Intendedness of pregnancy among active duty women in the U.S. Army

Objective. The objective of this study was to determine the prevalence of unintended pregnancy and the association between social and demographic factors among a population of active duty women in the U.S. Army giving birth to viable infants at a U.S. Army hospital at Fort Hood, Texas. Prevalence of unintended pregnancy in this group was 50.9% (95% CI 44.0 to 57.9) with 36.3% being mistimed (95% CI 29.8 to 33.2) and 14.6% being unwanted (95% CI 10.2 to 20.1). A further 14.2% of the women experienced ambivalence (95% CI 9.8 to 19.6). ^ The study population was a cross-sectional group of active duty pregnant women who represent the target population of all female soldiers that deliver viable infants in the Army. Using a survey based on previous studies, intendedness of pregnancy at conception was retrospectively determined. Unintended births are further characterized as mistimed or unwanted. Demographic and other exposures were described bivariately. Associations were evaluated using measures of relative risk and chi-square analysis. ^ The results of the research indicate that in the study population, race/ethnicity is not associated with unintended pregnancy and non-commissioned officers had a lower rate of unintended pregnancy than other rank groupings. ^

Breaking Points: Mutiny in the Continental Army

The mutinies of the Continental Army during the American Revolution threatened both the integrity of the army and the viability of the Revolution itself. They were complex phenomena, stemming from numerous underlying physical and psychological causes. Having slowly developed over the course of the war, the problems confronting the Continental Army eventually brought it to the breaking point. No less than four major mutinies, involving soldiers or officers, occurred between 1780-1783. This essay focuses on the reasons for the mutinies and how the participants justified their actions. It also examines responses from General Washington and other senior officers, and what effects these actions had on the army. Finally, this essay addresses the question of why so few major mutinies occurred given the miserable state of the Continental Army.

The astrological works of Abraham Ibn Ezra : a literary and linguistic study with special reference to the Old French translation of Hagin

by Raphael Levy

Physician's adherence to the standard protocol for diabetes treatment in Brooke Army Medical Center (BAMC)

The level of compliance with clinical practice guidelines for patients with Type II Diabetes Mellitus was evaluated in 157 patients treated at BAMC from 1 January 2006 to 1 January 2007. This retrospective analysis was conducted reviewing data from medical records and following the VA/DOD protocols that health care providers are expected to follow at this facility. Data collected included patient’s age and gender, presence or absence of complications of diabetes, physical examination findings, glycemic and lipid control, eye care, foot care, kidney function, and self-management and education. Subjects were selected performing systematic random sampling, and included both male and female patients, from a variety of ages and ethnic groups. The Diabetes complications screened for included glycemic and lipid complications, retinopathy, cardiovascular complications, peripheral circulation complications, and nephropathy. The results revealed that 19.10% had no complications and that the most common complications were: cardiovascular (49.68%), glycemic and lipid control (10.82%), retinopathy and peripheral circulation (8.28% each), and nephropathy (2.54%). Only 2.54% of the records reviewed did not include information on complications. Strictly following the Department of Defense guidelines, six treatment modules were evaluated independently and together to get a final percentage of adherence to the clinical practice guidelines. It was established that the level of adherence was going to be graded as follows: Extremely deficient: 0-15%; very poor: 16-30%; Poor and in need of improvement: 31-45%. Acceptable: 46-60%; Good: 61-80%, and Excellent: 81-100%. The results indicated that the percentage of physicians' adherence to each protocol was as follows: 88.31%, 89.93%, 90.63%, 89.42%, 89.42% and 89.64%. When the results were pooled, the level of adherence to the clinical practice guidelines was 89.55%, proving my hypothesis that Brooke Army Medical Center physicians have excellent adherence to the standard protocols for Diabetes Type II to treat their patients. ^

PRETERM BIRTH AND OCCUPATIONAL PHYSICAL ACTIVITY: A CASE-CONTROL STUDY OF THE RELATIONSHIP BETWEEN LENGTH OF GESTATION AND THE PHYSICAL DEMAND OF U.S. ARMY MILITARY OCCUPATIONAL SPECIALTIES (UNITED STATES)

A case-control study has been conducted examining the relationship between preterm birth and occupational physical activity among U.S. Army enlisted gravidas from 1981 to 1984. The study includes 604 cases (37 or less weeks gestation) and 6,070 controls (greater than 37 weeks gestation) treated at U.S. Army medical treatment facilities worldwide. Occupational physical activity was measured using existing physical demand ratings of military occupational specialties.^ A statistically significant trend of preterm birth with increasing physical demand level was found (p = 0.0056). The relative risk point estimates for the two highest physical demand categories were statistically significant, RR's = 1.69 (p = 0.02) and 1.75 (p = 0.01), respectively. Six of eleven additional variables were also statistically significant predictors of preterm birth: age (less than 20), race (non-white), marital status (single, never married), paygrade (E1 - E3), length of military service (less than 2 years), and aptitude score (less than 100).^ Multivariate analyses using the logistic model resulted in three statistically significant risk factors for preterm birth: occupational physical demand; lower paygrade; and non-white race. Controlling for race and paygrade, the two highest physical demand categories were again statistically significant with relative risk point estimates of 1.56 and 1.70, respectively. The population attributable risk for military occupational physical demand was 26%, adjusted for paygrade and race; 17.5% of the preterm births were attributable to the two highest physical demand categories. ^

MEASURING THE EFFECT OF ILLNESS ON THE EXPECTED REMAINING SERVICE TIME FOR THE ACTIVE DUTY ARMY: A LIFE TABLE APPROACH

A life table methodology was developed which estimates the expected remaining Army service time and the expected remaining Army sick time by years of service for the United States Army population. A measure of illness impact was defined as the ratio of expected remaining Army sick time to the expected remaining Army service time. The variances of the resulting estimators were developed on the basis of current data. The theory of partial and complete competing risks was considered for each type of decrement (death, administrative separation, and medical separation) and for the causes of sick time.^ The methodology was applied to world-wide U.S. Army data for calendar year 1978. A total of 669,493 enlisted personnel and 97,704 officers were reported on active duty as of 30 September 1978. During calendar year 1978, the Army Medical Department reported 114,647 inpatient discharges and 1,767,146 sick days. Although the methodology is completely general with respect to the definition of sick time, only sick time associated with an inpatient episode was considered in this study.^ Since the temporal measure was years of Army service, an age-adjusting process was applied to the life tables for comparative purposes. Analyses were conducted by rank (enlisted and officer), race and sex, and were based on the ratio of expected remaining Army sick time to expected remaining Army service time. Seventeen major diagnostic groups, classified by the Eighth Revision, International Classification of Diseases, Adapted for Use In The United States, were ranked according to their cumulative (across years of service) contribution to expected remaining sick time.^ The study results indicated that enlisted personnel tend to have more expected hospital-associated sick time relative to their expected Army service time than officers. Non-white officers generally have more expected sick time relative to their expected Army service time than white officers. This racial differential was not supported within the enlisted population. Females tend to have more expected sick time relative to their expected Army service time than males. This tendency remained after diagnostic groups 580-629 (Genitourinary System) and 630-678 (Pregnancy and Childbirth) were removed. Problems associated with the circulatory system, digestive system and musculoskeletal system were among the three leading causes of cumulative sick time across years of service. ^

Mean annual surface displacement of the Laurichard rock glacier, French Alps

The Laurichard active rock glacier is the permafrost-related landform with the longest record of monitoring in France, including an annual geodetic survey, repeated geoelectrical campaigns from 1979 onwards and continuous recording of ground temperature since 2003. These data were used to examine changes in creep rates and internal structure from 1986 to 2006. The control that climatic variables exert on rock glacier kinematics was investigated over three time scales. Between the 1980s and the early 2000s, the main observed changes were a general increase in surface velocity and a decrease in internal resistivity. At a multi-year scale, the high correlation between surface movement and snow thickness in the preceding December appears to confirm the importance of snow cover conditions in early winter through their influence on the ground thermal regime. A comparison of surface velocities, regional climatic datasets and ground sub-surface temperatures over six years suggests a strong relation between rock glacier deformation and ground temperature, as well as a role for liquid water due to melt of thick snow cover. Finally, unusual surface lowering that accompanied peak velocities in 2004 may be due to a general thaw of the top of the permafrost, probably caused both by two successive snowy winters and by high energy inputs during the warm summer of 2003.

Physical properties, sedimentation rates, and accumulation rates of bottom sediments from the Laptev Sea collected during SPASIBA-91 Russian-French Program

Humidity and wet and dry bulk densities were determined for bottom sediments of the Lena River marginal filter within a 700 km section from the outer boundary of the river delta. Earlier determinations of suspended matter concentration in water, material and grain-size composition and age of sediments were made along the same section. Sediment matter fluxes (accumulation rates), their changes in space and time (about 14 ka) were inferred from measurements of physical parameters. A correlation was found between the physical parameters of bottom sediments and changes in the Lena river marginal filter including those caused by sea-level fluctuations.

Mineral and organic geochemistry from Lake Anterne sediments (North French Alps)

A high-resolution sedimentological and geochemical study was performed on a 20 m long core from the alpine Lake Anterne (2063 m a.s.l., NW French Alps) spanning the last 10 ka. Sedimentation is mainly of minerogenic origin. The organic matter quantity (TOC%) as well as its quality (hydrogen (HI) and oxygen (OI) indices) both indicate the progressive onset and subsequent stabilization of vegetation cover in the catchment from 9950 to 5550 cal. BP. During this phase, the pedogenic process of carbonate dissolution is marked by a decrease in the calcium content in the sediment record. Between 7850 and 5550 cal. BP, very low manganese concentrations suggest anoxic conditions in the bottom-water of Lake Anterne. These are caused by a relatively high organic matter (terrestrial and lacustrine) content, a low flood frequency and longer summer stratification triggered by warmer conditions. From 5550 cal. BP, a decrease in TOC, stabilization of HI and higher sedimentation rates together reflect increased erosion rates of leptosols and developed soils, probably due to a colder and wetter climate. Then, three periods of important soil destabilization are marked by an increased frequency and thickness of flood deposits during the Bronze Age and by increases in topsoil erosion relative to leptosols (HI increases) during the late Iron Age/Roman period and the Medieval periods. These periods are also characterized by higher sedimentation rates. According to palynological data, human impact (deforestation and/or pasturing activity) probably triggered these periods of increased soil erosion.