Peace and war: trajectories of posttraumatic stress disorder symptoms before, during, and after military deployment in Afghanistan.

In the study reported here, we examined posttraumatic stress disorder (PTSD) symptoms in 746 Danish soldiers measured on five occasions before, during, and after deployment to Afghanistan. Using latent class growth analysis, we identified six trajectories of change in PTSD symptoms. Two resilient trajectories had low levels across all five times, and a new-onset trajectory started low and showed a marked increase of PTSD symptoms. Three temporary-benefit trajectories, not previously described in the literature, showed decreases in PTSD symptoms during (or immediately after) deployment, followed by increases after return from deployment. Predeployment emotional problems and predeployment traumas, especially childhood adversities, were predictors for inclusion in the nonresilient trajectories, whereas deployment-related stress was not. These findings challenge standard views of PTSD in two ways. First, they show that factors other than immediately preceding stressors are critical for PTSD development, with childhood adversities being central. Second, they demonstrate that the development of PTSD symptoms shows heterogeneity, which indicates the need for multiple measurements to understand PTSD and identify people in need of treatment.

Implementation of automated reporting of estimated glomerular filtration rate among Veterans Affairs laboratories: a retrospective study.

BACKGROUND: Automated reporting of estimated glomerular filtration rate (eGFR) is a recent advance in laboratory information technology (IT) that generates a measure of kidney function with chemistry laboratory results to aid early detection of chronic kidney disease (CKD). Because accurate diagnosis of CKD is critical to optimal medical decision-making, several clinical practice guidelines have recommended the use of automated eGFR reporting. Since its introduction, automated eGFR reporting has not been uniformly implemented by U. S. laboratories despite the growing prevalence of CKD. CKD is highly prevalent within the Veterans Health Administration (VHA), and implementation of automated eGFR reporting within this integrated healthcare system has the potential to improve care. In July 2004, the VHA adopted automated eGFR reporting through a system-wide mandate for software implementation by individual VHA laboratories. This study examines the timing of software implementation by individual VHA laboratories and factors associated with implementation. METHODS: We performed a retrospective observational study of laboratories in VHA facilities from July 2004 to September 2009. Using laboratory data, we identified the status of implementation of automated eGFR reporting for each facility and the time to actual implementation from the date the VHA adopted its policy for automated eGFR reporting. Using survey and administrative data, we assessed facility organizational characteristics associated with implementation of automated eGFR reporting via bivariate analyses. RESULTS: Of 104 VHA laboratories, 88% implemented automated eGFR reporting in existing laboratory IT systems by the end of the study period. Time to initial implementation ranged from 0.2 to 4.0 years with a median of 1.8 years. All VHA facilities with on-site dialysis units implemented the eGFR software (52%, p<0.001). Other organizational characteristics were not statistically significant. CONCLUSIONS: The VHA did not have uniform implementation of automated eGFR reporting across its facilities. Facility-level organizational characteristics were not associated with implementation, and this suggests that decisions for implementation of this software are not related to facility-level quality improvement measures. Additional studies on implementation of laboratory IT, such as automated eGFR reporting, could identify factors that are related to more timely implementation and lead to better healthcare delivery.

RED COATS AND WILD BIRDS: MILITARY CULTURE AND ORNITHOLOGY ACROSS THE NINETEENTH-CENTURY BRITISH EMPIRE

“Red coats and wild birds: military culture and ornithology across the nineteenth-century British Empire” investigates the intersections between British military culture and the practices and ideas of ornithology, with a particular focus on the British Mediterranean. Considering that British officers often occupied several imperial sites over the course of their military careers, to what extent did their movements shape their ornithological knowledge and identities at “home” and abroad? How did British military naturalists perceive different local cultures (with different attitudes to hunting, birds, field science, etc.) and different local natures (different sets of birds and environments)? How can trans-imperial careers be written using not only textual sources (for example, biographies and personal correspondence) but also traces of material culture? In answering these questions, I centre my work on the Mediterranean region as a “colonial sea” in the production of hybrid identities and cultural practices, and the mingling of people, ideas, commodities, and migratory birds. I focus on the life geographies of four military officers: Thomas Wright Blakiston, Andrew Leith Adams, L. Howard Lloyd Irby, and Philip Savile Grey Reid. By the mid-nineteenth century, the Mediterranean region emerged as a crucial site for the security of the British “empire route” to India and South Asia, especially with the opening of the Suez Canal in 1869. Military stations served as trans-imperial sites, connecting Britain to India through the flow of military manpower, commodities, information, and bodily experiences across the empire. By using a “critical historical geopolitics of empire” to examine the material remnants of the “avian imperial archive,” I demonstrate how the practices and performances of British military field ornithology helped to: materialize the British Mediterranean as a moral “semi-tropical” place for the physical and cultural acclimatization of British officers en route to and from India; reinforce imperial presence in the region; and make “visible in new ways” the connectivity of North Africa to Europe through the geographical distribution of birds. I also highlight the ways in which the production of ornithological knowledge by army officers was entwined with forms of temperate martial masculinity.