Many countries show a growing willingness to use militaries in support of global health efforts. This Series paper summarises the varied roles, responsibilities, and approaches of militaries in global health, drawing on examples and case studies across peacetime, conflict, and disaster response environments. Militaries have many capabilities applicable to global health, ranging from research, surveillance, and medical expertise to rapidly deployable, large-scale assets for logistics, transportation, and security. Despite this large range of capabilities, militaries also have limitations when engaging in global health activities. Militaries focus on strategic, operational, and tactical objectives that support their security and defence missions, which can conflict with humanitarian and global health equity objectives. Guidelines both within and outside militaries for military engagement in global health are often lacking, as are structured opportunities for military and civilian organisations to engage one another. We summarise policies that can help close the gap between military and civilian actors to catalyse the contributions of all participants to enhance global health.

This study evaluated travelers' diarrhea among US military personnel on short-term deployment to Incirlik Air Base, Turkey, from June through September 2002. Upon reporting for care for travelers' diarrhea, subjects were enrolled into the study and completed a series of questionnaires and provided stool specimens for pathogen identification and antimicrobial susceptibility testing. Fifty-three percent of the 202 participating subjects had a pathogen isolated from their stool. Enterotoxigenic Escherichia coli (ETEC) was the predominant pathogen (41%), followed by Campylobacter spp. (12%). The most common ETEC phenotype recovered was stable toxin (ST) CS6 (47% of all ETEC). Most (91.1%) of the cases presented with water diarrhea regardless of isolated pathogen. However, there were some differences in nongastrointestinal symptoms among subjects with Campylobacter spp. All illnesses were well managed with antibiotics with or without loperamide with a median time to the last unformed stool of 9 h (interquartile range, 1–32 h). We found no food or environmental factors associated with a differential risk of infection with a specific pathogen. Travelers' diarrhea among a US military population in and around Incirlik, Turkey, can commonly be attributed to ETEC and Campylobacter spp. The high proportion of ST-only–producing CS6 ETEC in this region highlights the pathogen's worldwide diversity. Future studies of travelers' diarrhea in this population should adapt more novel microbiologic techniques such as polymerase chain reaction and enhanced culture methods to increase the likelihood of identifying pathogenic E. coli.

We describe a case series of group A Streptococcus (GAS) necrotizing fasciitis occurring over a 10-week period in military recruits undergoing intense physical training. These cases highlight that GAS may cause life-threatening infections in addition to mild diseases such as pharyngitis. This series suggests that the incidence of severe GAS infections may be increasing in certain populations and it emphasizes the importance of considering prophylactic measures against GAS in high-risk populations.

We identified 10 individuals who had undiagnosed human immunodeficiency virus type 1 (HIV-1) infection at the time of smallpox vaccination. Mean CD4 cell count was 483 cells/mm3 (range, 286-751 cells/mm3), and mean log10 plasma HIV-1 RNA load was 4.13 copies/cm3 (range, 2.54-5.16 copies/cm3). All vaccinees (3 primary and 7 repeat) had a normal, robust reaction without complications. Smallpox vaccine was well-tolerated in this small series of HIV-1-infected military personnel.

Throughout history, infectious diarrhea has been associated with crowding, poor sanitation, and war. Although descriptions of infectious diarrhea exist in the earliest records of civilization, effective measures for prevention were not widely or consistently used until the modern era of active public health promotion. Advances in the understanding of etiologies and therapies have revolutionized prognosis; however, constant vigilance against lapses in public health is necessary to prevent outbreaks of disease.

We recently evaluated a cluster of cases of disseminated coccidioidomycosis referred to the Naval Medical Center San Diego. Between March and June of 2002, seven cases were diagnosed and treated. In a 5-year record review (March 1997-February 2002), we found only seven cases of disseminated disease attributable to Coccidioides immitis at the same institution. This report of seven cases over a 3-month period represents a 20-fold increase in the number of complicated C. immitis infections. All cases were non-Caucasians, had disseminated disease to bone and/or skin without meningeal involvement, and had a delay of 1.5 to 6 months from symptom onset until the diagnosis of coccidioidomycosis. Four of our cases occurred in previously healthy, young active duty members, emphasizing the importance of this mycosis in U.S. military personnel.

BACKGROUND:Rapidly growing mycobacteria (RGM) can cause a variety of cutaneous and systemic diseases. The causative organisms are typically Mycobacterium fortuitum or Mycobacterium chelonae (also known as Mycobacterium abscessus). Primary cutaneous lesions may develop after a variable latent period, from weeks to several months, and usually result from direct inoculation after trauma, from injections, or during surgery via contaminated medical instruments. Recently, investigators from the Centers for Disease Control and Prevention, Atlanta, Ga, and the California Department of Health Services, Berkeley, documented a large, unprecedented outbreak of community-acquired RGM infection, during which more than 100 patrons of a northern California nail salon contracted furunculosis in their legs as a result of exposure to whirlpool footbaths that were contaminated with M fortuitum.OBSERVATIONS:We report the clinical and epidemiological findings in 3 cases of lower extremity RGM infections that occurred after similar whirlpool footbath exposure at several different nail salons in southern California. These infections typically presented as recurrent furunculosis, causing considerable morbidity as a result of scarring, delayed diagnosis, and the need for long-term polymicrobial therapy.CONCLUSIONS:Rapidly growing mycobacterial infections related to pedicures may continue to occur in a sporadic fashion. Clinicians should consider the possibility of RGM infection and inquire about recent pedicures in a patient with recurrent lower extremity furunculosis and abscesses that are unresponsive to conventional antibiotic therapy.

Triiodothyronine (T 3 ) stimulates the synthesis of growth hormone and enhances the growth of neoplastic rat pituitary somatomam‐motrophs (GH cells) in culture. Moreover, T 3 has been shown to stimulate the production and secretion of an autocrine growth factor by these cells. We have previously demonstrated the presence of specific receptors for insulin‐like growth factors (IGF) on GH cells. Since GH 3 cells contain mRNA encoding IGF‐I, it has been suggested that IGF‐I might act in an autocrine fashion in these cells. Therefore, it was of interest to learn how T 3 affects IGF‐I binding to GH 3 cells. T 3 increased [ 125 I]IGF‐I binding in a time ‐ and dose‐dependent manner. After 48 h of exposure to T 3 , an increase in IGF‐I binding was seen with 10 −11 M T 3 , maximizing with 10 −8 M T 3 . When cells were exposed to 10 −8 T 3 , [ 125 I]IGF‐I binding reached a maximum of 218 ± 20.8% of control (±SEM, P < 0.002) after 72 h of incubation. Scatchard analysis indicated that T 3 did not alter the K d of IGF‐I for its receptor, but that the total receptor number was increased. Dexamethasone (10 −7 M) inhibited the T 3 ‐induced increase in IGF‐I binding, but glucocorticoid alone did not substantially alter receptor number. No significant change in insulin or IGF‐II binding was seen after hormone treatment. 10 −8 M T 3 or IGF‐I increased the growth of the GH 3 cells by ≥30%. Our data indicate that T 3 upregulates IGF‐I binding in GH 3 cells without altering insulin binding and thereby provides a means for enhancing potential autocrine regulation in this cell line.

Increasingly, work-integrated learning (WIL) is becoming a strategic priority in universities. The "RMIT 2010" strategy includes strong engagement with industry and has as a priority work and industry relevant learning. In such educational contexts there is great diversity of practice in the use of WIL activities, and there are many benefits derived from WIL. Importantly, risk management and ethical practice are integral to the design and implementation of WIL activities, as they are to other ways of learning. Educators need to reconcile risk management against benefits when implementing WIL. On the one hand, ethical risks need to be recognised and addressed; while on the other, unrealistic barriers should not impede the learning process. The issue of ethics in relation to WIL is complex and has not been comprehensively addressed in the literature to date. Ethics related to WIL incorporates both ensuring that WIL activities are designed and implemented ethically, as well as helping students to learn about ethical practice. This involves identifying and addressing ethical aspects when designing and implementing WIL activities (doing WIL ethically ), as well as developing students' ethical awareness through WIL activities (learning about ethical practice ). In this paper we focus on both issues - doing WIL ethically and helping students learn about ethical practice in tertiary coursework programs. We explore a series of ethical aspects to consider in order to mitigate risk when students, staff and the university engage with industry and the community. We also provide examples from the literature of using WIL activities to develop students' ethical awareness, and discuss constraints and challenges when doing so. We highlight the need for a clear framework and useful suite of resources that support WIL and outline a number of possible actions to take to help mitigate risks, extend and enrich WIL experiences, and prepare students for the real world of work.