A case study of contaminants on military ranges: Camp Edwards, Massachusetts, USA

An extensive investigation at the Camp Edwards, Massachusetts Military Reservation (MMR) demonstrates that assessment of groundwater and soil contamination at military ranges can be limited primarily to explosive-related compounds such as RDX, HMX, perchlorate, TNT and their transformation products. A modified analytical method is recommended to expand the list of explosives and to improve the detection limits. Analyses of metals, VOCs, SVOCs, and TICs are unnecessary. Soil samples may require the analyses of PAHs and PCNs for burn areas. Camp Edwards, as one of the few military ranges that have been exhaustively investigated for contaminants, is an ideal point of departure for evaluating other ranges. The permeable site soils promote leaching of contaminants and inhibit biotic and abiotic transformations. Moreover, the site has experienced an unusual extent of activities in its more than ninety years of active use. The recommendations in this report are based on data obtained for more than 200 analytes from more than 15,000 environmental samples.

Prevalence and factors associated with renal dysfunction among HIV-infected patients

Renal dysfunction is an increasingly recognized non-AIDS-defining comorbidity among HIV-infected persons. The role of HIV-related factors in renal dysfunction remains unclear. We performed a cross-sectional study at two military clinics with open access to care to determine the impact of HIV factors, including antiretroviral therapy, on renal function. Renal dysfunction was defined as a glomerular filtration rate (GFR) < 60 mL/min/1.73 m(2). We evaluated 717 HIV patients with a median age of 41 years; 92% were male, 49% Caucasian, and 38% African American; median CD4 count was 515 cells/mm(3) and 73% were receiving highly active antiretroviral therapy (HAART). Twenty-two patients (3%) had renal dysfunction. Factors associated with renal dysfunction in the multivariate logistic analyses included older age (odds ratio [OR] 2.0 per 10 year increase, p = 0.006), lower CD4 nadir (OR 0.6 per 100 cell change, p = 0.02), and duration of tenofovir use (OR 1.5 per year use, p = 0.01). Among persons initiating tenofovir (n = 241), 50% experienced a reduction in GFR (median -10.5 mL/min/1.73 m(2), 95% CI, -8.9 to -13.3) within 2 years. Among tenofovir users, factors associated with a reduction in GFR included female gender (p < 0.001), African American ethnicity (p = 0.003), and lower CD4 nadir (p = 0.002). In summary, renal dysfunction was relatively uncommon among our HIV-infected patients, perhaps due to their young age, lack of comorbidities, or as a result of our definition that did not include proteinuria. Renal dysfunction was associated with duration of tenofovir use. Factors associated with renal loss among tenofovir users included female gender, African American ethnicity, and CD4 nadir <200 cells/mm(3). Consideration for more frequent monitoring of kidney function among these select HIV patients may be warranted.

Medical advances during the Civil War

The contributions to medical care that developed during the Civil War have not been fully appreciated, probably because the quality of care administered was compared against modern standards rather than the standards of the time. The specific accomplishments that constituted major advances were as follows. 1. Accumulation of adequate records and detailed reports for the first time permitted a complete military medical history. This led to the publication of the Medical and Surgical History of the War of the Rebellion, which was identified in Europe as the first major academic accomplishment by US medicine. 2. Development of a system of managing mass casualties, including aid stations, field hospitals, and general hospitals, set the pattern for management of the wounded in World War I, World War II, and the Korean War. 3. The pavilion-style general hospitals, which were well ventilated and clean, were copied in the design of large civilian hospitals over the next 75 years. 4. The importance of immediate, definitive treatment of wounds and fractures was demonstrated and it was shown that major operative procedures, such as amputation, were optimally carried out in the first 24 hours after wounding. 5. The importance of sanitation and hygiene in preventing infection, disease, and death among the troops in the field was demonstrated. 6. Female nurses were introduced to hospital care and Catholic orders entered the hospital business. 7. The experience and training of thousands of physicians were upgraded and they were introduced to new ideas and standards of care. These included familiarity with prevention and treatment of infectious disease, with anesthetic agents, and with surgical principles that rapidly advanced the overall quality of American medical practice. 8. The Sanitary Commission was formed, a civilian-organized soldier's relief society that set the pattern for the development of the American Red Cross.

Impact of temperature and storage duration on the chemical and odor quality of military packaged water in polyethylene terephthalate bottles

The impact of temperature and storage time on military packaged water (MPW) quality was examined at four temperatures (23.0 °C to 60.0 °C) for 120 days. Polyethylene terephthalate (PET) bottles were filled in California and Afghanistan with unbuffered water treated by reverse osmosis. The US military's water pH long-term potability standard was exceeded, and US Food and Drug Administration (USFDA) and US Environmental Protection Agency (USEPA) drinking water pH and odor intensity limits were also exceeded. During a 70 day exposure period, Port Hueneme MPW total organic carbon and total trihalomethane levels increased from < 0.25mg/L to 2.0 ± 0.0mg/L and <0.05 μg/L to 51.5 ± 2.1 μg/L, respectively. PET released organic contaminants into MPW and residual disinfectant generated trihalomethane contaminants. After 14 days at 37.7 °C and 60.0 °C, Afghanistan MPW threshold odor number values were 8.0 and 8.6, respectively. Total organic carbon concentration only increased with exposure duration at 60.0 °C. Acetaldehyde and formaldehyde contaminants were not detected likely due to the high method detection limits applied in this study. Phthalate contaminants detected and their maximum levels were butylbenzylphthalate (BBP) 0.43 μg/L, di-n-butylphthalate (DnBP) 0.38 μg/L, di(2-ethylhexyl)phthalate (DEHP) 0.6 μg/L, and diethylphthalate (DEP) 0.32 μg/L. Antimony was only detected in 60.0 °C Afghanistan MPW on Day 28 and beyond, and its maximum concentration was 3.6 ± 0.3 μg/L. No antimony was found in bottles exposed to lesser temperatures. Environmental health, PET synthesis and bottle manufacturers, and bottle users can integrate results of this work to improve health protective decisions and doctrine.

A Pseudo-Outbreak of Skin Disease in British Troops

When a newspaper report claimed that a serious outbreak of skin disease had occurred in British Army troops stationed at the Bočac Dam, in western Bosnia, all troops at the Bočac Dam location (n=96), followed by a matched control group of troops (n=91) at a nearby location, were examined by two investigators.

14% of the study population and 21% of the control group were found to have skin disorders. Most were complaints that are commonly encountered in general medical practice. There was a striking absence of skin infestations. The historical consultation rate for skin disorders had not increased. It was concluded that an outbreak of skin disease had not occurred in British troops guarding the dam.

This epidemiological study shows that, even under conditions of modern field hygiene, up to one in five soldiers will have skin disease. Skin infestations, however, have become progressively less common during military campaigns this century, probably because of better personal hygiene, good preventive medicine practices and better access to effective health care.

Protection From Mosquito Biting Provided by Permethrin-Treated Military Fabrics

A study to evaluate the protection provided by permethrin-treated fabric following cold-water washing against biting by mosquitoes is reported. Australian Defense Force (ADF) disruptive pattern combat uniform (DPCU) shirt fabric and entire shirts were treated by dipping in a 0.6% emulsion (Perigen Defense, containing 500 g/liter permethrin), and commercial factory treatment in the United States (Factory A) and Europe (Factory B). Protection was recorded after 1, 3, 5, 10, 30, and 50 washes. The treated fabric provided 100% protection against bites of Anopheles farauti Laveran for at least 50 washes, although only 4.8-19.0% of this species fed through untreated DPCU. The protection provided by each type of permethrin treatment against Aedes aegypti (L.) biting was variable; however, there were no significant differences between the percentage of mosquitoes biting between 1 and 10 washes. A comparison between the two factory treatments for 1-50 washes also showed no statistical difference in Ae. aegypti feeding. Chemical analysis of fabric was conducted using gas chromatography and showed that the initial dose was 0.125 mg/cm(2) for Perigen-treated fabric, which fell to 0.004 mg/cm(2) after 10 washes. By contrast, factory treatments resulted in initial dose rates of 0.20 mg/cm(2) for Factory A and 0.19 mg/cm(2) for Factory B. After 10 washes, Factory A-treated fabric had 0.09 mg/cm(2) and Factory B 0.15 mg/cm(2) of permethrin. Despite the higher concentrations of permethrin in the fabric, there was not a commensurate increase in biting protection provided by the factory-treated fabric, compared with fabric treated by dipping in permethrin emulsion.

The evolution of military medical services 1854 to 1914

A contemporary examination of the response of British and United States military organizations to the increased manpower wastage occasioned by the diseases and weaponry of war during the period 1854 to 1914 and the resulting changes in how these respective medical services were organized and employed.

Contact lenses in the military service

This paper discusses contact lenses in a military environment and reports the results of a literature survey, an extensive questionnaire sent to 1400 spectacle and contact lens wearers, and a short questionnaire given to soldiers taking part in a large scale and long military maneuver. Only a small number of publications were found concerning the relation between adverse environmental conditions and contact lens wearing. In Vietnam dust and poor hygiene often led to eye irritations that precluded the wearing of contact lenses by soldiers. Nevertheless, persons in the army are often in favor of contact lenses. In the air force and navy, wearing contact lenses seems compatible with nearly all military duties. A questionnaire was sent to all known contact lens wearers in the Dutch army and air force and to about an equal number of spectacle wearers. The responses indicate that the proportion of contact lens wearers is 1.8%. The distribution of hard vs. soft lenses was 60 and 40%, respectively. Military personnel wore their lenses during nearly all daily activities. Most contact lens wearers were of the opinion that in military conditions contact lenses have advantages over spectacles. To obtain more information on field exercises, a second questionnaire was handed out immediately after a large-scale NATO field maneuver. Twenty percent of the contact lens wearers had decided in advance not to wear their lenses, but another 30% ceased wearing their lenses during the exercise. It was recommended that for nearly all functions and/or conditions, wearing of contact lenses should be allowed, but that during extended field exercises wearing of hard contact lenses should be discouraged.