This review summarizes the history and usage of teledermatology in the US Military and potential directions in the future. Given the remote and austere environment that operational settings present, it is hard to provide specialized medical care for soldiers who are deployed. Telemedicine has been shown to improve health care in the military. It is well documented that non-life-threatening skin disease comprises the majority of specialty care requests in the deployed setting. Thus, teledermatology is a critical resource in military operational medical settings. Teledermatology continues as a critical component of military medicine to preserve the fighting forces by increasing access to specialty care. Teledermatology evaluations are more cost-effective and efficient than in-person consults at field hospitals. The US military continues to devise improved technology for teledermatology quality, including artificial intelligence. These advances may allow for autonomous teledermatology consults in the future for austere settings without bandwidth.

OBJECTIVE:Relatively little is known about sources of variation in human breastmilk composition. Previous research posits that composition may be affected by the low oxygen environment found at high altitude (HA). Our objective is to compare the milk composition of a sample of HA Andeans to previously published data on HA Tibetans and low altitude (LA) Peruvians.METHODS:Mid-feed milk samples were collected from 22 women and tested for lipid, carbohydrate and protein content in addition to dietary surveys and anthropometric measures. We examined relationships between maternal and infant characteristics (maternal BMI, adiposity, age, skinfold thickness, infant age) and milk composition using multiple regression analyses. A Welch-Satterthause t-test was used to compare summary measures from Andean sample and Tibetan samples.RESULTS:Milk fat, sugar, and true protein content were correlated with different maternal and infant characteristics, with only waist to hip ratio negatively affecting fat and positively affecting sugar content in full models. Nuñoan and LA Peruvian milk exhibited significantly lower lactose levels (6.01 ± .89 g/100 mL and 6.38 ± 0.03 g/100 mL) than Tibetans (7.25 ± 0.35 g/100 mL). Fat content among Nuñoans was similar to that of Tibetans (4.5 ± 0.78 g/100 mL and 4.6 ± 1.51 g/100 mL, respectively), and higher than those of LA Peruvians.CONCLUSIONS:Both HA populations demonstrate relatively high fat content and both Peruvian samples exhibited relatively higher protein and lower lactose than Tibetan samples, suggesting that both population-based differences in feeding behavior and climatic differences may influence composition.