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Introductions:Healthcare workers use less tobacco than other working populations. In contrast, US military members use more tobacco than civilians. Military healthcare workers, therefore, represent a unique group with regard to occupational factors that may influence tobacco use.Aims/Methods:Records of workers at a military community hospital were reviewed to describe tobacco use. An anonymous survey assessed impressions of a worksite policy change that prohibited tobacco use anywhere on hospital grounds.Results:Hospital staff included 2,074 professionals. Tobacco use was significantly associated with male sex and being a military enlisted worker. In fact, 37% of male enlisted members used tobacco; fewer than 10% of all other workers used tobacco. Among 232 survey respondents, 61% agreed with tobacco-restrictive worksite policies, but only 33% thought policies were effective. Nearly one-third of tobacco users reported decreasing use in the past year. In multivariable modelling, changing habits in response to worksite policy was the only factor significantly associated with decreased tobacco use.Conclusions:Tobacco use among US military healthcare workers varies markedly by demographic characteristics. Male, military enlisted workers use tobacco at very high rates, paralleling the troops they serve. Implementation of tobacco-restrictive worksite policies is associated with decreased tobacco use in this population.

To describe an intervention among overweight and obese hypertensive patients, encouraging Dietary Approaches to Stop Hypertension (DASH) diet and lifestyle changes, designed and led by a primary care nurse practitioner (NP).A pre- and postintervention quasi-experimental time-series design was implemented over 2 months. Intervention included three group classes and two individual counseling telephone calls. Forty-five hypertensive patients enrolled, with a mean age of 55 years and mean initial BMI of 32. Twenty-six (58%) completed the program. Standard instruments (Rapid Eating Assessment for Patients [REAP] and Partners in Health [PIH] questionnaires) were used to evaluate diet and lifestyle factors before and after the program.Participants had statistically significant improvements in diet and lifestyle scores on both REAP and PIH questionnaires, as well as statistically significant weight loss (average 3.6 pounds lost) over the 2-month intervention period.This NP-led primary care intervention on diet and lifestyle showed early success in improving the health of overweight and obese hypertensive patients. Investment in NP-led diet and lifestyle counseling should be considered among high-risk patients in the primary care setting.

We hypothesize that an anecdotally observed increase in tourniquet breakage and decrease in efficacy may be secondary to environmental exposure during military deployment. This was a study comparing efficacy and breakage of 166 Afghanistan-exposed tourniquets to 166 unexposed tourniquets. Afghanistan exposure was defined as tourniquet carriage by field staff in the operational environment for approximately 6 months. In a controlled environment in the United States, a previously exposed tourniquet was tested on one thigh of each subject, while an unexposed tourniquet was tested on the opposite thigh. We recorded tourniquet efficacy (absence of distal pedal pulse for at least 30 seconds), breakage, and the number of turns required to stop the distal pedal pulse. A Wilcoxon sign-rank test was used to test differences between exposed and unexposed tourniquets. Tourniquets exposed to the environment broke more often (14/166 versus 0/166) and had decreased efficacy (63% versus 91%; p0.001). Three turns were required for most tourniquets to be efficacious. Environmental exposure of military tourniquets is associated with decreased efficacy and increased breakage. In most cases, tourniquets require three turns to stop the distal lower extremity pulse.

Memory for olfactory stimuli may be particularly affected by age-related brain changes in humans and may be an early indicator of cognitive impairment and Alzheimer's disease. Studies involving rats have offered insights into impaired cognition in aged animals, but few have examined odor memory. Therefore, it is unclear whether aged rats are a good model for possible age-related changes in odor memory in humans. Young (6-month-old) and old (24-month-old) rats were tested on associative learning tasks involving visual and olfactory stimuli. The first task examined age-related differences in discrimination and reversal learning for olfactory and visual stimuli; the second task utilized an associative contextual learning task involving olfactory and visual cues. Although old rats were able to perform the olfactory and visual discrimination tasks as well as young rats, old rats displayed significant age-related impairment on the reversal learning and contextual learning tasks. The results suggest that aging may have a similar deleterious effect on odor memory in rats and in humans. The findings may have important implications for the selection of memory paradigms for future research studies on aging. In addition, the use of an animal model to investigate the effects of aging on odor memory will allow researchers the ability to investigate how age-related neuroanatomical and neurochemical changes may result in impaired odor memory.

Objective To describe outpatient prescription treatment for active-duty military members with posttraumatic stress disorder (PTSD). Medical records were screened for drug-drug interactions with PTSD-related medications and for adverse drug events. Method A retrospective chart review was conducted of the medical records of active-duty service members aged 18 to 65 years who had a diagnosis of PTSD (ICD-9 criteria) and received psychiatric treatment at Naval Hospital Camp Pendleton, Camp Pendleton, California, between October 1, 2010, and October 31, 2010. Prescription medication treatment over a 6-month period (October 1, 2010, through March 31, 2011) was reviewed. Results Among 275 patients, 243 (88.4%) had at least 1 prescription dispensed and 219 (79.6%) had at least 1 PTSD-related medication dispensed. More than 1 PTSD-related medication was dispensed to 153 (55.6%) patients. The most common medication classes dispensed were selective serotonin reuptake inhibitors (SSRIs) and serotonin-norepinephrine reuptake inhibitors (SNRIs) (35.1%), novel antidepressants (15.6%), and anticonvulsants (15.0%). The most frequently dispensed PTSD-related medications were zolpidem: 149 (9.8%), sertraline: 147 (9.7%), gabapentin: 134 (8.8%), prazosin: 111 (7.3%), and trazodone: 110 (7.2%). In the subgroup of 219 patients who received PTSD-related medications, overlapping periods of treatment between an SSRI and another PTSD-related medication occurred in 58 (26.5%) patients. Potential drug-drug interactions with this combination involved 44 (20.1%) patients; no adverse drug events were reported. Among these 44 patients, 55 different potential drug-drug interactions were identified. Conclusions Patients receiving medications for PTSD are frequently treated with SSRIs or SNRIs and are likely to be prescribed more than 1 PTSD-related medication.

Age-related changes in temporal order memory have been well documented in older adults; however, little is known about this ability during middle age. We tested healthy young, middle-aged, and older adults on a previously published visuospatial temporal order memory test involving high and low interference conditions. When interference was low, young and middle-aged adults did not differ, but both groups significantly outperformed older adults. However, when interference was high, significant differences were found among all three age groups. The data provide evidence that temporal order memory may begin to decline in middle age, particularly when temporal interference is high.

Using the proper greeting may be important to help establish rapport between health care providers and their patients. It may be particularly useful for family medicine physicians working in a military medical facility, where military rank and traditions are important. A total of 259 anonymous surveys were collected from patients treated at a military family medicine clinic. Most of the patients who completed the survey preferred to shake hands with their provider, be greeted using only their first name, and preferred that the provider introduce themselves using their last name only. Active duty patients were more likely than civilians to prefer a handshake (odds ratio [OR] 3.05, 95% confidence interval [CI] 1.46-6.39) and officers were more likely to prefer a handshake compared to enlisted service members (OR 3.29; 95% CI 1.18-9.20). Respondents who were older were more likely to prefer a formal introduction by their provider compared to respondents under 35 years old (OR 2.92, 95% CI 1.35-6.31). Although most patients in this facility expressed a preference for how they would like to be greeted, providers are still encouraged to ask their patients how they would prefer to be addressed.

Two experiments tested the effect of temporal interference on order memory for fixed and random sequences in young adults and nondemented older adults. The results demonstrate that temporal order memory for fixed and random sequences is impaired in nondemented older adults, particularly when temporal interference is high. However, temporal order memory for fixed sequences is comparable between older adults and young adults when temporal interference is minimized. The results suggest that temporal order memory is less efficient and more susceptible to interference in older adults, possibly due to impaired temporal pattern separation.

Joubert syndrome (JBTS), related disorders (JSRDs) and Meckel syndrome (MKS) are ciliopathies. We now report that MKS2 and CORS2 (JBTS2) loci are allelic and caused by mutations in TMEM216, which encodes an uncharacterized tetraspan transmembrane protein. Individuals with CORS2 frequently had nephronophthisis and polydactyly, and two affected individuals conformed to the oro-facio-digital type VI phenotype, whereas skeletal dysplasia was common in fetuses affected by MKS. A single G218T mutation (R73L in the protein) was identified in all cases of Ashkenazi Jewish descent (n = 10). TMEM216 localized to the base of primary cilia, and loss of TMEM216 in mutant fibroblasts or after knockdown caused defective ciliogenesis and centrosomal docking, with concomitant hyperactivation of RhoA and Dishevelled. TMEM216 formed a complex with Meckelin, which is encoded by a gene also mutated in JSRDs and MKS. Disruption of tmem216 expression in zebrafish caused gastrulation defects similar to those in other ciliary morphants. These data implicate a new family of proteins in the ciliopathies and further support allelism between ciliopathy disorders.

The current study investigated memory for sequentially presented objects in young rats 6 months of age (n=12) and aged rats 24 months of age (n=12). Rats were tested on a task involving three exploratory trials and one probe test. During the exploratory trials, the rat explored a set of three sequentially presented object pairs (A-A, B-B, and C-C) for 5 min per pair with a 3 min delay between each pair. Following the exploratory trials, a probe test was conducted where the rat was presented simultaneously with one object from the first exploratory trial (A) and one object from the third exploratory trial (C). Results from the three exploratory trials showed no significant age-related differences in exploration, indicating that 24 month old rats explored the object pairs as much as 6 month old rats. Results from the probe test demonstrated that 6 month old rats spent significantly more time exploring object A compared to object C, indicating that young rats show intact memory for the temporal order of the exploratory trial objects. In contrast, 24 month old rats showed no preference for object A and spent a relatively equal amount of time exploring objects A and C. The results suggest that temporal order memory may decline as a result of age-related changes in the rodent brain. In addition, the findings may reflect differences in attraction to objects with different memory strengths. Since no significant age-related differences were detected during the exploratory trials, age-related differences on the probe trial were not due solely to decreased exploration, motivation, or locomotion in aged rats.

Ciliopathies are an expanding group of rare conditions characterized by multiorgan involvement, that are caused by mutations in genes encoding for proteins of the primary cilium or its apparatus. Among these genes, CEP290 bears an intriguing allelic spectrum, being commonly mutated in Joubert syndrome and related disorders (JSRD), Meckel syndrome (MKS), Senior-Loken syndrome and isolated Leber congenital amaurosis (LCA). Although these conditions are recessively inherited, in a subset of patients only one CEP290 mutation could be detected. To assess whether genomic rearrangements involving the CEP290 gene could represent a possible mutational mechanism in these cases, exon dosage analysis on genomic DNA was performed in two groups of CEP290 heterozygous patients, including five JSRD/ MKS cases and four LCA, respectively. In one JSRD patient, we identified a large heterozygous deletion encompassing CEP290 C -terminus that resulted in marked reduction of mRNA expression. No copy number alterations were identified in the remaining probands. The present work expands the CEP290 genotypic spectrum to include multiexon deletions. Although this mechanism does not appear to be frequent, screening for genomic rearrangements should be considered in patients in whom a single CEP290 mutated allele was identified.

Age-related changes have been documented in regions of the brain shown to process reward information. However, few studies have examined the effects of aging on associative memory for reward. The present study tested 7- and 24-month-old rats on a conditioned flavor preference task. Half of the rats in each age group received an unsweetened grape-flavored solution (CS-) on odd-numbered days and a sweetened cherry-flavored solution (CS+) on even-numbered days. The remaining rats in each age group received a sweetened grape-flavored solution (CS+) on odd-numbered days and an unsweetened cherry-flavored solution (CS-) on even-numbered days. During the acquisition phase of testing, the designated solution (CS+ or CS-) was presented to each rat for 15 min daily across six consecutive days. On the preference phase, each rat received unsweetened cherry and unsweetened grape-flavored solutions simultaneously for 15 min daily across four consecutive days. The 7-month-old rats showed a significant preference for the flavor that was previously sweetened during the acquisition phase (CS+) compared to the previously unsweetened solution (CS-) when the two unsweetened solutions were presented simultaneously during the preference phase of testing. In contrast, the 24-month-old rats did not show a preference and consumed roughly equal amounts of the previously sweetened (CS+) and unsweetened (CS-) solutions. Thus, the data suggest that the ability to form flavor-reward associations declines with increasing age, resulting in impaired conditioned flavor preference.