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VUMC plays active role in training today’s military medical personnel - VUMC News

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href="https://news.vumc.org/location/vanderbilt-kennedy-center/"> Vanderbilt Kennedy Center </a> </li> <li> <a href="https://news.vumc.org/location/vanderbilt-psychiatric-hospital/"> Vanderbilt Psychiatric Hospital </a> </li> <li> <a href="https://news.vumc.org/location/vanderbilt-wilson-county-hospital/"> Vanderbilt Wilson County Hospital </a> </li> <li> <a href="https://news.vumc.org/location/vanderbilt-stallworth-rehabilitation-hospital/"> Vanderbilt Stallworth Rehabilitation Hospital </a> </li> <li> <a href="https://news.vumc.org/location/vanderbilt-tullahoma-harton-hospital/"> Vanderbilt Tullahoma-Harton Hospital </a> </li> <li> <a href="https://news.vumc.org/location/vanderbilt-university-hospital/"> Vanderbilt University Hospital </a> </li> </ul> </div> <div class="featured-story"> <h5 class="featured-story__heading">Featured Story</h5> <a href="https://news.vumc.org/2024/07/10/the-lifeflight-legacy-40-years-in-40-photos/"> <img width="1856" height="1202" src="https://vumc-reporter.s3.amazonaws.com/uploads/SEE-F.P.O_7.jpg" class="attachment-post-thumbnail size-post-thumbnail wp-post-image" alt="" decoding="async" fetchpriority="high" srcset="https://vumc-reporter.s3.amazonaws.com/uploads/SEE-F.P.O_7.jpg 1856w, https://vumc-reporter.s3.amazonaws.com/uploads/SEE-F.P.O_7-450x291.jpg 450w, https://vumc-reporter.s3.amazonaws.com/uploads/SEE-F.P.O_7-790x512.jpg 790w, https://vumc-reporter.s3.amazonaws.com/uploads/SEE-F.P.O_7-768x497.jpg 768w, https://vumc-reporter.s3.amazonaws.com/uploads/SEE-F.P.O_7-1536x995.jpg 1536w" sizes="(max-width: 1856px) 100vw, 1856px" data-attachment-id="363378" data-permalink="https://news.vumc.org/see-f-p-o-2/" data-orig-file="https://vumc-reporter.s3.amazonaws.com/uploads/SEE-F.P.O_7.jpg" data-orig-size="1856,1202" data-comments-opened="0" data-image-meta="{&quot;aperture&quot;:&quot;0&quot;,&quot;credit&quot;:&quot;&quot;,&quot;camera&quot;:&quot;&quot;,&quot;caption&quot;:&quot;&quot;,&quot;created_timestamp&quot;:&quot;0&quot;,&quot;copyright&quot;:&quot;&quot;,&quot;focal_length&quot;:&quot;0&quot;,&quot;iso&quot;:&quot;0&quot;,&quot;shutter_speed&quot;:&quot;0&quot;,&quot;title&quot;:&quot;SEE F.P.O.&quot;,&quot;orientation&quot;:&quot;1&quot;}" data-image-title="SEE F.P.O." data-image-description="" data-image-caption="&lt;p&gt;Pilot Bill Hamblin and flight nurses prepare for a flight. LifeFlight began using the larger twin engine BK-117 craft, which is capable of simultaneous transport of two patients, in 1986. (photo by John Howser) &lt;/p&gt; " data-medium-file="https://vumc-reporter.s3.amazonaws.com/uploads/SEE-F.P.O_7-450x291.jpg" data-large-file="https://vumc-reporter.s3.amazonaws.com/uploads/SEE-F.P.O_7-790x512.jpg" /> <h6 class="featured-story__category">Emergency &amp; Trauma</h6> <h3 class="featured-story__title">The LifeFlight legacy: 40 years in 40 photos</h3> </a> </div> </div> </div> </header> <main id="primary" class="site-main"> <header class="single-post-header"> <div class="single-post-header__eyebrow"> <a href="https://news.vumc.org/section/emergency-trauma/" class="single-post-header__category"> Emergency &amp; Trauma </a> <h3 class="single-post-header__date"> November 8, 2024 </h3> </div> <h1>VUMC plays active role in training today’s military medical personnel</h1> <div class="single-post-header__excerpt"> <p>Vanderbilt University Medical Center is extensively involved in partnerships with the military that both assist individuals as they transition out of service to be civilian veterans and help active-duty military medical personnel maintain their critical skills needed during deployment.</p> </div> </header> <div class="content-with-sidebar"> <article id="post-369863" class="post-369863 post type-post status-publish format-standard has-post-thumbnail hentry category-emergency-trauma tag-department-of-emergency-medicine tag-department-of-ophthalmology-and-visual-sciences tag-department-of-orthopaedic-surgery tag-department-of-pediatric-surgery tag-u-s-military tag-veterans vumc_highlight-all-news vumc_highlight-vumc-people location-vanderbilt-university-hospital"> <div class="post-opening"> <div class="feature-media"> <div class="feature-media__image"> <a href="https://news.vumc.org/2024/11/08/vumc-plays-active-role-in-training-todays-military-medical-personnel/"> <img src="https://vumc-reporter.s3.amazonaws.com/uploads/20240219SU040-790x510.jpg" alt=""> </a> <cite class="caption">Strategic Medical Asset Readiness Training (SMART) rotator Matthew McCann works in the emergency department. (photo by Susan Urmy) </cite> </div> </div> <div class="post-opening__share-print share-print"> <div class="share-print__share"> <h5>Share:</h5> <a href="https://www.facebook.com/sharer/sharer.php?u=https%3A%2F%2Fnews.vumc.org%2F2024%2F11%2F08%2Fvumc-plays-active-role-in-training-todays-military-medical-personnel%2F" target="_blank" rel="noopener noreferrer" class="share-link share-link--facebook"> <span class="screen-reader-text">Share on Facebook</span> <img src="https://news.vumc.org/wp-content/themes/vumc-news/images/social/facebook_blue.png" alt="Facebook" /> </a> <a href="https://bsky.app/intent/compose/?text=VUMC+plays+active+role+in+training+today%E2%80%99s+military+medical+personnel https%3A%2F%2Fnews.vumc.org%2F2024%2F11%2F08%2Fvumc-plays-active-role-in-training-todays-military-medical-personnel%2F" target="_blank" rel="noopener noreferrer" class="share-link share-link--bsky"> <span class="screen-reader-text">Share on Bsky</span> <img src="https://news.vumc.org/wp-content/themes/vumc-news/images/social/bluesky_blue.png" alt="Bluesky" /> </a> <a href="https://x.com/intent/tweet?url=https%3A%2F%2Fnews.vumc.org%2F2024%2F11%2F08%2Fvumc-plays-active-role-in-training-todays-military-medical-personnel%2F&text=VUMC+plays+active+role+in+training+today%E2%80%99s+military+medical+personnel" target="_blank" rel="noopener noreferrer" class="share-link share-link--twitter"> <span class="screen-reader-text">Share on X</span> <img src="https://news.vumc.org/wp-content/themes/vumc-news/images/social/x_blue.png" alt="X" /> </a> <a href="https://www.linkedin.com/shareArticle?mini=true&url=https%3A%2F%2Fnews.vumc.org%2F2024%2F11%2F08%2Fvumc-plays-active-role-in-training-todays-military-medical-personnel%2F&title=VUMC+plays+active+role+in+training+today%E2%80%99s+military+medical+personnel&source=VUMC+News" target="_blank" rel="noopener noreferrer" class="share-link share-link--linkedin"> <span class="screen-reader-text">Share on LinkedIn</span> <img src="https://news.vumc.org/wp-content/themes/vumc-news/images/social/linkedin_blue.png" alt="LinkedIn" /> </a> <a href="mailto:?subject=VUMC+plays+active+role+in+training+today%E2%80%99s+military+medical+personnel&body=https%3A%2F%2Fnews.vumc.org%2F2024%2F11%2F08%2Fvumc-plays-active-role-in-training-todays-military-medical-personnel%2F" target="_blank" rel="noopener noreferrer" class="share-link share-link--email"> <span class="screen-reader-text">Share via Email</span> <img src="https://news.vumc.org/wp-content/themes/vumc-news/images/social/email_blue.png" alt="Email" /> </a> </div> <div class="share-print__print"> <h5>Print:</h5> <a href="javascript:window.print()" class="post-opening__print-link"> <span class="screen-reader-text">Print this article</span> <img src="https://news.vumc.org/wp-content/themes/vumc-news/images/social/print_blue.png" alt="Print" /> </a> </div> </div> <div class="post-opening__byline"> By: Jill Clendening </div> </div> <div class="entry-content clearfix"> <p>United States military medical personnel are a daily presence at Vanderbilt University Medical Center as they receive skills training and work alongside their civilian counterparts through initiatives such as Strategic Medical Asset Readiness Training (SMART), Army Military-Civilian Trauma Team Training (AMCT3), and as part of educational outreach at Fort Campbell and Blanchfield Army Community Hospital (BACH) in Kentucky.</p> <p>These military-civilian partnerships extend to the end of their military careers and beyond as individuals transitioning out of military service come to the Medical Center to shadow employees through the Department of Defense SkillBridge/Career Skills Program (CSP) .</p> <p>In 2018, orthopaedic trauma surgeon and U.S. Army colonel Daniel Stinner, MD, PhD, an associate professor of Orthopaedic Surgery, became the first dual-appointment faculty member, spending four days a week in clinical duties at VUMC and one day at BACH. Lucas Groves, MD, assistant professor of Clinical Ophthalmology, and Maggie Gallagher, MD, assistant professor of Clinical Pediatric Surgery, also serve as dual-appointment faculty. Gallagher serves as BACH’s chief of General Surgery.</p> <p>The dual appointment allows Stinner to care for a greater volume of higher acuity patients. During his time at VUMC, he’s been deployed twice — to Afghanistan in 2019 and to Iraq in 2021.</p> <p>“There’s a huge benefit in being exposed to high acuity trauma — both the blunt and penetrating injuries that we see at Vanderbilt that get you extremely comfortable with dealing with severe injuries on a daily basis,” Stinner said. “Then when you have to deal with similar injuries in a more austere, resource-limited environment, you’re very comfortable managing them, as well as knowing what is expected for the downstream surgeon and what they will be doing, so you can optimize their care.”</p> <p>Stinner has experienced another benefit as he works closely with VUMC’s Trauma Education and Outreach team, particularly as they teach Advanced Trauma Life Support courses at Fort Campbell.</p> <p>“I’ve gotten to be very facile with doing things that are outside the normal orthopaedic surgeon’s skill set, such as doing FAST exams (image-guided assessments to quickly pinpoint internal trauma),” Stinner said. “On my surgical team during deployment, when we received a patient, I was the one doing the FAST exam while the general surgeon began the patient assessment and prepared for any lifesaving interventions.”</p> <div class="wp-block-image"> <figure class="aligncenter size-large"><img decoding="async" width="790" height="503" data-attachment-id="369872" data-permalink="https://news.vumc.org/2024/11/08/vumc-plays-active-role-in-training-todays-military-medical-personnel/041423-smart-training-2/" data-orig-file="https://vumc-reporter.s3.amazonaws.com/uploads/20230414EOS117-scaled.jpg" data-orig-size="2560,1631" data-comments-opened="0" data-image-meta="{&quot;aperture&quot;:&quot;2.8&quot;,&quot;credit&quot;:&quot;Erin O. Smith \/ Vanderbilt University Medical Center&quot;,&quot;camera&quot;:&quot;Canon EOS 5D Mark IV&quot;,&quot;caption&quot;:&quot;Christopher Brown, a Critical Care Paramedic and Trauma Outreach Educator, speaks during the VUMC mil-civ programs Army Strategic Medical Asset Readiness Training (SMART) Friday, April 14, 2023 in Light Hall at Vanderbilt University Medical Center in Nashville, Tennessee.&quot;,&quot;created_timestamp&quot;:&quot;1681489336&quot;,&quot;copyright&quot;:&quot;Copyright VUMC News and Communications 2023&quot;,&quot;focal_length&quot;:&quot;38&quot;,&quot;iso&quot;:&quot;2000&quot;,&quot;shutter_speed&quot;:&quot;0.00125&quot;,&quot;title&quot;:&quot;041423 SMART training&quot;,&quot;orientation&quot;:&quot;1&quot;}" data-image-title="041423 SMART training" data-image-description="" data-image-caption="&lt;p&gt;Christopher Brown, center, a critical care paramedic and trauma outreach educator at VUMC, uses a simulation mannequin to lead instruction for Army Strategic Medical Asset Readiness Training participants. (photo by Erin O. Smith)&lt;/p&gt; " data-medium-file="https://vumc-reporter.s3.amazonaws.com/uploads/20230414EOS117-450x287.jpg" data-large-file="https://vumc-reporter.s3.amazonaws.com/uploads/20230414EOS117-790x503.jpg" src="https://vumc-reporter.s3.amazonaws.com/uploads/20230414EOS117-790x503.jpg" alt="" class="wp-image-369872" srcset="https://vumc-reporter.s3.amazonaws.com/uploads/20230414EOS117-790x503.jpg 790w, https://vumc-reporter.s3.amazonaws.com/uploads/20230414EOS117-450x287.jpg 450w, https://vumc-reporter.s3.amazonaws.com/uploads/20230414EOS117-768x489.jpg 768w, https://vumc-reporter.s3.amazonaws.com/uploads/20230414EOS117-1536x979.jpg 1536w, https://vumc-reporter.s3.amazonaws.com/uploads/20230414EOS117-2048x1305.jpg 2048w" sizes="(max-width: 790px) 100vw, 790px" /><figcaption class="wp-element-caption">Christopher Brown, center, a critical care paramedic and trauma outreach educator at VUMC, uses a simulation mannequin to lead instruction for Army Strategic Medical Asset Readiness Training participants. (photo by Erin O. Smith)</figcaption></figure></div> <p>Josh Smith, DO, assistant professor of Clinical Surgery in the Division of Acute Care Surgery, is a major in the U.S. Army, selected for promotion to lieutenant colonel in May 2025. Smith completed a fellowship in surgical critical care and acute care surgery at VUMC, then joined the AMCT3 program at the Medical Center.</p> <p>During his time at VUMC, he has been deployed once to the Horn of Africa as part of Operation Enduring Freedom, where the high volume of trauma cases he covers at VUMC influenced the job he was able to do as a trauma surgeon overseas.</p> <p>“My surgical team during deployment was a 10-man team — that was it,” he said. “Being here led to me never being uncomfortable, no matter what happened. If I didn’t have as much experience, I’m sure it would have been more frightening. Every single trauma patient I take care of here is applicable to what I do in the Army.”</p> <p>And he enjoys teaching trainees at the Medical Center how to make do with less and come up with solutions during challenging situations.</p> <p>“I do a lot of things differently when I’m deployed because I don’t have a lot of the fancy stuff,” he said. “Like, I know how to make my own wound vacs for open abdomens. I enjoy teaching the trainees old tips and tricks so they can be prepared for anything.”</p> <figure class="wp-block-image size-large"><img decoding="async" width="790" height="620" data-attachment-id="369878" data-permalink="https://news.vumc.org/2024/11/08/vumc-plays-active-role-in-training-todays-military-medical-personnel/20240423dj67-1/" data-orig-file="https://vumc-reporter.s3.amazonaws.com/uploads/20240423DJ67-1-scaled.jpg" data-orig-size="2560,2010" data-comments-opened="0" data-image-meta="{&quot;aperture&quot;:&quot;2.8&quot;,&quot;credit&quot;:&quot;Donn Jones&quot;,&quot;camera&quot;:&quot;Canon EOS 5D Mark IV&quot;,&quot;caption&quot;:&quot;VUMC employee headshots on April 24, 2024. Photos by Donn Jones\/Vanderbilt University Medical Center&quot;,&quot;created_timestamp&quot;:&quot;1713881828&quot;,&quot;copyright&quot;:&quot;&quot;,&quot;focal_length&quot;:&quot;70&quot;,&quot;iso&quot;:&quot;4000&quot;,&quot;shutter_speed&quot;:&quot;0.005&quot;,&quot;title&quot;:&quot;&quot;,&quot;orientation&quot;:&quot;1&quot;}" data-image-title="20240423DJ67 (1)" data-image-description="" data-image-caption="&lt;p&gt;A handshake between Maj. Gen. Anthony L. McQueen, Deputy Surgeon General of the United States Army, and C. Wright Pinson, MD, MBA, Deputy CEO and Chief Health System Officer, symbolizes the many partnerships in place between VUMC and the military. (photo by Donn Jones)&lt;/p&gt; " data-medium-file="https://vumc-reporter.s3.amazonaws.com/uploads/20240423DJ67-1-450x353.jpg" data-large-file="https://vumc-reporter.s3.amazonaws.com/uploads/20240423DJ67-1-790x620.jpg" src="https://vumc-reporter.s3.amazonaws.com/uploads/20240423DJ67-1-790x620.jpg" alt="" class="wp-image-369878" srcset="https://vumc-reporter.s3.amazonaws.com/uploads/20240423DJ67-1-790x620.jpg 790w, https://vumc-reporter.s3.amazonaws.com/uploads/20240423DJ67-1-450x353.jpg 450w, https://vumc-reporter.s3.amazonaws.com/uploads/20240423DJ67-1-768x603.jpg 768w, https://vumc-reporter.s3.amazonaws.com/uploads/20240423DJ67-1-1536x1206.jpg 1536w, https://vumc-reporter.s3.amazonaws.com/uploads/20240423DJ67-1-2048x1608.jpg 2048w" sizes="(max-width: 790px) 100vw, 790px" /><figcaption class="wp-element-caption">A handshake between Maj. Gen. Anthony L. McQueen, Deputy Surgeon General of the United States Army, and C. Wright Pinson, MD, MBA, Deputy CEO and Chief Health System Officer, symbolizes the many partnerships in place between VUMC and the military. (photo by Donn Jones)</figcaption></figure> <div id='jp-relatedposts' class='jp-relatedposts' > <h3 class="jp-relatedposts-headline"><em>Related</em></h3> </div> </div> <div class="share-bar share-print"> <div class="share-print__share"> <h5>Share:</h5> <a href="https://www.facebook.com/sharer/sharer.php?u=https%3A%2F%2Fnews.vumc.org%2F2024%2F11%2F08%2Fvumc-plays-active-role-in-training-todays-military-medical-personnel%2F" target="_blank" rel="noopener noreferrer" class="share-link share-link--facebook"> <span class="screen-reader-text">Share on Facebook</span> <img src="https://news.vumc.org/wp-content/themes/vumc-news/images/social/facebook_blue.png" alt="Facebook" /> </a> <a href="https://bsky.app/intent/compose/?text=VUMC+plays+active+role+in+training+today%E2%80%99s+military+medical+personnel https%3A%2F%2Fnews.vumc.org%2F2024%2F11%2F08%2Fvumc-plays-active-role-in-training-todays-military-medical-personnel%2F" target="_blank" rel="noopener noreferrer" class="share-link share-link--bsky"> <span class="screen-reader-text">Share on Bsky</span> <img src="https://news.vumc.org/wp-content/themes/vumc-news/images/social/bluesky_blue.png" alt="Bluesky" /> </a> <a href="https://x.com/intent/tweet?url=https%3A%2F%2Fnews.vumc.org%2F2024%2F11%2F08%2Fvumc-plays-active-role-in-training-todays-military-medical-personnel%2F&text=VUMC+plays+active+role+in+training+today%E2%80%99s+military+medical+personnel" target="_blank" rel="noopener noreferrer" class="share-link share-link--twitter"> <span class="screen-reader-text">Share on X</span> <img src="https://news.vumc.org/wp-content/themes/vumc-news/images/social/x_blue.png" alt="X" /> </a> <a href="https://www.linkedin.com/shareArticle?mini=true&url=https%3A%2F%2Fnews.vumc.org%2F2024%2F11%2F08%2Fvumc-plays-active-role-in-training-todays-military-medical-personnel%2F&title=VUMC+plays+active+role+in+training+today%E2%80%99s+military+medical+personnel&source=VUMC+News" target="_blank" rel="noopener noreferrer" class="share-link share-link--linkedin"> <span class="screen-reader-text">Share on LinkedIn</span> <img src="https://news.vumc.org/wp-content/themes/vumc-news/images/social/linkedin_blue.png" alt="LinkedIn" /> </a> <a href="mailto:?subject=VUMC+plays+active+role+in+training+today%E2%80%99s+military+medical+personnel&body=https%3A%2F%2Fnews.vumc.org%2F2024%2F11%2F08%2Fvumc-plays-active-role-in-training-todays-military-medical-personnel%2F" target="_blank" rel="noopener noreferrer" class="share-link share-link--email"> <span class="screen-reader-text">Share via Email</span> <img src="https://news.vumc.org/wp-content/themes/vumc-news/images/social/email_blue.png" alt="Email" /> </a> </div> </div> </article><!-- #post-369863 --> <aside class="sidebar"> <div class="sidebar__blue-cta sidebar__item"> <h3 class="sidebar__blue-cta__heading"> </h3> <div class="sidebar__blue-cta__content"> </div> </div> <div class="sidebar__plain-cta sidebar__item"> <h3 class="sidebar__plain-cta__heading">Military-civilian partnerships continue to expand at VUMC</h3> <div class="sidebar__plain-cta__content"><p>Vanderbilt University Medical Center is extensively involved in partnerships with the military that both assist individuals as they transition out of service to be civilian veterans and help active-duty military medical personnel maintain their critical skills needed during deployment.</p> <p>Many of these relationships stem from a directive in the National Defense Authorization Act for fiscal year 2017 instructing the Military Health System to establish partnerships with civilian institutions so personnel could better maintain trauma care competency.</p> <p>Most programs take place in the emergency room, intensive care units and operating rooms at the Medical Center, but trauma educators and faculty also travel to Fort Campbell, Kentucky, to provide instruction to military personnel there.</p> <p>VUMC participates in the following partnership programs and training efforts:</p> <p>The <strong>ASSET+ </strong>course establishes combat training competencies and coordinates training to develop and sustain DOD trauma surgeons in operational environments, military treatment facilities or at Level 1 trauma treatment facilities. Trauma educators from VUMC will lead the ASSET+ course in February 2025.</p> <p>The <strong>Fundamental Critical Care Support: Resource Limited (FCCS: RL) </strong>course combines lectures with interactive skill stations to prepare medical professionals for challenges in providing lifesaving care in austere settings. VUMC’s Trauma Education and Outreach team led this course in July 2024 for 12 Tennessee National Guard participants.</p> <p>The<strong> Department of Defense SkillBridge/Career Skills Program (CSP) </strong>allows members of the military to shadow and do internships in civilian settings during their final months of service. VUMC began participating in this program in December 2021, and to date 15 individuals have come here for SkillBridge/CSP, with three here currently. Interns are also welcome in nonmedical areas such as IT.</p> <p><strong>Operation Strategic Medical Asset Readiness Training (SMART)</strong> is an Army partnership with civilian health care facilities to train military personnel and enable them to sustain their required medical skills. This program brings combat medics, licensed practical nurses and operating room technologists to VUMC, so they can complete much of their annual medical skills competency requirements. VUMC’s first SMART rotation was in May 2021 with six soldiers. To date, 167 have completed the program at the Medical Center.</p> <p>In March 2021, VUMC became an official site of the <strong>Army Military-Civilian Trauma Team Training (AMCT3) </strong>program, which assigns military medical personnel to civilian trauma centers to help them sustain the highest level of clinical proficiency in their specialties. Currently, eight members of the military — an emergency medicine physician, an anesthesiologist, two trauma surgeons, a CRNA, a critical care RN, an emergency medicine RN and a paramedic — are here as part of AMCT3.</p> <p>A partnership to establish <strong>dual-appointment faculty</strong> roles began in 2018, and currently three faculty members split their clinical time between VUMC and BACH.</p> <p><strong>Medical Proficiency Training (MPT)</strong> is required skills sustainment training for advanced Army Special Operations Combat Medics. 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<p class="pojo-a11y-toolbar-title">Accessibility Tools</p> <ul class="pojo-a11y-toolbar-items pojo-a11y-tools"> <li class="pojo-a11y-toolbar-item"> <a href="#" class="pojo-a11y-toolbar-link pojo-a11y-btn-resize-font pojo-a11y-btn-resize-plus" data-action="resize-plus" data-action-group="resize" tabindex="-1" role="button"> <span class="pojo-a11y-toolbar-icon"><svg version="1.1" xmlns="http://www.w3.org/2000/svg" width="1em" viewBox="0 0 448 448"><title>Increase Text</title><path fill="currentColor" d="M256 200v16c0 4.25-3.75 8-8 8h-56v56c0 4.25-3.75 8-8 8h-16c-4.25 0-8-3.75-8-8v-56h-56c-4.25 0-8-3.75-8-8v-16c0-4.25 3.75-8 8-8h56v-56c0-4.25 3.75-8 8-8h16c4.25 0 8 3.75 8 8v56h56c4.25 0 8 3.75 8 8zM288 208c0-61.75-50.25-112-112-112s-112 50.25-112 112 50.25 112 112 112 112-50.25 112-112zM416 416c0 17.75-14.25 32-32 32-8.5 0-16.75-3.5-22.5-9.5l-85.75-85.5c-29.25 20.25-64.25 31-99.75 31-97.25 0-176-78.75-176-176s78.75-176 176-176 176 78.75 176 176c0 35.5-10.75 70.5-31 99.75l85.75 85.75c5.75 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Text</span> </a> </li> <li class="pojo-a11y-toolbar-item"> <a href="#" class="pojo-a11y-toolbar-link pojo-a11y-btn-background-group pojo-a11y-btn-grayscale" data-action="grayscale" data-action-group="schema" tabindex="-1" role="button"> <span class="pojo-a11y-toolbar-icon"><svg version="1.1" xmlns="http://www.w3.org/2000/svg" width="1em" viewBox="0 0 448 448"><title>Grayscale</title><path fill="currentColor" d="M15.75 384h-15.75v-352h15.75v352zM31.5 383.75h-8v-351.75h8v351.75zM55 383.75h-7.75v-351.75h7.75v351.75zM94.25 383.75h-7.75v-351.75h7.75v351.75zM133.5 383.75h-15.5v-351.75h15.5v351.75zM165 383.75h-7.75v-351.75h7.75v351.75zM180.75 383.75h-7.75v-351.75h7.75v351.75zM196.5 383.75h-7.75v-351.75h7.75v351.75zM235.75 383.75h-15.75v-351.75h15.75v351.75zM275 383.75h-15.75v-351.75h15.75v351.75zM306.5 383.75h-15.75v-351.75h15.75v351.75zM338 383.75h-15.75v-351.75h15.75v351.75zM361.5 383.75h-15.75v-351.75h15.75v351.75zM408.75 383.75h-23.5v-351.75h23.5v351.75zM424.5 383.75h-8v-351.75h8v351.75zM448 384h-15.75v-352h15.75v352z"></path></svg></span><span class="pojo-a11y-toolbar-text">Grayscale</span> </a> </li> <li class="pojo-a11y-toolbar-item"> <a href="#" class="pojo-a11y-toolbar-link pojo-a11y-btn-background-group pojo-a11y-btn-high-contrast" data-action="high-contrast" data-action-group="schema" tabindex="-1" role="button"> <span class="pojo-a11y-toolbar-icon"><svg version="1.1" xmlns="http://www.w3.org/2000/svg" width="1em" viewBox="0 0 448 448"><title>High Contrast</title><path fill="currentColor" d="M192 360v-272c-75 0-136 61-136 136s61 136 136 136zM384 224c0 106-86 192-192 192s-192-86-192-192 86-192 192-192 192 86 192 192z"></path></svg></span><span class="pojo-a11y-toolbar-text">High Contrast</span> </a> </li> <li class="pojo-a11y-toolbar-item"> <a href="#" class="pojo-a11y-toolbar-link pojo-a11y-btn-background-group pojo-a11y-btn-negative-contrast" data-action="negative-contrast" data-action-group="schema" tabindex="-1" role="button"> <span class="pojo-a11y-toolbar-icon"><svg version="1.1" xmlns="http://www.w3.org/2000/svg" width="1em" viewBox="0 0 448 448"><title>Negative Contrast</title><path fill="currentColor" d="M416 240c-23.75-36.75-56.25-68.25-95.25-88.25 10 17 15.25 36.5 15.25 56.25 0 61.75-50.25 112-112 112s-112-50.25-112-112c0-19.75 5.25-39.25 15.25-56.25-39 20-71.5 51.5-95.25 88.25 42.75 66 111.75 112 192 112s149.25-46 192-112zM236 144c0-6.5-5.5-12-12-12-41.75 0-76 34.25-76 76 0 6.5 5.5 12 12 12s12-5.5 12-12c0-28.5 23.5-52 52-52 6.5 0 12-5.5 12-12zM448 240c0 6.25-2 12-5 17.25-46 75.75-130.25 126.75-219 126.75s-173-51.25-219-126.75c-3-5.25-5-11-5-17.25s2-12 5-17.25c46-75.5 130.25-126.75 219-126.75s173 51.25 219 126.75c3 5.25 5 11 5 17.25z"></path></svg></span><span class="pojo-a11y-toolbar-text">Negative Contrast</span> </a> </li> <li class="pojo-a11y-toolbar-item"> <a href="#" class="pojo-a11y-toolbar-link pojo-a11y-btn-background-group pojo-a11y-btn-light-background" data-action="light-background" 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11.75-20.5-2-26.75-24.75-53.5-42-72.5s-25.75-41.25-25.75-67c0-68 64.75-112 128-112s128 44 128 112z"></path></svg></span><span class="pojo-a11y-toolbar-text">Light Background</span> </a> </li> <li class="pojo-a11y-toolbar-item"> <a href="#" class="pojo-a11y-toolbar-link pojo-a11y-btn-links-underline" data-action="links-underline" data-action-group="toggle" tabindex="-1" role="button"> <span class="pojo-a11y-toolbar-icon"><svg version="1.1" xmlns="http://www.w3.org/2000/svg" width="1em" viewBox="0 0 448 448"><title>Links Underline</title><path fill="currentColor" d="M364 304c0-6.5-2.5-12.5-7-17l-52-52c-4.5-4.5-10.75-7-17-7-7.25 0-13 2.75-18 8 8.25 8.25 18 15.25 18 28 0 13.25-10.75 24-24 24-12.75 0-19.75-9.75-28-18-5.25 5-8.25 10.75-8.25 18.25 0 6.25 2.5 12.5 7 17l51.5 51.75c4.5 4.5 10.75 6.75 17 6.75s12.5-2.25 17-6.5l36.75-36.5c4.5-4.5 7-10.5 7-16.75zM188.25 127.75c0-6.25-2.5-12.5-7-17l-51.5-51.75c-4.5-4.5-10.75-7-17-7s-12.5 2.5-17 6.75l-36.75 36.5c-4.5 4.5-7 10.5-7 16.75 0 6.5 2.5 12.5 7 17l52 52c4.5 4.5 10.75 6.75 17 6.75 7.25 0 13-2.5 18-7.75-8.25-8.25-18-15.25-18-28 0-13.25 10.75-24 24-24 12.75 0 19.75 9.75 28 18 5.25-5 8.25-10.75 8.25-18.25zM412 304c0 19-7.75 37.5-21.25 50.75l-36.75 36.5c-13.5 13.5-31.75 20.75-50.75 20.75-19.25 0-37.5-7.5-51-21.25l-51.5-51.75c-13.5-13.5-20.75-31.75-20.75-50.75 0-19.75 8-38.5 22-52.25l-22-22c-13.75 14-32.25 22-52 22-19 0-37.5-7.5-51-21l-52-52c-13.75-13.75-21-31.75-21-51 0-19 7.75-37.5 21.25-50.75l36.75-36.5c13.5-13.5 31.75-20.75 50.75-20.75 19.25 0 37.5 7.5 51 21.25l51.5 51.75c13.5 13.5 20.75 31.75 20.75 50.75 0 19.75-8 38.5-22 52.25l22 22c13.75-14 32.25-22 52-22 19 0 37.5 7.5 51 21l52 52c13.75 13.75 21 31.75 21 51z"></path></svg></span><span class="pojo-a11y-toolbar-text">Links Underline</span> </a> </li> <li class="pojo-a11y-toolbar-item"> <a href="#" class="pojo-a11y-toolbar-link pojo-a11y-btn-readable-font" data-action="readable-font" data-action-group="toggle" tabindex="-1" role="button"> <span 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