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The author suggests the statewide and regional reorganization of police structures as a strategy in the prevention and remediation of police excessive force in the U.S. Topics discussed include the importance of mandating a statewide or regional police force structure with better training, higher educational requirements for officer entry and reduced militarized appearance, features of an ideal police disciplinary procedure, and the importance of public education about policing.

Objective: Military personnel are at increased risk for traumatic brain injury (TBI) from combat and noncombat exposures. The sequelae of moderate to severe TBI are well described, but little is known regarding long-term performance decrements associated with mild TBI. Furthermore, while alcohol and drug use are well known to increase risk for TBI, little is known regarding the reverse pattern. The authors sought to assess possible associations between mild TBI and addiction-related disorders in active-duty U.S. military personnel. Method: A historical prospective study was conducted using electronically recorded demographic, medical, and military data for more than a half million active-duty U.S. Air Force service members. Cases were identified by ICD-9-CM codes considered by an expert panel to be indicative of mild TBI. Outcomes included ICD-9-CM diagnoses of selected addiction- related disorders. Cox proportional hazards modeling was used to calculate hazard ratios while controlling for varying lengths of follow-up and potential confounding variables. Results: Airmen with mild TBI were at increased risk for certain addiction-related disorders compared with a similarly injured non-mild TBI comparison group. Hazards for alcohol dependence, nicotine dependence, and nondependent abuse of drugs or alcohol were significantly elevated, with a consistent decrease over time. Conclusions: A novel finding of this study was the initial increased risk for addiction-related disorders that decreased with time, thus eroding war fighter performance in a military population. Moreover, these results suggest that mild TBI is distinguished from moderate to severe TBI in terms of timing of the risk, indicating that there is a need for screening and prevention of addiction-related disorders in mild TBI. Screening may be warranted in military troops as well as civilians at both short- and long-term milestones following mild TBI. [ABSTRACT FROM AUTHOR]

Introduction: Being one of the few existing measures of primary care functions, physician-level continuity of care (Phy-CoC) is measured by the weighted average of patient continuity scores. Compared with the well-researched patient-level continuity, Phy-CoC is a new instrument with limited evidence from Medicare beneficiaries. This study aimed to expand the patient sample to include patients of all ages and all types of insurance and reassess the associations between full panel-based Phy-CoC scores and patient outcomes., Methods: Cross-sectional analysis at patient-level using Virginia All-Payer Claims Database (VA-APCD). Phy-CoC scores were calculated by averaging patient's Bice-Boxerman Index scores and weighted by the total number of visits. Patient outcomes included total cost and preventable hospitalization., Results: In a sample of 1.6 million Virginians, patients who lived in rural areas or had Medicare as primary insurance were more likely to be attributed to physicians with the highest Phy-CoC scores. Across all adult patient populations, we found that being attributed to physicians with higher Phy-CoC was associated with 7%-11.8% higher total costs, but was not associated with the odds of preventable hospitalization. Results from models with interactions revealed nuanced associations between Phy-CoC and total cost with patient's age and comorbidity, insurance payer, and the specialty of their physician., Conclusions: In this comprehensive examination of Phy-CoC using all populations from the VA-APCD, we found an overall positive association of higher full panel-based Phy-CoC with total cost, but a non-significant association with the risk of preventable hospitalization. Achieving higher full panel-based Phy-CoC may have unintended cost implications., Competing Interests: Conflict of interest: Drs. Dai, Morgan, Peterson, and Bazemore declared no conflict of interest.Dr. Russel’s declaration: VHI received funding from the ABFM, under contract to the Virginia Center for Health Innovation (VCHI), to provide access to Virginia All Payer Claims Database (APCD) data and related technical support for the submitted study topic.Dr. Bortz’s declaration: VCHI received funding from the ABFM Foundation to oversee this specific physician-continuity research project, and a portion of the funding was to support staff time dedicated to research findings dissemination., (© Copyright by the American Board of Family Medicine.)

Owing to their physical characteristics, electron beams are a crucial component in radiotherapy of human tumors. Besides their main indications (skin cancers, head and neck tumors, breast, chest wall recurrence, low pelvic tumors) other types and sites of malignancies are to be considered: skin lymphomas, soft tissue sarcomas, Kaposi's sarcoma in AIDS patients, as well as Intra Operative Radiotherapy.