bluuebunny/crossref_metadata_2025 huggingface dataset:
Shock Wave Physics as Related to Primary Non-Impact Blast-Induced Traumatic Brain Injury
Authors: Rutter Barbara , Song Hailong , DePalma Ralph G , Hubler Graham , Cui Jiankun , Gu Zezong , Johnson Catherine E
Published: January 2021

Introduction

Blast overpressure exposure, an important cause of traumatic brain injury (TBI), may occur during combat or military training. TBI, most commonly mild TBI, is considered a signature injury of recent combat in Iraq and Afghanistan. Low intensity primary blast-induced TBI (bTBI), caused by exposure to an explosive shock wave, commonly leaves no obvious physical external signs. Numerous studies have been conducted to understand its biological effects; however, the role of shock wave energy as related to bTBI remains poorly understood. This report combines shock wave analysis with established biological effects on the mouse brain to provide insights into the effects of shock wave physics as related to low intensity bTBI outcomes from both open-air and shock tube environments.

Methods

Shock wave peak pressure, rise time, positive phase duration, impulse, shock velocity, and particle velocity were measured using the Missouri open-air blast model from 16 blast experiments totaling 122 mice to quantify physical shock wave properties. Open-air shock waves were generated by detonating 350-g 1-m suspended Composition C-4 charges with targets on 1-m elevated stands at 2.15, 3, 4, and 7 m from the source.

Results

All mice sustained brain injury with no observable head movement, because of mice experiencing lower dynamic pressures than calculated in shock tubes. Impulse, pressure loading over time, was found to be directly related to bTBI severity and is a primary shock physics variable that relates to bTBI.

Discussion

The physical blast properties including shock wave peak pressure, rise time, positive phase duration, impulse, shock velocity, and particle velocity were examined using the Missouri open-air blast model in mice with associated neurobehavioral deficits. The blast-exposed mice sustained ultrastructural abnormalities in mitochondria, myelinated axons, and synapses, implicating that primary low intensity blast leads to nanoscale brain damage by providing the link to its pathogenesis. The velocity of the shock wave reflected back from the target stand was calculated from high-speed video and compared with that of the incident shock wave velocity. Peak incident pressure measured from high sample rate sensors was found to be within 1% of the velocity recorded by the high-speed camera, concluding that using sensors in or close to an animal brain can provide useful information regarding shock velocity within the brain, leading to more advanced knowledge between shock wave physics and tissue damage that leads to bTBIs.
The Trifecta of Tele-Critical Care: Intrahospital, Operational, and Mass Casualty Applications
Authors: Ieronimakis Kristina M , Colombo Christopher J , Valovich Justin , Griffith Mark , Davis Konrad L , Pamplin Jeremy C
Published: January 2021

Introduction

Tele-critical care (TCC) has improved outcomes in civilian hospitals and military treatment facilities (MTFs). Tele-critical care has the potential to concurrently support MTFs and operational environments and could increase capacity and capability during mass casualty events. TCC services distributed across multiple hub sites may flexibly adapt to rapid changes in patient volume and complexity to fully optimize resources. Given the highly variable census in MTF intensive care units (ICU), the proposed TCC solution offers system resiliency and redundancy for garrison, operational, and mass casualty needs, while also maximizing return on investment for the Defense Health Agency.

Materials and Methods

The investigators piloted simultaneous TCC support to the MTF during three field exercises: (1) TCC concurrently monitored the ICU during a remote mass casualty exercise: the TCC physician monitored a high-risk ICU patient while the nurse monitored 24 simulated field casualties; (2) TCC concurrently monitored the garrison ICU and a remote military medical field exercise: the physician provided tele-mentoring during prolonged field care for a simulated casualty, and the nurse provided hospital ICU TCC; (3) the TCC nurse simultaneously monitored the ICU while providing reach-back support to field hospital nurses training in a simulation scenario.

Results

TCC proved feasible during multiple exercises with concurrent tele-mentoring to different care environments including physician and nurse alternating operational and hospital support roles, and an ICU nurse managing both simultaneously. ICU staff noted enhanced quality and safety of bedside care. Field exercise participants indicated TCC expanded multipatient monitoring during mass casualties and enhanced novice caregiver procedural capability and scope of patient complexity.

Conclusions

Tele-critical care can extend critical care services to anywhere at any time in support of garrison medicine, operational medicine, and mass casualty settings. An interoperable, flexibly staffed, and rapidly expandable TCC network must be further developed given the potential for large casualty volumes to overwhelm a single TCC provider with multiple duties. Lessons learned from development of this capability should have applicability for managing military and civilian mass casualty events.
Evaluation of Fluorescent Light Energy for the Treatment of Acute Second-degree Burns
Authors: Mellergaard Maiken , Fauverghe Stéphane , Scarpa Carlotta , Pozner Vladimir Luca , Skov Søren , Hebert Lise , Nielsen Michael , Bassetto Franco , Téot Luc
Published: January 2021

Introduction

The use of photobiomodulation has been proposed to improve wound healing for the last two decades. Recent development in photobiomodulation has led to the development of a novel biophotonic platform that utilizes fluorescent light energy (FLE) within the visible spectrum of light for healing of skin inflammation and wounds.

Materials and Methods

In this article, FLE was used in preliminary analysis on 18 case studies of acute second-degree burns and in a pilot study using an ex vivo human skin model. Efficacy of FLE on wound healing and tissue remodeling was evaluated by monitoring improvements in the treated tissues, assessing pain for the patients, and by performing human genome microarray analysis of FLE-treated human skin samples.

Results

Healing was reported for all 18 patients treated with FLE for acute second-degree burns without reported adverse effects or development of infections. Furthermore, preliminary ex vivo skin model data suggest that FLE impacts different cellular pathways including essential immune-modulatory mechanisms.

Conclusions

The results presented in this article are encouraging and suggest that FLE balances different stages of wound healing, which opens the door to initiating randomized controlled clinical trials for establishing the efficacy of FLE treatment in different phases of wound healing of second-degree burns.
Integrating User Voice in Hearing Care With Focus on Off-Duty Warfighter
Authors: Gupta Shayan , Xu Xuan , Liu Wilford , Zhang Jacqueline , Kelly Shawn
Published: January 2021

Introduction

Noise-Induced Hearing Loss (NIHL) is a growing public health concern in the USA and globally because of the emergence of lifestyle preferences and environmental exposures to sound levels exceeding safe listening limits for extended periods of time. In the military, hearing and communication are important for survival and the Department of Defense’s Hearing Center of Excellence highlights the importance of protection from NIHL. Issuance of the World health organization safe audio listening standards along with existing U.S. federal and military standards provides a framework for developing an accessible tool for promoting safe listening.

Methods

An App is being proposed for an aggregated assessment of a user’s daily sound exposure, through personal audio system and ambient sources and providing tools for managing personal sound exposures. The key elements for development of App features were integration of user voice for functionalities, computations based on global standards, including military, for safe listening and alignment with regulatory standards for Apps.

Results

Features of the App are “Track” for audio and ambient exposures, “Compute” for real-time and cumulative exposures vs. safe listening standards, “Alert” for unsafe exposures using visual and haptic, “Inform” for personal exposures vs. safe dose, associated NIHL risk and education, “Choice” for alternatives that can be relatable to personal lifestyle, and “Share” for informing others as determined by the user. App safety is ensured by privacy and cybersecurity regulatory standards.

Conclusion

The overall goals of the App are to increase NIHL awareness and to empower users to improve personal listening behaviors that can potentially reduce the risk of NIHL.
A Paradigm Shift in Critical Care Infrastructure in Complex Settings: Evaluating an Ultraportable Operating Room to Improve Field Surgical Safety
Authors: Teodorescu Debbie L , Okajima Stephen , Moten Asad , Teodorescu Mike H M , El Hechi Majed , Gutierrez-Arango Samantha , Meier Karien , Smalley Robert J , King David R
Published: January 2021

Introduction

Scarcity of operating rooms and personal protective equipment in far-forward field settings make surgical infections a potential concern for combat mortality and morbidity. Surgical and transport personnel also face infectious risks from bodily fluid exposures. Our study aimed to describe the serial, proof-of-concept testing of the SurgiBox technology: an inflatable sterile environment that addresses the aforementioned problems, fits on gurneys and backpacks, and drapes over incisions.

Materials and Methods

The SurgiBox environmental control unit and inflatable enclosure were optimized over five generations based on iterative feedback from stakeholders experienced in surgery in austere settings. The airflow system was developed by analytic modeling, verified through in silico modeling in SOLIDWORKS, and confirmed with prototype smoke-trail checking. Particulate counts evaluated the enclosure’s ability to control and mitigate users’ exposures to potentially infectious contaminants from the surgical field in various settings. SurgiBox enclosures were setup over a mannequin’s torso, in a configuration and position for either thoracic or abdominal surgery. A particle counter was serially positioned in sternotomy and laparotomy positions, as well as bilateral flank positions. This setup was repeated with open ports exposing the enclosure to the external environment. To simulate stress scenarios, sampling was repeated with enclosure measurements during an increase in external particulate concentration.

Results

The airflow technology effectively kept contaminants away from the incision and maintained a pressure differential to reduce particle entry. Benchtop testing demonstrated that even when ports were opened or the external environment had high contaminant burden, the enclosed surgical field consistently registered 0 particle count in all positions. Time from kit opening to incision averaged 54.5 seconds, with the rate-limiting step being connecting the environmental control unit to the enclosure. The portable kit weighted 5.9 lbs.

Conclusions

Analytic, in silico, and mechanical airflow modeling and benchtop testing have helped to quantify the SurgiBox system’s reliability in creating and maintaining an operating room-quality surgical field within the enclosure as well as protecting the surgical team outside the enclosure. More recent and ongoing work has focused on specifying optimal use settings in the casualty chain of care, expanding support for circumferential procedures, automating airflow control, and accelerating system setup. SurgiBox’s ultimate goal is to take timely, safe surgery to patients in even the most austere of settings.
MG53 as a Novel Therapeutic Protein to Treat Acute Lung Injury
Authors: Whitson Bryan A , Mulier Kristine , Li Haichang , Zhou Xinyu , Cai Chuanxi , Black Sylvester M , Tan Tao , Ma Jianjie , Beilman Greg J
Published: January 2021

Introduction

Lung injury has several inciting etiologies ranging from trauma (contusion and hemorrhage) to ischemia reperfusion injury. Reflective of the injury, tissue and cellular injury increases proportionally with the injury stress and is an area of potential intervention to mitigate the injury. This study aims to evaluate the therapeutic benefits of recombinant human MG53 (rhMG53) protein in porcine models of acute lung injury (ALI).

Materials and Methods

We utilized live cell imaging to monitor the movement of MG53 in cultured human bronchial epithelial cells following mechanical injury. The in vivo efficacy of rhMG53 was evaluated in a porcine model of hemorrhagic shock/contusive lung injury. Varying doses of rhMG53 (0, 0.2, or 1 mg/kg) were administered intravenously to pigs after induction of hemorrhagic shock/contusive induced ALI. Ex vivo lung perfusion system enabled assessment of the isolated porcine lung after a warm ischemic induced injury with rhMG53 supplementation in the perfusate (1 mg/mL).

Results

MG53-mediated cell membrane repair is preserved in human bronchial epithelial cells. rhMG53 mitigates lung injury in the porcine model of combined hemorrhagic shock/contusive lung injury. Ex vivo lung perfusion administration of rhMG53 reduces warm ischemia-induced injury to the isolated porcine lung.

Conclusions

MG53 is an endogenous protein that circulates in the bloodstream. Therapeutic treatment with exogenous rhMG53 may be part of a strategy to restore (partially or completely) structural morphology and/or functional lung integrity. Systemic administration of rhMG53 constitutes a potential effective therapeutic means to combat ALI.
Quantifying Clinical Opportunities at the Navy Trauma Training Center
Authors: Schmied Blackman Virginia , Torres Tony , Stakley Jami A , Raiciulescu Sorana , Garcia Elizabeth , Ross Jeffrey L , Polk Travis M , Stotts Nancy A
Published: January 2021

Introduction

Military-Civilian partnerships (MCPs), such as the Navy Trauma Training Center, are an essential tool for training military trauma care providers. Despite Congressional and military leadership support, sparse data exist to quantify participants’ clinical opportunities in MCPs. These preliminary data from an ongoing Navy Trauma Training Center outcomes study quantify clinical experiences and compare skill observation to skill performance.

Materials and Methods

Participants completed clinical logs after each patient encounter to quantify both patients and procedures they were involved with during clinical rotations; they self-reported demographic data. Data analyses included descriptive statistics and chi-square statistics to compare skills observed to skills performed between the first and second half of the 21-day course.

Results

A sample of 47 Navy personnel (30 corpsmen, 10 nurses, 3 physician assistants, 4 physicians) completed 551 clinical logs. Most logs (453/551) reflected experiences in the emergency department, where corpsmen and nurses each spent 102.0 hours, and physician assistants and physicians each spent 105.4 hours. Logs completed per participant ranged from 1 to 31, (mean = 8). No professional group was more likely than others to complete the clinical logs. Completion rates varied by cohort, both overall and by clinical role. Of emergency department logs, 39% reflected highest acuity patients, compared with 21% of intensive care unit logs, and 61% of operating room logs. Penetrating trauma was reported on 16.5% of logs. Primary and secondary trauma assessments were the most commonly reported clinical opportunities, followed by obtaining intravenous access and administration of analgesic medications. With few exceptions, logs reflected skill observation versus skill performance, a ratio that did not change over time.

Conclusion

Prospective real-time data of actual clinical activity is a crucial measure of the success of MCPs. These preliminary data provide a beginning perspective on how these experiences contribute to maintaining a skilled military medical force.
Prevention of Blast-induced Auditory Injury Using 3D Printed Helmet and Hearing Protection Device – A Preliminary Study on Biomechanical Modeling and Animal
Authors: Jiang Shangyuan , Gannon Ariana N , Smith Kyle D , Brown Marcus , Liang Junfeng , Gan Rong Z
Published: January 2021

Introduction

Repeated blast exposures result in structural damage to the peripheral auditory system (PAS) and the central auditory system (CAS). However, it is difficult to differentiate injuries between two distinct pathways: the mechanical damage in the PAS caused by blast pressure waves transmitted through the ear and the damage in the CAS caused by blast wave impacts on the head or traumatic brain injury. This article reports a preliminary study using a 3D printed chinchilla “helmet” as a head protection device associated with the hearing protection devices (e.g., earplugs) to isolate the CAS damage from the PAS injuries under repeated blast exposures.

Materials and Methods

A finite element (FE) model of the chinchilla helmet was created based on micro-computed tomography images of a chinchilla skull and inputted into ANSYS for FE analysis on the helmet’s protection against blast over pressure. The helmet was then 3D printed and used for animal experiments. Chinchillas were divided into four cases (ears open, with earplug only, with both earplug and helmet, and with helmet only) and exposed to three blasts at blast over pressure of 15 to 20 psi. Hearing function tests (e.g., auditory brainstem response) were performed before and after blast on Day 1 and Days 4 and 7 after blasts.

Results

The FE model simulation showed a significant reduction in intracranial stress with the helmet, and the animal results indicated that both earplug and helmet reduced the severity of blast-induced auditory injuries by approximately 20 dB but with different mechanisms.

Conclusions

The biomechanical modeling and animal experiments demonstrated that this four-case study in chinchillas with helmet and hearing protection devices provides a novel methodology to investigate the blast-induced damage in the PAS and CAS.
Quality of Life After Open Abdominal Treatment With Vacuum-Assisted Wound Closure and Mesh-Mediated Fascial Traction
Authors: Schaaf Sebastian , Schwab Robert , Willms Arnulf
Published: January 2021

Introduction

Little is known about the long-term outcome of open abdomen treatment with vacuum-assisted wound closure and mesh-3. Therefore, this study’s purpose is to evaluate this with a particular focus on incisional hernia development and quality of life (QoL).

Materials and Methods

Fifty-five patients who underwent vacuum-assisted wound closure and mesh-mediated fascial traction at our institution from 2006 to 2013 were prospectively enrolled in this study. After a median follow-up period of 3.8 years, 34 patients attended a follow-up examination, including the SF-36 QoL questionnaire.

Results

The fascial closure rate was 74% (intention-to-treat) and 89% (per-protocol). Enteroatmospheric fistulae occurred in 1.8%. In-hospital mortality was 16.4%, and during the follow-up period, it was 27.4%. Incisional hernias developed in 35% of the cases.

The SF-36 physical role (54.6 ± 41.0 (0-100), P < 0.01), physical functioning (68.4 ± 29.5 (0-100), P = 0.01), and physical component summary (41.6 ± 13.0 (19-62), P = 0.01) scores for the patient population were significantly lower than normative scores. The mental dimensions of QoL showed no differences.

A subgroup analysis revealed that the lower scores for physical role, physical functioning, and physical component summary only existed in the subgroup of incisional hernia patients. In contrast, physical and mental SF-36 scores of patients without incisional hernias did not differ from the normative scores.

Conclusions

Vacuum-assisted wound closure and mesh-mediated fascial traction seems to result in low complication rates. However, incisional hernias occur in 35%, which are the leading cause of reduced QoL. Measures to further improve this rate, such as prophylactic meshes, have to be evaluated.
Neck Vertebral Level-specific Forces and Moments Under G-x Accelerative Loading
Authors: Purushothaman Yuvaraj , Humm John , Jebaseelan Davidson , Yoganandan Narayan
Published: January 2021

Introduction

It is important to determine the local forces and moments across the entire cervical spine as dysfunctions such as spondylosis and acceleration-induced injuries are focused on specific levels/segments. The aims of the study were to determine the axial and shear forces and moments at each level under G-x accelerative loading for female and male spines.

Methods

A three-dimensional finite element model of the male head-cervical spinal column was developed. G-x impact acceleration was applied using experimental data from whole body human cadaver tests. It was validated with experimental head kinematics. The model was converted to a female model, and the same input was applied. Segmental axial and shear forces and moments were obtained at all levels from C2 to T1 in male and female spines.

Results

The time of occurrence of peak axial forces in male and female spines ranged from 37 to 41 ms and 31 to 35 ms. The peak times for the shear forces in male and female spines ranged from 65 to 86 ms and 58 to 78 ms. The peak times for the bending moment ranged from 79 to 91 ms for male and 75 to 83 ms for female spines. Other data are given.

Conclusions

All metrics reached their peaks earlier in female than male spines, representing a quicker loading in the female spine. Peak magnitudes were also lower in the female spines. Moments and axial forces varied differently compared to the shear forces in the female spine, suggesting that intersegmental loads vary nonuniformly. Effects of head inertia contributed to the greatest increase in axial force under this impact acceleration vector. Because female spines have a lower biomechanical tolerance to injury, female spines may be more vulnerable to injury under this load vector.
Fast-Running Tools for Personalized Monitoring of Blast Exposure in Military Training and Operations
Authors: Przekwas Andrzej , Garimella Harsha T , Chen Z J , Zehnbauer Tim , Gupta Raj K , Skotak Maciej , Carr Walter S , Kamimori Gary H
Published: January 2021

Introduction

During training and combat operations, military personnel may be exposed to repetitive low-level blast while using explosives to gain entry or by firing heavy weapon systems such as recoilless weapons and high-caliber sniper rifles. This repeated exposure, even within allowable limits, has been associated with cognitive deficits similar to that of accidental and sports concussion such as delayed verbal memory, visual-spatial memory, and executive function. This article presents a novel framework for accurate calculation of the human body blast exposure in military heavy weapon training scenarios using data from the free-field and warfighter wearable pressure sensors.

Materials and Methods

The CoBi human body model generator tools were used to reconstruct multiple training scenes with different weapon systems. The CoBi Blast tools were used to develop the weapon signature and estimate blast overpressure exposure. The authors have used data from the free-field and wearable pressure sensors to evaluate the framework.

Results

Carl-Gustav and 0.50 caliber sniper training scenarios were used to demonstrate and validate the developed framework. These simulations can calculate spatially and temporally resolved blast loads on the whole human body and on specific organs vulnerable to blast loads, such as head, face, and lungs.

Conclusions

This framework has numerous advantages including easier model setup and shorter simulation times. The framework is an important step towards developing an advanced field-applicable technology to monitor low-level blast exposure during heavy weapon military training and combat scenarios.
Biomechanically Based Correlate for Localized Lung Contusion From Nonlethal Blunt Impact Projectiles
Authors: Cui Jianxia , Rapo Mark , Mathews Kiran , Webber Charles , Ng Laurel
Published: January 2021

Introduction

Injury mechanics of blunt impact projectiles differ from those experienced in whole body motor vehicle collisions because the effects are localized around the point of impact, and thus, injury thresholds based upon gross chest kinematics (e.g., force, velocity) may not be applicable across impact types. Therefore, knowledge of biomechanically based tissue injury correlates for blunt impact projectiles are needed to better guide design and development of protective systems as well as assess injury risks from blunt impact projectile weapons.

Materials and Methods

In this study, subject-specific swine finite element models were used to quantify the tissue-level stresses and strains resulting from high speed projectile impact. These tissue-level injury doses were correlated to pathology injury outcomes to produce injury risk curves for lung contusion. Details of the pathology data and finite element results are provided in Appendix 1. Survival analysis regression methods were applied to develop lung injury regression curves and a number of statistical methods were used to evaluate several biomechanical metrics as correlates to lung contusion. Uncertainty and sensitivity analyses were used to further confirm the selection of the correlate.

Results

Statistical analysis revealed that normalized strain-energy density was the best correlate for prediction of lung tissue damage. Going further, normalized strain-energy density also proved to be suitable for prediction of the percentage of contused lung volume, a more meaningful medical diagnosis. As expected, peak strain-energy density is most sensitive to muscle-skin properties, as quantified through a comprehensive uncertainty and sensitivity analysis over three sets of projectile weights and speeds.

Conclusions

Normalized strain-energy density was found to be the best correlate for prediction of lung tissue damage and correlate well to extent of contused lung volume.
Superior Monitoring of Chemical Exposure Using Nanoconfinement Technology
Authors: Apblett Allen , Materer Nicholas , Kadossov Evgueni , Shaikh Shoaib
Published: January 2021

Introduction

Military personnel are exposed to a broad range of potentially toxic compounds that can affect their health. These hazards are unpredictable because military service occurs in a wide array of uncontrolled environments. Therefore, a novel sorbent was developed that allows the fabrication of lightweight personal samplers that are both capable of sorbing an extremely wide range of organic chemical types and able to stabilize reactive compounds.

Materials and Methods

OSU-6, a nanoporous silica, was provided by XploSafe LLC. The sorption capacity for several volatile organic compounds, the temperatures required for thermal desorption of adsorbed compounds, and the sampling rates for targeted analytes were determined.

Results

The uptake capacity was found to be on average 1.5 g/g of sorbent. Analytes were not only held tightly but also could be desorbed upon heating the sorbate to temperatures below 150°C. Sampling rates for volatile organic compound by an OSU-6 sampler badge were on average, 5.7 times higher than those for a commercially available activated carbon badge. Theoretical calculations showed that sorption of volatile organic compounds on the surface of the tightly curved pore walls in OSU-6 is because of exceptionally strong cumulative addition of Van der Waals forces. Analytes could readily be analyzed by either solvent extraction or thermal desorption gas chromatography/mass spectrometry techniques. Excellent sampling rates, high concentrations of analytes in the OSU-6 sorbent matrix, and high desorption efficiencies (recoveries) were obtained using the thermal desorption method.

Conclusions

The performance of the OSU-6 sorbent makes it highly capable of meeting the need for personal samplers that enable Individual Longitudinal Exposure Records development. It can adsorb an extremely wide array of different volatile organic compounds, it can stabilize reactive compounds, it has high sampling rates coupled with high capacity that provide both sensitivity and resistance to saturation, and it is unique in being very amenable to thermal desorption in combination with having strong sorbate binding and high capacity and surface area.
Disability Status Attenuates Treatment Effects in an Intensive Outpatient Program for PTSD
Authors: Hoyt Tim , Shumaker Brianna E Staley
Published: January 2021

Introduction

The utilization of intensive outpatient programs for the treatment of military-related post-traumatic stress disorder (PTSD) has increased through initiatives both inside and outside the military health care system. However, research in veteran populations suggest that patients concurrently undergoing disability evaluation may not respond well to such interventions. This study evaluates the relationship between disability separation and endorsement of PTSD symptoms during treatment at an intensive outpatient program.

Methods

Patients in this retrospective study were 81 service members enrolled in a half-day, 6-week intensive outpatient program for PTSD. Sixty-seven percent (n = 54) were concurrently enrolled in the integrated disability evaluation system and were pending medical separation. Fifty-two percent (n = 42) also received a 4-week skills training intervention before beginning PTSD treatment. Patients completed the PTSD Checklist before, during, and after the treatment program as an index of PTSD symptoms.

Results

A significant interaction effect was observed in which PTSD symptoms throughout program enrollment differed as a function of enrollment in the integrated disability evaluation system. Patients undergoing disability evaluations did not show significant changes in endorsed PTSD symptoms during program enrollment, whereas significant decreases in PTSD symptoms were observed in patients not undergoing disability evaluations. These effects controlled for lost treatment days as a result of training or other appointments.

Conclusions

These results provide preliminary data indicating that participation in disability separation may attenuate the effect of PTSD treatment and endorsement of PTSD symptoms in an intensive outpatient setting.
Efficacy of Hemostatic Gauzes in a Swine Model of Prolonged Field Care with Limb Movement
Authors: Landers Grace D , Townsend Cassandra , Gaspary Micah , Kachur Ryan , Thorne Brian , Stuart Sean , Henao Jose , Zarow Gregory J , Natarajan Ramesh , Boboc Michael
Published: January 2021

Introduction

Prolonged field care for junctional wounds is challenging and involves limb movement to facilitate transport. No studies to date have explored the efficacy of gauze products to limit rebleeding in these scenarios.

Materials and Methods

We randomly assigned 48 swine to QuikClot Combat Gauze, ChitoGauze, NuStat Tactical, or Kerlix treatment groups (12 each) and then inflicted a severe groin injury by utilizing a modified Kheirabadi model of a 6-mm femoral artery punch followed by unrestricted bleeding for 60 seconds. We reassessed rebleed following limb movement at 30 minutes of stabilization and 4 hours after stabilization.

Results

Swine treated with Combat Gauze proved to have the lowest incidence of rebleeding, and conversely, NuStat Tactical had the highest incidence of rebleeding at wounds after limb movement. Importantly, rebleeds occurred at a rate of 25%-58% across all swine treatment groups at 30 minutes postinjury and 0%-42% at 270 minutes postinjury demonstrating that limb movements universally challenge hemostatic junctional wounds.

Conclusions

Our findings highlight the difficulty of controlling hemorrhage from junctional wounds with hemostatic gauze in the context of prolonged field care and casualty transport. Our research can guide selection of hemorrhage control gauze when patients have prolonged field extraction or difficult transport. Our data demonstrates the frequency of junctional wound rebleeding after movement and thus the importance of frequent patient reassessment.
Quantification of Dual-task Performance in Healthy Young Adults Suitable for Military Use
Authors: Penko Amanda L , Linder Susan M , Miller Koop Mandy , Dey Tanujit , Alberts Jay L
Published: January 2021

Introduction

Dual-task performance, in which an individual performs two tasks simultaneously, is compromised following mild traumatic brain injury (mTBI). Proficient dual-task performance is essential in a military setting for both military member safety and execution of skilled tasks. To address the unique needs of military members, a portable dual-task assessment was developed incorporating an auditory dual-task task as a novel assessment module utilizing mobile-device technology. The aim of this study was to develop and validate a dual-task mobile device-based application that accurately quantifies cognitive and motor function.

Materials and Methods

Fifty, healthy, military-age civilians completed three cognitive tasks in single- and dual-task conditions with eyes open and closed: visual Stroop, auditory Stroop at 1.5- and 2.5-second stimulus presentation, and number discrimination. All dual-task conditions required the maintenance of postural stability while simultaneously completing a cognitive task.

Results

There were no differences between single- and dual-task conditions for cognitive performance on any of the tests, and a ceiling effect was observed for the visual Stroop and auditory Stroop 1.5-second stimulus presentation (P > .05). Significant differences in postural stability were observed between the eyes-open and eyes-closed conditions in all single- and dual-task conditions (P < .01). Significant differences in postural stability were observed between the eyes-open single-task condition and all dual-task conditions (P < .01).

Conclusions

Based on the performance of healthy young adults, the number discrimination task may be optimal for detecting subtle changes in dual-task performance. The detected differences found between the eyes-open and eyes-closed conditions provide discriminatory value and insight into the reliance of vision of postural stability performance. While dual-task cognitive performance was not observed in this healthy population, individuals with mTBI may exhibit decreased dual-task performance. The independent evaluation of cognitive and motor function under dual-task conditions has the potential to transform the management and treatment of mTBI.
Brain Injury: What Influences the Beliefs U.S. Service Members Have About Reporting and Seeking Care?
Authors: Jorgensen-Wagers Kendra , Young Vanessa , Collins Dawn , Chavez Bianca , Lenski Dayna , Khokhar Bilal
Published: January 2021

Introduction

Despite the recent Department of Defense emphasis on traumatic brain injury (TBI) education and improvements in treatment, social, and attitudinal beliefs instilled in the military community hinder seeking medical assistance at the time of injury. This survey research presents injury reporting and care seeking behavioral patterns of service members (SMs) stationed in the Landstuhl catchment area in the context of TBI. This descriptive study investigated whether sociocultural factors influence health decision-making among SMs stationed abroad and how these compare to the SMs stationed in Fort Bliss and Fort Hood.

Materials and Methods

A total of 969 of U.S. Army, Air Force, and Navy SMs completed a voluntary and anonymous 2- to 5-minute paper survey during the month of March 2019. As a result of illegibility and incompleteness, 15 survey responses were removed from the total sample.

Results

Data analyses show three main findings about SMs in the Landstuhl catchment area: (a) older population (25-34, ≥48%; 18-24, 26.1%; +35, 25.4%) when compared to Fort Hood and Fort Bliss (≥48%; 18-24); (b) more years in service (7-13 years; 30.2%) versus 6 years or less in both Fort Hood and Fort Bliss (≥69%); (c) 54.8% of participants did not think TBI requires care versus 63.5% in both Fort Bliss and Fort Hood.

Conclusion

Results suggest that TBI beliefs and influences are constant variables hindering health decision-making choices in the military population. Beliefs about thinking that the injury does not require care, fear to jeopardize the career, and knowledge about TBI and treatments vary among the respondents and all these components influence treatment-seeking behaviors. The findings provide a preliminary framework to further investigate the role of culture in reporting and seeking treatment behaviors among SMs.
The Advanced Modular Manikin Open Source Platform for Healthcare Simulation
Authors: Hananel David , Silverglate Dan , Burke Dan , Riggs Benjamin , Norfleet Jack , Sweet Robert M
Published: January 2021

Introduction

Current thinking in healthcare education stipulates a holistic approach with a focus on patient management, bringing together technical skills, decision-making, and team performance. In parallel, training opportunities with actual patients have diminished, and the number of different interventions to master has increased. Training on simulators has become broadly accepted; however, requirements for such training devices have outpaced the development of new simulators. The Department of Defense (DoD) targeted this gap with a development challenge. This article introduces the Advanced Modular Manikin (AMM) platform and describes the path followed to address the challenge.

Materials and Methods

Under Contract # W81XWH-14-C-0101, our interdisciplinary team of healthcare providers, educators, engineers, and scientists, together with partners in industry and the government collaborated to establish a set of comprehensive requirements and develop an overarching system architecture and specifications to meet healthcare simulation needs. In order to instantiate the architecture and investigate usability of the platform, a demonstration modular manikin was created that incorporated physical and digital peripherals.

Results

The system architecture and corresponding data models have been completed and published as open source. A developer’s tool kit has been created, including instructional materials and required hardware and software for interested parties to develop AMM-compatible modules. A reference manikin was created based on the platform specifications and successfully supported a usability study that was performed by the American College of Surgeons, Education Division at the Naval Medical Center San Diego.

Conclusions

The formal release of a functional modular, interoperable open-source healthcare simulation platform is complete. Next steps involve a strategy for maintaining the open standards and verification of AMM-compatibility for modules. Increasing awareness of this powerful tool and prioritization of module-development to address the wide range of healthcare education needs could lead to a renaissance in military and civilian healthcare simulation-based training.
An Analysis of the Effectiveness of High-level Disinfection for Surgical Instruments Used by Department of Defense Austere Surgical Teams
Authors: Hune Samantha R , DiGeorge Foushee Ann-Marie , Ervin Meredith C , Anderson Stephen J , Ervin Mark D , Mallory Amber M
Published: January 2021

Introduction

The purpose of this investigation was to evaluate the efficacy of currently employed commercial disinfectants in a simulated austere surgical environment similarly faced by ground surgical teams in forward deployed positions. Severe contamination of traumatic combat wounds along with limitations of operations in austere environments may result in available disinfectants providing inadequate surgical instrument decontamination.

Materials and Methods

The study consisted of nine experimental groups and two control groups evaluating hemostatic forceps found in kits of ground surgical teams. Hemostats were contaminated in a manner replicating the use in austere wartime surgery, cleaned by manual debridement and soaked in a disinfectant. Initially, instruments were debrided in one of three initial liquids (potable water, sterile water, or potable water with Envirocleanse A) and subsequently treated with one of three terminal disinfectants (Cidex OPA, CaviCide, or Neutral Disinfectant Cleaner). Treated hemostats were placed in sterile wire-closure bags for various storage times and tested for viable bacteria measured by colony-forming units.

Results

Our findings indicated that mechanical debridement in water, independent of Envirocleanse A, followed by soaking in any of the three terminal disinfectants achieved a marked reduction in recovered bacteria from hemostats regardless of storage length. Of the three disinfectants tested, Cidex OPA appeared to be the most robust in terms of decontamination, followed by CaviCide and Neutral Disinfectant Cleaner.

Conclusions

This study supports the conclusion that all evaluated disinfectants are capable of rapidly producing instruments with minimal bacterial contaminants when standard sterilization is unavailable. Therefore, when lifesaving surgical intervention must be performed in a deployed environment, austere surgical teams can confidently utilize either product with minimal risk of infection. However, of the disinfectants, Cidex OPA appears to be most effective in reducing bacterial contamination for both rapid and slow turnover of instrument usage, and thus, the disinfectants are recommended for application when sterilization is not available.
Carcinoma Ex-Pleomorphic Adenoma Diagnosis During Global Health Engagement Operations
Authors: Haltiner Caitlin C , Betz Sasha , Smith Jenny , Nelson Brenda , Ambrosio Art A
Published: January 2021

Introduction

In global health engagement settings, performance of oncologic surgery is evaluated by understanding the host nation healthcare capacity to include inpatient care support and the available postoperative adjunctive therapy to include chemotherapy and radiation therapy.

Materials and Methods

We present a case during Pacific Partnership 2018 of a patientwith a malignant facial mass diagnosed postoperatively. A literature review was conducted, searching specifically for cases related to pleomorphic adenoma (PA), carcinoma ex-PA, cases of misdiagnosis, and global health engagement operations.

Results

The patient presented without constitutional symptoms, clinical lymphadenopathy, or cranial nerve VII weakness with a preoperative host nation diagnosis of a benign salivary neoplasm (PA). Postoperatively, a gross total resection of the mass was diagnosed as high-grade adenocarcinoma—a carcinoma ex-PA of the parotid gland. Oncologic staging was noted to be advanced at T3N0, and the patient was referred back to the host nation surgeons for radiation oncology consultation and clinical surveillance to follow.

Discussion

Diagnosis of carcinoma ex-PA—a rare form of salivary gland malignancy—is not always straightforward because of its high degree of cellular heterogeneity, leading to inconsistencies in preoperative sampling results. This case addresses the preoperative diagnostic challenges associated with this type of malignancy, different types of possible treatment modalities aimed at reducing postoperative morbidity, and the preoperative and postoperative challenges that are critical to address during health engagement operations.
Enabling Technology for Remote Prosthetic Alignment Tuning
Authors: Boone David A , Chang Sarah R
Published: January 2021

Introduction

This research has resulted in a system of sensors and software for effectively adjusting prosthetic alignment with digital numeric control. We called this suite of technologies the Prosthesis Smart Alignment Tool (ProSAT) system.

Materials and Methods

The ProSAT system has three components: a prosthesis-embedded sensor, an alignment tool, and an Internet-connected alignment expert system application that utilizes machine learning to analyze prosthetic alignment. All components communicate via Bluetooth. Together, they provide for numerically controlled prosthesis alignment adjustment. The ProSAT components help diagnose and guide the correction of very subtle, difficult-to-see imbalances in dynamic gait. The sensor has been cross-validated against kinetic measurement in a gait laboratory, and bench testing was performed to validate the performance of the tool while adjusting a prosthetic socket based on machine learning analyses from the software application.

Results

The three-dimensional alignment of the prosthetic socket was measured pre- and postadjustment from two fiducial points marked on the anterior surface of the prosthetic socket. A coordinate measuring machine was used to derive an alignment angular offset from vertical for both conditions: pre- and postalignment conditions. Of interest is the difference in the angles between conditions. The ProSAT tool is only controlling the relative change made to the alignment, not an absolute position or orientation.

Target alignments were calculated by the machine learning algorithm in the ProSAT software, based on input of kinetic data samples representing the precondition and where a real prosthetic misalignment condition was known a priori. Detected misalignments were converted by the software to a corrective adjustment in the prosthesis alignment being tested. We demonstrated that a user could successfully and quickly achieve target postalignment change within an average of 0.1°.

Conclusions

The accuracy of a prototype ProSAT system has been validated for controlled alignment changes by a prosthetist. Refinement of the ergonomic form and technical function of the hardware and clinical usability of the mobile software application are currently being completed with benchtop experiments in advance of further human subject testing of alignment efficiency, accuracy, and user experience.