Central and South America. Studies on the behavior of this species are rare, resulting in the fact that its ethology is one of the lesser known among the mustelids. The Neotropical otter is considered solitary and territorial but not aggressive, and it generally shows a shy and elusive behavior. Here we described the first two documented cases of attack by Neotropical otters on humans. The first occurred in Sacatepéquez, Guatemala, and the second, in La Guajira, Colombia. Respectively, adult female and male humans were injured with differences in the severity of the wounds, clinical course, and outcomes. We recommend further research on the agonistic behavior of Neotropical otters. A protocol for attention to injuries caused by Neotropical otters is suggested.</p>","PeriodicalId":49360,"journal":{"name":"Wilderness & Environmental Medicine","volume":" ","pages":"10806032241304736"},"PeriodicalIF":1.4,"publicationDate":"2025-01-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143014547","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Case Report of a Traumatic Arthrotomy of the Knee Diagnosed by Ultrasound.","authors":"Marc Heronemus, Spencer Tomberg","doi":"10.1177/10806032241310385","DOIUrl":"https://doi.org/10.1177/10806032241310385","url":null,"abstract":"<p><p>In this case report we describe evaluating a patient for a traumatic knee arthrotomy using ultrasound in a resource-limited medical clinic at the base of a ski area. A 23-y-old female presented with a laceration superior to the patella of the left leg. On examination, the wound tracked deep, and providers had concern for traumatic arthrotomy. Lacerations around the knee have the highest risk for traumatic arthrotomy of any joint. This risk is due to the joint capsule of the knee extending up to 12 cm proximally from the joint line of the knee, making suprapatellar lacerations a risk. Although surgical evaluation is the gold standard for diagnosing a traumatic arthrotomy, computed tomography scan has been shown to be more sensitive than the saline-load test for identifying open traumatic arthrotomies. However, computed tomography scan was not available at the ski area clinic, and the authors have found the saline-load test to be extremely painful for patients. In this case, a novel technique using ultrasound to visualize a sterile cotton swab being inserted into the wound until it contacted the knee's joint line successfully identified a traumatic arthrotomy in a proximal knee laceration. The patient was transferred to a trauma center, where she had a surgical washout of her left knee joint. In conclusion, providers should be aware of the risk of traumatic arthrotomy in wounds that are proximal/superior to the patella. In this case, an ultrasound was used to confirm that the wound entered the proximal knee joint.</p>","PeriodicalId":49360,"journal":{"name":"Wilderness & Environmental Medicine","volume":" ","pages":"10806032241310385"},"PeriodicalIF":1.4,"publicationDate":"2025-01-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143014689","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Simulated Patient as a Learner: Medical Volunteers Gain Knowledge by Participating in a Wilderness Medicine Training Session.","authors":"Geoffrey Comp, Michael Foggia, Cody Blentlinger, Bikash Bhattarai, Cornel Popescu, Andrea Ferrari","doi":"10.1177/10806032251313961","DOIUrl":"https://doi.org/10.1177/10806032251313961","url":null,"abstract":"<p><strong>Introduction: </strong>-A multifaceted approach to wilderness medicine education and training is necessary to provide a high-quality learning experience, often requiring innovative instructional techniques. Using volunteers to act as patients in medical education is a well-established practice that helps teach crucial skills. However, more is needed to know if there is potential knowledge acquisition through participation. This study examined the educational benefits for medical students serving as a simulated patient (SP), hypothesizing that these individuals will improve self-assessed knowledge and confidence and demonstrate improved performance of injury-management skills while participating in a medical education course.</p><p><strong>Methods: </strong>-A descriptive feasibility pilot study was conducted with 10 SPs to assess knowledge and skill acquisition. Study participants were evaluated before and after participating as an SP in 2 scenarios involving hemorrhage control and wrist injury assessment and management, with a subjective confidence survey and an objective skill and knowledge demonstration, as measured by a critical action checklist.</p><p><strong>Results: </strong>-The subjects all reported self-assessed knowledge improvement from the pre- to postintervention survey, with an average increase of 17 points. They also demonstrated improved objective skill and knowledge demonstration, with an average increase of 4.6 points for the wrist injury scenario and 2.5 points for the hemorrhage control scenario.</p><p><strong>Conclusions: </strong>-This study demonstrated that volunteer medical students acting as SPs in a medical training course passively acquire knowledge and improve their medical skills and self-perceived confidence. The findings contribute to a broader understanding of medical education, suggesting that participating as SPs offers educational benefits. The results encourage consideration of simulated patient roles as a valuable adjunct to medical education, warranting further scholarly exploration to substantiate and expand on these preliminary findings.</p>","PeriodicalId":49360,"journal":{"name":"Wilderness & Environmental Medicine","volume":" ","pages":"10806032251313961"},"PeriodicalIF":1.4,"publicationDate":"2025-01-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143014699","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Technical Validation of a Spatial Tracking Configuration for Augmented and Co-Localized Medical Assistance Under Gravity Variations in Parabolic Flights.","authors":"Séamus Thierry, Ronan Querrec, Cécile Isabelle Bernard, Sébastien Kubicki, Elisabetta Bevacqua","doi":"10.1177/10806032241308457","DOIUrl":"https://doi.org/10.1177/10806032241308457","url":null,"abstract":"<p><strong>Introduction: </strong>Augmented reality is a promising technology for enhancing remote medical assistance. It assists users by directly projecting the relevant virtual assistance in the real world at the right moment and at the right location. This modality is called colocalization but has not been validated in parabolic flights. Our hypothesis was that this modality is technically feasible in weightlessness and is superior to a paper checklist in assisting a caregiver during a simulated medical emergency.</p><p><strong>Methods: </strong>During parabolic flight campaigns, we conducted an abdominal pain simulation scenario and sought to compare procedural assistances. Participants performed a basic medical examination using either classic cognitive aids (such as a paper checklist) or an augmented-reality device projecting visual co-localized (situated or embedded) assistance.</p><p><strong>Results: </strong>Gravity variations induced technical difficulties in the nominal functioning of augmented-reality headsets due to the native accelerometers in these devices. Clinical data were not interpretable due to small sample size secondary to the technical difficulties encountered. Finally, an efficient and stable spatial tracking configuration was found during the last flight, offering future research perspectives.</p><p><strong>Conclusions: </strong>Our study validated the first achievement of a stable co-localized assistance under gravity variation. The augmented-reality headset required an external tracking system based on surrounding infrared cameras and an in-flight calibration to recreate the virtual environment (spatial mapping) independently of gravity conditions. Further studies are needed to clinically validate the potential benefits of co-localized augmented reality for space medicine.</p>","PeriodicalId":49360,"journal":{"name":"Wilderness & Environmental Medicine","volume":" ","pages":"10806032241308457"},"PeriodicalIF":1.4,"publicationDate":"2025-01-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143014702","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Insulin Delivery Pumps for Human Spaceflight: Steps Toward an Accessible Space Future.","authors":"Kyle J Horn, Jeffrey A Hoffman","doi":"10.1177/10806032241304439","DOIUrl":"https://doi.org/10.1177/10806032241304439","url":null,"abstract":"<p><p>Commercially available insulin pumps for treatment of diabetes mellitus are currently not qualified to operate in the space environment. This work rigorously tested the fluid delivery performance of a Tandem t:slim X2 insulin pump in both micro- and hypergravity during a parabolic microgravity research flight. The parabolic research flight environment serves as an analogue to the types of transient gravitational loadings experienced during human-led missions, which provides a foundation to expand testing to suborbital and orbital flights in addition to other extreme environmental tests for wilderness dependency. The results of the flight data showed no significant difference between fluid delivery performance at 0, 1, and 2g acceleration regimes, nor at the transitions between gravity environments. Recommendations are made for further experimentation and qualification tests before use in future spaceflight missions.</p>","PeriodicalId":49360,"journal":{"name":"Wilderness & Environmental Medicine","volume":" ","pages":"10806032241304439"},"PeriodicalIF":1.4,"publicationDate":"2025-01-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143014698","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Fishhook Injuries and Antibiotic Prescribing Patterns: A Retrospective Analysis.","authors":"Alan A Lazzara, Jacob S Sinkoff, Robert Thompson, Khader Zahdan, Jonathan Baptiste","doi":"10.1177/10806032241308834","DOIUrl":"https://doi.org/10.1177/10806032241308834","url":null,"abstract":"<p><strong>Introduction: </strong>Fishhook injuries are a common occurrence among anglers. There are no guidelines for prophylactic antibiotic use after fishhook removal. This study analyzed the management of embedded fishhooks, prophylactic antibiotic use, and complication rate at a Michigan county emergency department to observe whether antibiotic use changes patient outcome. Commentary on a freshwater pathogen (<i>Aeromonas hydrophila</i>) is also included.</p><p><strong>Methods: </strong>Cases were obtained through a retrospective chart review of patients seen for fishhook injury between 2016 and 2022. We analyzed age, sex, relevant medical history, type of fishhook, site preparation, removal technique, antibiotic use, return visit within 30 days, and complications.</p><p><strong>Results: </strong>Fifty-one patients with fishhooks injuries were identified. Mean age was 48±17 y. Forty-three patients were male (84%), and 8 were female (16%). Hook site varied, with most occurring in the finger/thumb (78.4%) and scalp (5.9%). One case involved the ear cartilage. The most common removal technique was the advance and cut method (52.9%). Four patients had an immunocompromising condition (eg, diabetes). Oral antibiotics were prescribed to 26 patients (51%) on discharge. Prophylactic antibiotic choice varied-cephalexin predominated (61.5%). There were no wound infections or complications in cases where the fishhook was removed during the emergency department encounter (50 of 51). One case involved a delayed presentation, abscess formation, and outpatient hand surgery referral.</p><p><strong>Conclusions: </strong>In this small observational study, antibiotic prophylaxis for freshwater-associated fishhook injury did not change outcome regardless of fishhook location or presence of an immunocompromising condition. Further controlled studies are needed to determine the validity of these findings.</p>","PeriodicalId":49360,"journal":{"name":"Wilderness & Environmental Medicine","volume":" ","pages":"10806032241308834"},"PeriodicalIF":1.4,"publicationDate":"2025-01-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143014696","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Scorpionism in the State of Bahia, Brazil: A More Neglected Problem During the Pandemic?","authors":"Jacqueline Ramos Machado Braga, Luís Vinícius Sena Dos Santos, Amanda Cristina de Souza Mata, Isabel Cristina Moraes","doi":"10.1177/10806032241300163","DOIUrl":"https://doi.org/10.1177/10806032241300163","url":null,"abstract":"<p><strong>Introduction: </strong>During the confinement in the COVID-19 pandemic, there was an increase in the production of urban waste, increasing the risk of accidents caused by scorpions. We sought to determine the clinical and epidemiologic aspects of scorpionism records in the 7 mesoregions of the State of Bahia, Brazil, examining differences in periods before and during the pandemic.</p><p><strong>Methods: </strong>Data were obtained from SINAN, Brazil's Notifiable Diseases Information System (January 2010-December 2021). Measures of morbidity (incidence and lethality) and mortality were evaluated, comparing the averages before (2018 and 2019) and during the pandemic (2020 and 2021). Sociodemographic data (ie, gender, age group, and race) and conditions of care (ie, time, classification, and evolution) were compared by mesoregion.</p><p><strong>Results: </strong>A total of 159,982 cases of scorpionism were registered, with a higher proportion in the prepandemic period (<i>P</i><0.05) and a higher average incidence in the Center South of Bahia (267.32; n=82,059; 51.29%). Most cases occurred in mixed-race individuals (61.73%), females (n=81,292; 51.22%), and individuals between 20 and 39 y of age (n=48,876; 30.55%) and most cases were classified as mild (n=136,816; 85.52%), were attended in <1 h (n=81,941; 51.22%), and progresses to cure (n=142,082; 88.81%). There were 263 deaths (0.16%), with a mortality rate of 1.77/100,000 inhabitants and a lethality of 0.16%.</p><p><strong>Conclusion: </strong>It is suggested that during the COVID-19 pandemic, despite the upward curve of accidents, social isolation measures and collective fear may have decreased the search for medical care after a scorpion sting, reducing notifications of the condition in the State of Bahia.</p>","PeriodicalId":49360,"journal":{"name":"Wilderness & Environmental Medicine","volume":" ","pages":"10806032241300163"},"PeriodicalIF":1.4,"publicationDate":"2025-01-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142972944","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Artificial Intelligence Assistance in Point-of-Care Ultrasound Skill Retention for Novice Users in Space Medicine Scenarios.","authors":"Victoria S Hurd, Michael Del Valle, Victoria G Kravets, Arian L Anderson, Nhu-Nguyen Le, John L Kendall, Allison P Hayman, Matthew Riscinti","doi":"10.1177/10806032241304441","DOIUrl":"https://doi.org/10.1177/10806032241304441","url":null,"abstract":"<p><strong>Introduction: </strong>As humanity progresses further into space, astronauts must be increasingly independent from mission control, especially in high-consequence medical scenarios. The high-utility and low-mass nature of point-of-care ultrasound (POCUS) makes this imaging modality ideal for spaceflight mission deployment. However, POCUS operator skill degrades over time, presenting an operational barrier to continuous, effective use. Further, formal medical education and POCUS-specific training are not requirements for astronaut candidates, potentially exacerbating skill degradation. Artificial intelligence (AI) assistance may mitigate skill decay, enabling long-term POCUS skill retention. To characterize the utility of this paradigm in space, we evaluated AI assistance effects on POCUS skill retention in subject pools with astronaut-mimicking educational demographics.</p><p><strong>Methods: </strong>This prospective cohort study included 30 participants, evenly split into unassisted and AI-assisted cohorts. After undergoing 1 training session, participants collected 5 renal images, bladder images, and bladder volume estimations and completed usability and self-confidence surveys immediately, 2 wk, and 8 wk after initial training. Primary outcomes included target organ capture rates, image quality, bladder volume variability, perceived self-confidence, and perceived system usability.</p><p><strong>Results: </strong>AI assistance minimized bladder volume variability aggregated over time (<i>P</i>=0.004) and 2 wk after training (<i>P</i>=0.009) and mitigated perceived system usability degradation with time (<i>P</i>=0.04). No trends were found in organ-capture abilities, image quality, or self-confidence.</p><p><strong>Conclusion: </strong>POCUS AI decreased bladder volume variability and mitigated system usability decrement. We recommend increasing study duration or reducing the number of data collections in future study designs and the fieldwide adoption of objective ultrasound image-quality metrics.</p>","PeriodicalId":49360,"journal":{"name":"Wilderness & Environmental Medicine","volume":" ","pages":"10806032241304441"},"PeriodicalIF":1.4,"publicationDate":"2025-01-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142923787","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}