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"Cook, Glen"
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Garrett for hire
Meet Garrett, P.I. He's a hardboiled human detective who stands out in a crowd of elves, trolls, and other otherworldly denizens in the magical city of TunFaire.
Book
Introducing Garrett, P.I.
\"The first three novels from the classic series that brought 'a dose of gritty realism to fantasy.' Being a human detective in a world of gnomes, trolls, and damsels in distress is no easy task, but when trouble comes knocking, Garrett is always the man for the job.\"--P. [4] of cover.
Book
Risk of longer-term neurological conditions in the Deepwater Horizon Oil Spill Coast Guard Cohort Study – Five years of follow-up
Background
Long-term neurological health risks associated with oil spill cleanup exposures are largely unknown. We aimed to investigate risks of longer-term neurological conditions among U.S. Coast Guard (USCG) responders to the 2010
Deepwater Horizon
(DWH) oil spill.
Methods
We used data from active duty members of the DWH Oil Spill Coast Guard Cohort Study (
N
=45224). Self-reported oil spill exposures were ascertained from post-deployment surveys. Incident neurological outcomes were classified using International Classification of Diseases, 9th Revision, codes from military health encounter records up to 5.5 years post-DWH. We used Cox Proportional Hazards regression to calculate adjusted hazard ratios (aHR) and 95% confidence intervals (CI) for various incident neurological diagnoses (2010–2015). Oil spill responder (
n
=5964) vs. non-responder (
n
= 39260) comparisons were adjusted for age, sex, and race, while within-responder comparisons were additionally adjusted for smoking.
Results
Compared to those not responding to the spill, spill responders had reduced risks for
headache
(aHR=0.84, 95% CI: 0.74-0.96),
syncope and collapse
(aHR=0.74, 95% CI: 0.56-0.97), and
disturbance of skin sensation
(aHR=0.81, 95% CI: 0.68-0.96). Responders reporting ever (
n
=1068) vs. never (
n
=2424) crude oil inhalation exposure were at increased risk for several individual and grouped outcomes related to headaches and migraines (aHR range: 1.39-1.83). Crude oil inhalation exposure was also associated with elevated risks for an inflammatory nerve condition,
mononeuritis of upper limb and mononeuritis multiplex
(aHR=1.71, 95% CI: 1.04-2.83), and
tinnitus
(aHR=1.91, 95% CI: 1.23-2.96), a condition defined by ringing in one or both ears. Risk estimates for those neurological conditions were higher in magnitude among responders reporting exposure to both crude oil and oil dispersants than among those reporting crude oil only.
Conclusion
In this large study of active duty USCG responders to the DWH disaster, self-reported spill cleanup exposures were associated with elevated risks for longer-term neurological conditions.
Journal Article
Pure autonomic failure without synucleinopathy
Pure autonomic failure is a rare form of chronic autonomic failure manifesting with neurogenic orthostatic hypotension and evidence of sympathetic noradrenergic denervation unaccompanied by signs of central neurodegeneration. It has been proposed that pure autonomic failure is a Lewy body disease characterized by intra-neuronal deposition of the protein alpha-synuclein in Lewy bodies and neurites. A middle-aged man with previously diagnosed pure autonomic failure experienced a sudden, fatal cardiac arrest. He was autopsied, and tissues were harvested for neurochemical and immunofluorescence studies. Post-mortem microscopic neuropathology showed no Lewy bodies, Lewy neurites, or alpha-synuclein deposition by immunohistochemistry anywhere in the brain. The patient had markedly decreased immunofluorescent tyrosine hydroxylase in sympathetic ganglion tissue without detectable alpha-synuclein even in rare residual nests of tyrosine hydroxylase-containing ganglionic fibers. In pure autonomic failure, sympathetic noradrenergic denervation can occur without concurrent Lewy bodies or alpha-synuclein deposition in the brain or sympathetic ganglion tissue.
Journal Article
A Review of Mild Traumatic Brain Injury Diagnostics: Current Perspectives, Limitations, and Emerging Technology
Mild traumatic brain injury (mTBI) or concussion is a common battlefield and in-garrison injury caused by transmission of mechanical forces to the head. The energy transferred in such events can cause structural and/or functional changes in the brain that manifest as focal neurological, cognitive, or behavioral dysfunction. Current diagnostic criteria for mTBI are highly limited, variable, and based on subjective self-report. The subjective nature of the symptoms, both in quantity and quality, together with their large overlap in other physical and behavioral maladies, limit the clinician's ability to accurately diagnose, treat, and make prognostic decisions after such injuries. These diagnostic challenges are magnified in an operational environment as well. The Department of Defense has invested significant resources into improving the diagnostic tools and accuracy for mTBI. This focus has been to supplement the clinician's examination with technology that is better able to objectify brain dysfunction after mTBI. Through this review, we discuss the current state of three promising technologies--soluble protein biomarkers, advanced neuroimaging, and quantitative electroencephalography--that are of particular interest within military medicine.
Journal Article