The demonstration and validation of a linked watershed-riverine modeling system for DoD installations : user guidance report version 2.0

A linked watershed model was evaluated on three watersheds within the U.S.: (1) House Creek Watershed, Fort Hood, TX; (2) Calleguas Creek Watershed, Ventura County, CA; and (3) Patuxent River Watershed, MD. The goal of this demonstration study was to show the utility of such a model in addressing water quality issues facing DoD installations across a variety of climate zones. In performing the demonstration study, evaluations of model output with regards to accuracy, predictability and meeting regulatory drivers were completed. Data availability, level of modeling expertise, and costs for model setup, validation, scenario analysis, and maintenance were evaluated in order to inform installation managers on the time and cost investment needed to use a linked watershed modeling system. Final conclusions were that the system evaluated in this study would be useful for answering a variety of questions posed by installation managers and could be useful in developing management scenarios to better control pollutant runoff from installations.

Myopericarditis Associated With Smallpox Vaccination Among US Army Personnel – Fort Hood, Texas, 2018

Objective: In March 2018, the US Department of Defense (DOD) added the smallpox vaccination, using ACAM2000, to its routine immunizations, increasing the number of persons receiving the vaccine. The following month, Fort Hood reported a cluster of 5 myopericarditis cases. The Centers for Disease Control and Prevention and the DOD launched an investigation. Methods: The investigation consisted of a review of medical records, establishment of case definitions, causality assessment, patient interviews, and active surveillance. A 2-sided exact rate ratio test was used to compare myopericarditis incidence rates. Results: This investigation identified 4 cases of probable myopericarditis and 1 case of suspected myopericarditis. No alternative etiology was identified as a cause. No additional cases were identified. There was no statistically significant difference in incidence rates between the observed cluster (5.23 per 1000 vaccinated individuals, 95% CI: 1.7–12.2) and the ACAM2000 clinical trial outcomes for symptomatic persons, which was 2.29 per 1000 vaccinated individuals (95% CI: 0.3–8.3). Conclusions: Vaccination with ACAM2000 is the presumptive cause of this cluster. Caution should be exercised before considering vaccination campaigns for smallpox given the clinical morbidity and costs incurred by a case of myopericarditis. Risk of myopericarditis should be carefully weighed with risk of exposure to smallpox.

Brain Injury: What Influences the Beliefs U.S. Service Members Have About Reporting and Seeking Care?

ABSTRACT Introduction Despite the recent Department of Defense emphasis on traumatic brain injury (TBI) education and improvements in treatment, social, and attitudinal beliefs instilled in the military community hinder seeking medical assistance at the time of injury. This survey research presents injury reporting and care seeking behavioral patterns of service members (SMs) stationed in the Landstuhl catchment area in the context of TBI. This descriptive study investigated whether sociocultural factors influence health decision-making among SMs stationed abroad and how these compare to the SMs stationed in Fort Bliss and Fort Hood. Materials and Methods A total of 969 of U.S. Army, Air Force, and Navy SMs completed a voluntary and anonymous 2- to 5-minute paper survey during the month of March 2019. As a result of illegibility and incompleteness, 15 survey responses were removed from the total sample. Results Data analyses show three main findings about SMs in the Landstuhl catchment area: (a) older population (25-34, ≥48%; 18-24, 26.1%; +35, 25.4%) when compared to Fort Hood and Fort Bliss (≥48%; 18-24); (b) more years in service (7-13 years; 30.2%) versus 6 years or less in both Fort Hood and Fort Bliss (≥69%); (c) 54.8% of participants did not think TBI requires care versus 63.5% in both Fort Bliss and Fort Hood. Conclusion Results suggest that TBI beliefs and influences are constant variables hindering health decision-making choices in the military population. Beliefs about thinking that the injury does not require care, fear to jeopardize the career, and knowledge about TBI and treatments vary among the respondents and all these components influence treatment-seeking behaviors. The findings provide a preliminary framework to further investigate the role of culture in reporting and seeking treatment behaviors among SMs.

Mindset First, Strategy Second: Finding the Savings and Performance in Changing Culture

ABSTRACT Resolving major challenges for health care organizations is a constant challenge. Each military service provides its leaders with superb education and training to lead the constant needs and changes of the mission requirements. The primary trap we leaders may fall into, though, is when we mistake our own expertise and perspectives as the solutions to our organizational challenges. To fully unleash the potential of our people and organizations, we must be deliberate in setting a culture that leverages all the diversity within our organization. At the Carl R. Darnall Army Medical Center, Fort Hood, TX, our leadership team initiated an effort to shift the organizational mindset to create this cultural soil. The seeds of our education, training and strategic initiatives then were able to flourish and address our organizational challenges, but only after we addressed our own leadership mindset gap. By establishing and modeling a foundational outward mindset to ensure our team focused on the impact of our actions, we nurtured a culture that was inquisitive, collaborative, and without blame. In doing so, we eliminated negative financial and safety outcomes that threatened our institution and transformed it into a leading Army Medical Center.

Seasonal Emergence and Historical Contaminant Exposure of Cave Myotis (Myotis velifer) in Central Texas and Current Status of the Population

We examined the emergence patterns of Myotis velifer in central Texas in 2000 and assessed exposure to pesticide residues. We collected and analyzed guano from three caves for pesticide residues. In addition, bat carcasses were sampled from an active colony of cave myotis (Myotis velifer) in Shell Mountain. Organochlorine residue concentrations were highest in guano from the Egypt and Tippit Caves, whereas organophosphate concentrations were highest in Shell Mountain guano. Residue concentrations of organochlorines and metals in guano and carcasses collected from the three caves are considered low and probably of no biological concern. The study was one of very few to demonstrate the presence of OPs, including 18 different detectable compounds in the two most recent samples of bat guano. Comparisons between spring and fall guano samples from Shell Mountain suggest that HCB (hexachlorobenzene), total chlordanes, dieldrin, endrin, endosulfan II, p,p’-DDE (Dichloro-2,2-bis(p-chlorophenyl) ethylene), and o,p’-DDT (Dichlorodiphenyltrichloroethane) accumulated while bats were absent from the caves at Fort Hood. Lindane appeared to be the only chemical that increased while the bats were present at the site. Organochlorine concentrations in carcasses were generally lowest in lactating females and higher in nursing juveniles. The pattern of emergence coincides with the peak of agricultural activities, therefore, bats forage at a time when the insect pests are most abundant, but also potential to exposure to agricultural chemicals is highest. The current status of the population, however, remains stable in spite of the history of exposure.