Warren Air Force Base Research Articles

Pots of Gold at the End of Laboratory Benches and in Freezers.

Whether one is a paleopathologist probing ancient civilizations, a modern-day epidemiologist searching for clues about the natural history of a specific disease process, or even a research entomologist studying the evolution and differences among hundreds of beetle species identified through centuries, the study of previously collected biological specimens repeatedly has proven enlightening. As stated by Baker in her recent comprehensive discussion of biobanks, “High quality data-rich samples are essential for future research.” Often, as the result of investigator initiation or sometimes even by accident, discoveries from unique specimens continue to result in important scientific advances. There is no more appropriate example than the discovery and recovery of the 1918 Spanish influenza virus from human remains preserved in the Alaskan permafrost. Employing such concepts, the U.S. Military for centuries has made (and continues to make) numerous medical/scientific contributions. Not only has the Armed Forces Institute of Pathology itself contributed to scientific knowledge, but the collaboration of this renowned institute with civilian investigators has been a model for joint efforts. Noteworthy is the postmortem evaluation of casualties from the Korean War to uncover enlightening clues toward understanding the then-underappreciated early onset of human atherosclerosis. A common thread throughout such investigations has been the discovery and utilization of technological advances, such as modern molecular biology and imaging methods, to further mine these collected treasures. Laboratory methodology and other scientific inquiry have become more ingenious than were ever imagined by investigators during the original periods of study design and specimen collection decades previously. Because of the frequently unpredictable future value of such gathered specimens, careful oversight and long-term care of such repositories are required. This supplement to Military Medicine contains descriptions of several current instances of such stewardship. The specimen repositories directly or indirectly originated from military-related populations, and are representative of “pots of gold” at the end of laboratory benches from past and present clinical and epidemiologic studies. Individually and collectively these Military Medicine articles emphasize not only the opportunities for innovative biologic and technological approaches to long recognized enigmatic diseases, but the articles also allude to contemporaneous issues inherent in addressing ethical and quality assurance hurdles facing those who make use of these often unexplored treasures. However, the important food for thought discussed in this supplement demands enhanced proactive attention, not only for military-associated investigations, but also by colleagues in the academic and industrial scientific communities who find themselves as custodians/guardians for nonmilitaryassociated repositories of sera, of microorganisms, and of pathological specimens. The included articles describe continuing specific efforts by the Department of Defense (DoD) to create and maintain repositories. Perdue and colleagues’ description of the DoD gigantic serum repository and their discussion of maximizing present and future use of the millions of serum specimens now stored and comprehensively cataloged in this unique collection provide an excellent overview of what is required to create and efficiently maintain potentially usable resources. The description of the United States Air Force Ranch Hand Collection of biological specimens, collected from Vietnam veterans for study of the consequences of herbicide exposure, has important implications for future operations. Of considerable importance is the DoD’s collaboration with the Institute of Medicine (IOM), which has been granted considerable responsibility for this collection. The IOM has prepared to open The Ranch Hand collection to qualified investigators, including those not directly connected to the military as well as to projects of potential importance to current military members and veterans. Similar joint collaboration by the Medical Follow-up Agency of the IOM and the DoD (Air Force) has been initiated for the collection of slightly less than 45,000 sera obtained from Air Force recruits at Warren Air Force Base (AFB), Wyoming, during the Korean conflict. These sera resulted from studies of group A streptococcal infections and prevention of rheumatic fever. Those sentinel studies resulted in the 1954 awarding of a prestigious Lasker Award to the Warren Air Force Base Streptococcal Laboratory, another joint military–civilian effort. Although never foreseen by the civilian–military investigators at the time, study of the Warren serum collection (not described in this supplement) half a century later enhanced understanding of infection with hepatitis C virus (undiscovered at the time of the original studies in 1949–1954) as well as genomic studies of patients with celiac disease (using laboratory techniques not available in the 1940s and 1950s). Opportunities to use evolving technology to prospectively study historical biospecimens are a major thrust of the purpose of this supplement. Department of Pediatrics, University of Minnesota Medical School, MMC 296; 420 Delaware Street Southeast, Minneapolis, MN 55422. The opinions expressed are those of the author and should not be construed to represent those of the Department of Defense. doi: 10.7205/MILMED-D-15-00236

Increased Prevalence and Mortality in Undiagnosed Celiac Disease

The historical prevalence and long-term outcome of undiagnosed celiac disease (CD) are unknown. We investigated the long-term outcome of undiagnosed CD and whether the prevalence of undiagnosed CD has changed during the past 50 years. This study included 9133 healthy young adults at Warren Air Force Base (sera were collected between 1948 and 1954) and 12,768 gender-matched subjects from 2 recent cohorts from Olmsted County, Minnesota, with either similar years of birth (n = 5558) or age at sampling (n = 7210) to that of the Air Force cohort. Sera were tested for tissue transglutaminase and, if abnormal, for endomysial antibodies. Survival was measured during a follow-up period of 45 years in the Air Force cohort. The prevalence of undiagnosed CD between the Air Force cohort and recent cohorts was compared. Of 9133 persons from the Air Force cohort, 14 (0.2%) had undiagnosed CD. In this cohort, during 45 years of follow-up, all-cause mortality was greater in persons with undiagnosed CD than among those who were seronegative (hazard ratio = 3.9; 95% confidence interval, 2.0-7.5; P < .001). Undiagnosed CD was found in 68 (0.9%) persons with similar age at sampling and 46 (0.8%) persons with similar years of birth. The rate of undiagnosed CD was 4.5-fold and 4-fold greater in the recent cohorts, respectively, than in the Air Force cohort (both P < or = .0001). During 45 years of follow-up, undiagnosed CD was associated with a nearly 4-fold increased risk of death. The prevalence of undiagnosed CD seems to have increased dramatically in the United States during the past 50 years.

A location analysis approach for military maintenance scheduling with geographically dispersed service areas

This research uses a two-stage maximal covering location problem (MCLP) model to develop Inter continental ballistic missile (ICBM) maintenance schedules for the US Air Force. Solutions are compared to actual missile maintenance activities accomplished at F. E. Warren Air Force Base (AFB), Wyoming in May 2005. Sensitivity analysis is performed to determine the impact of altering security response times and the number of security patrol areas on the quality of daily maintenance schedules and personnel usage. Results indicate marked improvement over traditional Air Force scheduling methods. In addition sensitivity analysis identifies the levels at which the quality and quantity of maintenance performance is impacted.

Monitoring trichloroethene remediation at an iron permeable reactive barrier using stable carbon isotopic analysis

Stable carbon isotopic analysis, in combination with compositional analysis, was used to evaluate the performance of an iron permeable reactive barrier (PRB) for the remediation of ground water contaminated with trichloroethene (TCE) at Spill Site 7 (SS7), F.E. Warren Air Force Base, Wyoming. Compositional data indicated that although the PRB appeared to be reducing TCE to concentrations below treatment goals within and immediately downgradient of the PRB, concentrations remained higher than expected at wells further downgradient (i.e. > 9 m) of the PRB. At two wells downgradient of the PRB, TCE concentrations were comparable to upgradient values, and δ 13C values of TCE at these wells were not significantly different than upgradient values. Since the process of sorption/desorption does not significantly fractionate carbon isotope values, this suggests that the TCE observed at these wells is desorbing from local aquifer materials and was present before the PRB was installed. In contrast, three other downgradient wells show significantly more enriched δ 13C values compared to the upgradient mean. In addition, δ 13C values for the degradation products of TCE, cis-dichloroethene and vinyl chloride, show fractionation patterns expected for the products of the reductive dechlorination of TCE. Since concentrations of both TCE and degradation products drop to below detection limit in wells within the PRB and directly below it, these downgradient chlorinated hydrocarbon concentrations are attributed to desorption from local aquifer material. The carbon isotope values indicate that this dissolved contaminant is subject to local degradation, likely due to in situ microbial activity.

History of U.S. Military Contributions to the Study of Respiratory Infections

History reveals a tremendous impact of respiratory pathogens on the U.S. military, dating back to the time of the Revolutionary and Civil Wars, during which 90% of casualties were for nonbattle injury, including several respiratory illnesses such as measles, whooping cough, and complicated pneumonia. The devastating impact of the influenza pandemic at the end of World War I led to a more proactive approach to research into the etiologies and potential preventive measures for such diseases. The development of the Armed Forces Epidemiological Board, with its subordinate commissions, coincided with the massive mobilization for World War II. Efforts of the board during and after the war led to significant progress against many common pathogens, such as the landmark studies of group A Streptococcus among young trainees at Warren Air Force Base, which led to the development of highly effective prophylactic and therapeutic strategies to prevent rheumatic fever. Military pediatricians contributed greatly to this work, as well as subsequent investigations into both the pathogenesis of and prophylactic therapy for a variety respiratory pathogens, including pertussis and respiratory syncytial virus. The momentum of this work continues to this day, among researchers from all three military branches.

Defining TCE Plume Source Areas Using the Membrane Interface Probe (MIP)

A variety of traditional characterization methods, such as soil gas surveys, soil and groundwater sampling, and fixed laboratory analysis, is commonly used to define the magnitude and extent of soil and groundwater contamination in volatile organic compound source areas. One significant limitation of these methods is that they require multi-media sample collection to define the full unsaturated and saturated vertical profile in any given location. In addition, attaining higher resolution by increasing sample frequency increases costs substantially. A relatively new technology, the Membrane Interface Probe (MIP), was used to define trichloroethene plume source areas at F.E. Warren Air Force Base in Cheyenne, Wyoming, and at a confidential security products manufacturer in Tennessee. The MIP offered significant advantages over traditional drilling and direct-push methods and yielded data critical to a fuller understanding of subsurface conditions. The near-continuous MIP profile minimized the number of soil...

Defining TCE Plume Source Areas Using the Membrane Interface Probe (MIP)

A variety of traditional characterization methods, such as soil gas surveys, soil and groundwater sampling, and fixed laboratory analysis, is commonly used to define the magnitude and extent of soil and groundwater contamination in volatile organic compound source areas. One significant limitation of these methods is that they require multi-media sample collection to define the full unsaturated and saturated vertical profile in any given location. In addition, attaining higher resolution by increasing sample frequency increases costs substantially. A relatively new technology, the Membrane Interface Probe (MIP), was used to define trichloroethene plume source areas at F.E. Warren Air Force Base in Cheyenne, Wyoming, and at a confidential security products manufacturer in Tennessee. The MIP offered significant advantages over traditional drilling and direct-push methods and yielded data critical to a fuller understanding of subsurface conditions. The near-continuous MIP profile minimized the number of soil and groundwater samples required to fully delineate the extent of the plume-head source areas. In addition, the MIP is also able to collect data in the vadose and saturated zones, providing detailed vertical contaminant profiling information and geologic conditions based on soil conductivity that aided in the development of the site conceptual model. The MIP was not without its disadvantages; principal among these the relatively high detection limit (approximately 100 ppb in soil and groundwater), making the method useful for source characterization but limited for delineating lower levels of contamination. The data obtained from the MIP are considered screening-level data and need to be supplemented with analytical soil or groundwater data to fully support risk or remediation decisions. In summary, the vertical profiling obtained using the MIP aided in the interpretation of the complex relationship between the presence of gross contamination in soil and groundwater and the geologic conditions controlling contaminant distribution.

An Application of Cognitive-Behavioral Anger Management Training in a Military/Occupational Setting: Efficacy and Demographic Factors

This treatment outcome study evaluated the efficacy of a cognitive-behavioral psychoeducational anger management training application offered in a military/occupational setting. Additionally, demographic factors were analyzed to identify any relationship among age, gender, occupational/educational status, and anger subscale scores or treatment effects. The State-Trait Anger Expression Inventory was used as a pretest/post-test measure for 91 total participants in a series of four-session cognitive behavioral anger management training groups conducted through Francis E. Warren Air Force Base mental health clinic over an 18-month period. Significant improvements (p < 0.05) on all State-Trait Anger Expression Inventory anger scales were noted for the 46 participants who completed the program. Post hoc comparisons of demographic factors yielded no significant differences. The results are consistent with previously published findings insofar as the intervention was effective in reducing self-reported anger as measured by the State-Trait Anger Expression Inventory. The present study affirms the efficacy of a brief cognitive-behavioral psychoeducational approach to treat problem anger in a noncontrolled community/occupational sample.

Work Stress in the Military: Prevalence, Causes, and Relationship to Emotional Health

This study examined the prevalence and sources of occupational stress for military personnel and the relationship between work stress and emotional health in the military population. Four hundred seventy-two active duty military personnel stationed at F. E. Warren Air Force Base completed a 65-item survey that included items involving reported life events, perceptions about occupational stress, and perceptions about the relationship between work stress and emotional health. These military personnel were significantly more likely to report suffering from job stress than civilian workers (p < 0.001). One-quarter (26%) reported suffering from significant work stress, 15% reported that work stress was causing them significant emotional distress, and 8% reported experiencing work stress that was severe enough to be damaging their emotional health. Generic work stressors were endorsed more frequently than military-specific stressors. More than one-quarter of this sample of military personnel reported suffering from significant work stress and a significant number of these individuals suffered serious emotional distress. These results support previous research suggesting that work stress may be a significant occupational health hazard in the U.S. military.

Positive Psychiatry Portrayals A Rarity in Hollywood

Back to table of contents Previous article Next article Professional NewsFull AccessPositive Psychiatry Portrayals A Rarity in HollywoodChristine LehmannChristine LehmannSearch for more papers by this authorPublished Online:2 Aug 2002https://doi.org/10.1176/pn.37.15.0010Maj. Steven Pflanz: “Psychotherapy appeals to filmmakers because it deals with powerful human emotions, and art at its core is about human emotions.”Hollywood continues to be fascinated with psychiatric themes. At least 10 movies that featured different kinds of relationships between therapists and patients were box-office hits in the 1990s, said Maj. Steven Pflanz, a psychiatrist who led a workshop on psychiatry and film at APA’s 2002 annual meeting in May in Philadelphia.Among these films were “Good Will Hunting,” “Analyze This,” “As Good as It Gets,” “Don Juan DeMarco,” and “Grosse Pointe Blank.”“Psychotherapy appeals to filmmakers because it deals with powerful human emotions, and art is really about human emotions at its core,” said Pflanz, who has presented numerous workshops at previous annual meetings.Pflanz is chief of mental health services and deputy squadron commander of the 90th Medical Operations Squadron at F.E. Warren Air Force Base in Cheyenne, Wyo.But when does artistic license cross the line and become an irresponsible misrepresentation? The answer is not always clear.For example, in the 1997 movie “Good Will Hunting,” Robin Williams plays psychotherapist Shawn McGuire, who helps Will Hunting, a troubled math genius, come to terms with his abusive past. Pflanz and others at the workshop characterized the therapeutic relationship as a positive one that “transformed the patient and therapist.”However, the movie also includes a scene early in Will’s therapy in which he insults McGuire’s wife. McGuire responds by pushing Will against the wall and threatening to hit him if he ever again insults his wife, who is deceased. Later in the film, there are scenes of McGuire hugging Will and visiting each other at home.“We are supposed to be the agency of compassion,” said one psychiatrist who attended the session. “People seeing a therapist assault a patient might wonder if that would happen in therapy and feel unsafe.”Another audience member said, “Hugging a patient and visiting the patient in his home is clearly a line that many therapists would not cross.”In the 1999 movie “Analyze This,” Robert de Niro plays a Mafia boss who consults a psychiatrist, played by Billy Crystal, to help him deal with his emotional problems. To avoid being “whacked by the mob” for revealing secrets to a psychiatrist, de Niro insists on clandestine meetings with the psychiatrist, including impromptu visits while the psychiatrist is on vacation and at the psychiatrist’s home after breaking in.Crystal’s character “seemed weak and intimidated by de Niro,” commented an audience member. “There were numerous violations of professional boundaries,” said another.By contrast, the 1997 film “As Good as It Gets” got high marks from the workshop audience for depicting the psychiatrist in the movie as a professional who set boundaries with patients and providing a more realistic portrayal of how psychiatry is practiced.In one scene, for example, Melvin Udall, played by Jack Nicholson, barges into the psychiatrist’s office without an appointment and clearly expects to be seen immediately. The psychiatrist patiently but firmly explains to Udall that he will not make an exception for him and instead schedules an appointment.Hollywood movies tend to portray women therapists in more compromising roles than men, said Pflanz. As of 1989, there were twice as many films portraying unethical sexual behavior by women therapists as male therapists, according to the 1999 book Psychiatry and the Cinema by Gabbard and Gabbard (American Psychiatric Press Inc., 1999).That pattern continued in the 1990s with such movies as “The Prince of Tides.” Barbra Streisand plays a psychiatrist who becomes romantically involved with the brother of a suicidal patient. The brother is played by Nick Nolte.Portrayals of psychotherapists as dark characters who murder their patients in movies such as “Dressed to Kill” and “Whispers in the Dark” are examples of art misrepresenting psychotherapy, said Pflanz.“We should let producers know when they portray the profession in a responsible manner and when they don’t. We should also educate them about the profession so they have a better understanding of psychotherapy,” said Pflanz. ▪ ISSUES NewArchived

Rosette Recruitment of a Rare Endemic Forb (Gaura neomexicanaSubsp.coloradensis) with Canopy Removal of Associated Species

AbstractGaura neomexicanasubsp.coloradensisMunz (Onagraceae), (Colorado butterfly plant), a short‐lived perennial forb, became listed as a threatened species by the U.S. Fish and Wildlife Service in October 2000 because of its small global range and population size. This endemic subspecies consists of only 18 extant populations within southeastern Wyoming, southwestern Nebraska, and northeastern Colorado. Wyoming occurrences are on private land with the exception of three occurrences on F. E. Warren Air Force Base, near Cheyenne.Gaura neomexicanasubsp.coloradensismay be displaced by many competitors, includingCirsium arvense(L.) Scop. (Canada thistle), an invasive, noxious weed. In June 1998, threeG. neomexicanasubsp.coloradensispopulations were examined for rosette establishment in the presence of and after removal of associated species. The four study treatments removed: (1)Cirsium arvense, (2) grass and forb canopy and associated litter, (3) grass and forb canopy, litter, andC. arvense, and (4) no removal of associated plant species (control). MatureG. neomexicanasubsp.coloradensisplants were evaluated for height, number of leaves, and capsule production. The mature plant characteristics monitored in 1998 were not good indicators of subsequentG. neomexicanasubsp.coloradensisrosette densities in the following spring. Recruitment was assessed by counting new rosettes in the fall 1999. Although bothG. neomexicanasubsp.coloradensisand the exoticC. arvensehave comparable habitat, removal ofC. arvensedid not increaseG. neomexicanasubsp. coloradensis vegetative growth, seed capsule production, or rosette density. Removal of other forbs, grass, and litter, however, increasedG. neomexicanasubsp.coloradensisrosette density in the following two years, indicating that canopy removal of associated species can enhance rosette establishment of this rare native. The accumulation of dense vegetative cover and litter associated with the absence of herbivory and fire may contribute to the decline of rare species in rich riparian habitats. Return of herbivory and fire in mesic sites to reduce standing biomass accumulations should be considered in restoring recruitment potential to rare monocarpic species.

Anesthesia of Pronghorns Using Thiafentanil or Thiafentanil Plus Xylazine

Thiafentanil is a potent synthetic opioid anesthetic being developed for wildlife anesthesia. Thiafentanil was tested for safety and efficacy on free-ranging pronghorn (Antilocapra americana) inhabiting F. E. Warren Air Force Base in southeastern Wyoming. Pronghorn were darted with pre-measured dosages of either 4.0 or 5.0 mg of thiafentanil without (group 1) or with (group 2) the addition of 25.0 mg xylazine Seventeen pronghorn were captured in group 1 and 14 pronghorn in group 2. There were no differences between groups for capture times or physiological parameters (P ≥ 0.21). Anesthetic induction was rapid for both groups (≤ 2.7 ± 0.4 min) as was recovery after antagonism (≤ 0.7 ± 0.07 min). The dosage of thiafentanil administered was 0.10 ± 0.005 mg/kg and the dosage of xylazine was 0.56 ± 0.03 mg/kg. Anesthesia in both groups was characterized by muscle rigidity and rapid, shallow respiration. Twenty-five pronghorn were radiocollared and survived ≥21 days after capture. One adult male in group 1 died during capture. Thiafentanil was considered more effective on pronghorn than carfentanil-xylazine, ketamine-xylazine, or tiletamine-zolazepam-xylazine anesthetic regimens.

Analysis of a Transition Matrix Model for Gaura neomexicana Ssp. coloradensis (Onagraceae) Reveals Spatial and Temporal Demographic Variability

The fates of individuals in nine fixed plots in three areas were recorded for a population of Gaura neomexicana ssp. coloradensis on F. E. Warren Air Force Base in Cheyenne, Wyoming, U.S.A., from September 1992 to September 1994. The data were used to construct a stage-based transition matrix model for the population across two transitions. The specific goals were to determine if the population size is increasing, decreasing, or stable; if there is significant spatial and/or temporal variation in demographic parameters; which demographic transitions have the most impact on population growth; and the probability of extinction. An additional objective was to compare Gaura with other plant taxa that have been similarly modeled. The population is increasing, although some plots experienced a decline, as evidenced by the asymptotic growth rates (λ) calculated for the individual plots and for the population as well as the actual numbers of plants in the plots The population stage structure varied across the two transitions and was different from that predicted by the matrix model. Log-linear analysis revealed significant temporal and fine-scale spatial variation in demographic transition frequencies for Gaura. Elasticity analysis indicated that growth from one stage to another had the largest effect on population growth rate and that the most important single (nonsummed) transitions were from large rosette to flowering and recruitment into the small rosette stage. The population as a whole will persist, but there is a chance for local extinction under certain conditions. The mean growth (G), survival (L), and reproduction (F) elasticity values placed Gaura in the range of other semelparous herbs.

Habitat Associations and Effects of Urbanization on Macroinvertebrates of a Small, High-Plains Stream

ABSTRACT We described the relations between abundance of macroinvertebrates and several habitat variables in Crow Creek within F.E. Warren Air Force Base, Laramie County, Wyoming. Water velocity and longitudinal location showed the highest numbers of significant correlations with abundance of macroinvertebrate taxa. Changes in the macroinvertebrate community with changes in longitudinal location appeared to result from increasing urbanization with downstream movement. Caenis lattipennis, Ceratopogonidae, and Dubiraphia sp. were rare in the downstream portion of the study reach that has received substantial human disturbance.

Current distribution on isothermal rod electrodes in combustion MHD generators

'Drummond, J. P., and Hussaini, M. Y., A Detailed Numerical Model of a Supersonic Reacting Mixing Layer, AIAA Paper 861427, June 1986. Riggins, D. W., and McClinton, C. R., A Computational Investigation of Flow Losses in a Supersonic Combustor, AIAA Paper 90-2093, July 1990. Eklund, D. R., Northam, G. B., andHartfield, R. J., ADetailed Investigation of Staged Normal Injection into a Mach 2 Flow, 27th J ANNAF Combustion Meeting, F. E. Warren Air Force Base, Cheyenne, WY, Nov. 1990. Eklund, D. R., Northam, G. B., and Fletcher, D. G., A Validation Study of the SPARK Navier-Stokes Code for Nonreacting Scramjet Combustor Flowfields, AIAA Paper 90-2360, July 1990. Drummond, G. B., A Two-Dimensional Numerical Simulation of a Supersonic, Chemically Reacting Mixing Layer, NASA TM 4055, Dec. 1988. Hitch, B. D., and Senser, D. W., Reduced H2-O2 Mechanisms for Use in Reacting Flow Simulation, AIAA Paper 88-0732, Jan. 1988.

The decline of rheumatic fever: Role of medical intervention: Lewis W. Wannamaker Memorial Lecture

IT IS A PRIVILEGE and an honor for me to present the first Lewis W. Wannamaker Memorial Lecture. However, whatever feeling of pleasure I might have in being so honored is greatly diminished by the realization that he is no longer with us. I first met Dr. Wannamaker about 25 years ago, When I joined the American Heart Association Rheumatic Fever Prevention Committee, which he chaired. Although still a young man, he was already well known and highly respected for his scientific achievement. I was practicing general pediatrics in Baltimore at that time, and was appointed to the Committee to represent the practitioners' point of view. I recall being struck by Dr. Wannamaker's knowledge and interest in many of the problems faced by clinicians in dealing with the Prevention Committee's recommendations. It was refreshing to find a scientist of his caliber who was also concerned with the practical application of information obtained from epidemiologic and laboratory research. He maintained this concern throughout his life, and often took time away from his research to lecture and to write for clinical audiences. Whenever we met, he always found time to discuss problems, and I benefited greatly from his quiet wisdom and sound judgment. He did much to encourage me to continue my interest in rheumatic fever. Our last meeting was in Florida a month before he died, at a conference convened to reassess the recommendations for the management of streptococcal pharyngitis, now that rheumatic fever no longer is a significant problem in the United States. These recommendations had been based on studies done at Warren Air Force Base in Wyoming, which

Treatment of Sore Throat-Reply

Dr Ravenel and I both agree that the available evidence suggests that penicillin treatment produces only a modest acceleration in the resolution of symptoms. For reasons I will describe, I wonder if the available evidence is applicable to current practice. If it is not, we may never have the relevant evidence, since a controlled trial of penicillin therapy at this point in history would raise ethical questions. The study by Denny et al1and another report from the Warren Air Force Base by Brink et al2are pertinent. Both report controlled trials of penicillin therapy in young adult men with exudative pharyngitis, most of whom had streptococcal infection. In both studies history and physical examination data were collected meticulously. At the same time, certain limitations of these studies should be noted. Both are almost 30 years old and were performed at a time when the severity

Clinical Science

<h3>Head Irradiation of the Burro with Cobalt-60</h3> Lt. Col. U. S. G. Kuhn, III, V.C., U.S.A.F., Warren Air Force Base, Wyo., and Daniel G. Brown, D.V.M., Oak Ridge, Tenn. THE RESPONSE of burros (<i>Equus asinus asinus</i>) exposed to neutron-gamma radiation from an atomic detonation was distinguished by a high incidence of central nervous system (CNS) disturbance and early (24 hours) mortality.¹On the basis of previous total-body irradiation studies,^2-8a dramatic early mortality response was generally unexpected. The exposure to radiation from an atomic device introduced 2 factors which had not been previously studied with burros: an instantaneous dose and irradiation with neutrons. The present study was made to test the response of burros to a relatively high dose rate of gamma irradiation to the brain. <h3>Material and Methods</h3> Twenty-four male burros were exposed under identical conditions of geometry to a single source of Cobalt-60 (Co⁶⁰) in

Therapeutic agents in rheumatic carditis; comparative effects of acetylsalicylic acid, corticotropin, and cortisone.

Although the symptoms of acute rheumatic fever appear to be favorably altered by a number of drugs,* the essential problems of therapy are to prevent death from acute carditis and to decrease the incidence of subsequent valvular heart disease.⁴The present report compares the effect of acetylsalicylic acid (Aspirin), cortisone, and corticotropin (ACTH) on valvular heart disease as evidenced by the presence of murmurs 14 months after the onset of therapy.† A previous paper⁵concerning the same group of patients dealt with a comparison of the effects of these drugs on the acute course of rheumatic fever. <h3>METHODS</h3> Details of the methods employed and the population involved have been described elsewhere.⁵All male airmen admitted to Warren Air Force Base Hospital who met the standard diagnostic criteria and who exhibited signs of rheumatic activity on the day treatment began were accepted for study. Each patient was assigned