bluuebunny/crossref_metadata_2025 huggingface dataset:
Teaching vocabulary to young second- or foreign-language learners
Authors: Butler Yuko Goto
Published: March 2019

While vocabulary knowledge is considered a foundational element for young learners of a second or foreign language
(L2/FL), pedagogically useful information on this topic is not easily accessible for practitioners. This is in part due to the
fact that the relevant information is scattered across multiple fields, including first-language acquisition, child development,
and education. The aim of this paper is to synthesize recent knowledge from the related fields and to provide theoretically sound
and evidence-based information that is useful for teaching vocabulary to young learners of L2/FL. I identify four major
recommendations for vocabulary instruction: (a) ensure frequent and repeated exposure to the target words (as well as nontarget
words); (b) provide explicit word definitions and meanings in context; (c) create opportunities for discussions and interactions
around the words in question; and (d) use multimodal approaches to teach vocabulary. I also suggest future research directions,
with the goal of finding effective approaches that teachers can use to improve their vocabulary instruction while meeting the
specific needs of their young L2/FL students.
Working with parallel corpora
Authors: Rabadán Rosa
Published: March 2019

Although parallel corpora are vital for cross-linguistic and natural language processing (NLP) research, most have been designed for just one particular purpose, which may unnecessarily restrict their usefulness and usability. My argument is that the usefulness of existing parallel corpora increases exponentially when data so obtained are combined with those yielded by comparable and/or monolingual corpora. Usability criteria such as the choice of processing tools and adherence to international standards, among others, also have an impact on corpus usefulness. This chapter proposes courses of action that serve to improve the recycling and reprocessing of available resources. It also presents a corpus-based, post-editing and quality assessment application as an illustration of the multifarious uses parallel corpora may serve.
InterCorp
Authors: Čermák Petr
Published: March 2019

This chapter presents the current version of InterCorp, a parallel corpus created at the Faculty of Arts, Charles University in Prague. The corpus contains texts in Czech aligned with one or more foreign-language version(s), including Czech and 39 other languages. The chapter analyses its structure and technical parameters, and describes some technical tools used with the corpus (Kontext, a corpus query interface, and InterText, a parallel text alignment editor created specifically for the project). Similarly, the contribution discusses Treq (Translation Equivalents Database), a collection of bilingual Czech-foreign language dictionaries built automatically from InterCorp. In the last section of the chapter, the possibilities for methodological and linguistic exploitation of the corpus are discussed.
P-ACTRES 2.0
Authors: Sanjurjo-González Hugo , Izquierdo Marlén
Published: March 2019

This chapter describes an updated version of the ACTRES Parallel Corpus (P-ACTRES 2.0), an English-Spanish bidirectional corpus that contains over 4 million words. The composition of the corpus is recounted, regarding the number of words in each direction, and the types of texts included together with the linguistic variants that users will find in the corpus. Its composition is shaped by research purposes as well as availability issues. The computerization process is also explained, while commenting on the text processing, alignment and tagging. The chapter concludes with a brief demonstration of the usefulness and usability of P-ACTRES 2.0 in cross-linguistic research, be it contrastive linguistics or translation studies either independently or, most importantly, jointly.
Discovering bilingual collocations in parallel corpora
Authors: Garcia Marcos , García-Salido Marcos , Alonso-Ramos Margarita
Published: March 2019

This chapter presents a method that exploits parallel corpora to automatically extract bilingual collocation equivalents. First, we use dependency parsing and statistical measures to identify collocation candidates in corpora. Then, we leverage the parallel corpora to extract bilingual word-embeddings. Finally, we use these distributional models as probabilistic dictionaries in order to identify bilingual collocation equivalents. To evaluate our strategy we carry out a set of experiments in Portuguese and Spanish focusing on verb-object collocations, for example, “reach the maturity” (“atingir a maturidade” in Portuguese, “alcanzar la madurez” in Spanish). The results of our experiments show that this method is useful to automatically identify thousands of bilingual collocation equivalents, achieving a precision of 86%.
Agent-backgrounding in Turkish Sign Language (TİD)
Authors: Kelepir Meltem , Özkul Aslı , Özparlak Elvan Tamyürek
Published: March 2019

This paper investigates agent-backgrounding constructions in Turkish Sign Language (TİD). TİD displays many of the
agent-backgrounding strategies reported in the literature that signed (and spoken) languages employ (Barberà & Cabredo Hofherr, this volume). Use of non-specific indefinite pronominals is a major
strategy, and this paper is the first study that identifies these forms in TİD. Moreover, we show that TİD has ways of marking
clusivity distinctions of indefinite arguments, and has a special sign that derives exclusive indefinite pronominals,
other. We argue that (i) whereas lateral-high R-locus is unambiguously associated with non-specificity, non-high
(lateral and central) loci are underspecified in terms of specificity; (ii) the R-locus of indefinite arguments observed in
agent-backgrounding contexts in TİD consists of two spatial features [+high] and [+lateral] which express non-specificity and
exclusivity. This study further shows that clusivity, usually associated with personal pronouns, must be extended to indefinite
pronouns.
Longitudinal Changes in Spirometry in South African Adolescents Perinatally Infected With Human Immunodeficiency Virus Who Are Receiving Antiretroviral Therapy
Authors: Githinji Leah N , Gray Diane M , Hlengwa Sipho , Myer Landon , Machemedze Takwanisa , Zar Heather J
Published: March 2019

Background

Despite increased access to highly active antiretroviral therapy (HAART), lung disease remains common in human immunodeficiency virus (HIV)–infected (HIV+) adolescents. There is limited information on changes in lung function over time in perinatally HIV+ adolescents on HAART. The objective was to investigate the progression of spirometry findings over 2 years in HIV+ adolescents on HAART in a prospective cohort, the Cape Town Adolescent Antiretroviral Cohort (CTAAC).

Methods

HIV+ adolescents aged 9–14 years, with at least 6 months of HAART, and a comparator group of healthy HIV-uninfected (HIV–), age-matched controls were enrolled in CTAAC. Spirometry and bronchodilator testing were done at baseline, 12 months, and 24 months. Mixed-effect models were used to compute longitudinal changes in lung function.

Results

Five hundred fifteen HIV+ adolescents, mean age 12 (standard deviation [SD], 1.6) years, 50.4% male, and 110 HIV– adolescents, mean age 11.8 (SD, 1.8) years, 45.6% male, were tested at baseline; 477 (93%) HIV+ and 102 (93%) HIV– adolescents at 12 months; and 473 (92%) HIV+ and 97 (88%) HIV– adolescents at 24 months. Only 5.4% of the HIV+ adolescents had HIV viral load >10 000 copies/mL at baseline. Forced expiratory volume in 1 second (FEV1) and forced vital capacity (FVC) were lower in the HIV+ compared to the HIV– adolescents and tracked with no deterioration or catch-up over 2 years. Previous pulmonary tuberculosis (PTB) or lower respiratory tract infection (LRTI) was significantly associated with reduced FEV1 and FVC (P < .05 for both).

Conclusions

HIV+ adolescents had lower lung function over 2 years than HIV– adolescents. This study highlights the need for lung function surveillance and prevention of LRTIs and PTB in HIV+ adolescents.
The Impact of Human Immunodeficiency Virus Infection on Gut Microbiota α-Diversity: An Individual-level Meta-analysis
Authors: Tuddenham Susan A , Koay Wei Li A , Zhao Ni , White James R , Ghanem Khalil G , Sears Cynthia L ,   HIV Microbiome Re-analysis Consortium, Dillon Stephanie , Wilson Cara , Lozupone Catherine , Ward Honorine , Wanke Christine , Dubourg Gregory , Raoult Didier , Palmer Brent , Monaco Cynthia , Kwon Douglas , Mutlu Ece , Landay Alan , Paredes Roger , Noguera-Julian Marc , Sönnerborg Anders , Neogi Ujjwal , Nowak Rebecca , Ravel Jacques , Pérez-Santiago Josué , Smith Davey M , Pinto-Cardoso Sandra , Reyes-Terán Gustavo , Serrano-Villar Sergio , Gosalbes Soler Maria Jose , Vesterbacka Jan , Nowak Piotr , Pérez-Matute P , Oteo José A , D’Auria Giuseppe , Villar-García Judit , Yu Guoqin , Goedert James J
Published: March 2019

Background

Whether human immunodeficiency virus (HIV) infection impacts gut microbial α-diversity is controversial. We reanalyzed raw 16S ribosomal RNA (rRNA) gene sequences and metadata from published studies to examine α-diversity measures between HIV-uninfected (HIV–) and HIV-infected (HIV+) individuals.

Methods

We conducted a systematic review and individual level meta-analysis by searching Embase, Medline, and Scopus for original research studies (inception to 31 December 2017). Included studies reported 16S rRNA gene sequences of fecal samples from HIV+ patients. Raw sequence reads and metadata were obtained from public databases or from study authors. Raw reads were processed through standardized pipelines with use of a high-resolution taxonomic classifier. The χ2 test, paired t tests, and generalized linear mixed models were used to relate α-diversity measures and clinical metadata.

Results

Twenty-two studies were identified with 17 datasets available for analysis, yielding 1032 samples (311 HIV–, 721 HIV+). HIV status was associated with a decrease in measures of α-diversity (P < .001). However, in stratified analysis, HIV status was associated with decreased α-diversity only in women and in men who have sex with women (MSW) but not in men who have sex with men (MSM). In analyses limited to women and MSW, controlling for HIV status, women displayed increased α-diversity compared with MSW.

Conclusions

Our study suggests that HIV status, sexual risk category, and gender impact gut microbial community α-diversity. Future studies should consider MSM status in gut microbiome analyses.
How Truly Conserved Is the “Well-Conserved” Vertebrate Stress Response?
Authors: Romero L M , Gormally B M G
Published: March 2019

The vertebrate stress response is considered to be a highly conserved suite of responses that are evolved to help animals survive noxious environmental stimuli. The two major pathways of the stress response include the catecholamine release that is part of the autonomic nervous system and comprises the immediate fight-or-flight response, and the slower release of corticosteroids from the hypothalamic–pituitary–adrenal axis that help orchestrate longer-term responses. These two pathways are present in every vertebrate yet examined, and the anatomical and physiological architecture underlying these pathways are consistent. Despite these structural similarities, however, recent data indicate substantial temporal and species variation in the actual regulation of these pathways. For example, activation of both pathways varies seasonally in some species but not others, and responses of both pathways can be extensively modulated by an individual’s previous experience. Consequently, even though the anatomy of the stress response is highly conserved, the activation and functional output is not highly conserved. Given this variation, it is perhaps not surprising that it is proving difficult to correlate individual stress responses with differences in fitness outcomes. This review summarizes the challenge of making broad generalized assumptions about fitness consequences of the stress response given the functional variation we observe.
A Highly Immunogenic, Protective, and Safe Adenovirus-Based Vaccine Expressing Middle East Respiratory Syndrome Coronavirus S1-CD40L Fusion Protein in a Transgenic Human Dipeptidyl Peptidase 4 Mouse Model
Authors: Hashem Anwar M , Algaissi Abdullah , Agrawal Anurodh Shankar , Al-amri Sawsan S , Alhabbab Rowa Y , Sohrab Sayed S , S. Almasoud Abdulrahman , Alharbi Naif Khalaf , Peng Bi-Hung , Russell Marsha , Li Xuguang , Tseng Chien-Te K
Published: March 2019

Background

Infection control measures have played a major role in limiting human/camel-to-human transmission of Middle East respiratory syndrome coronavirus (MERS-CoV); however, development of effective and safe human or camel vaccines is warranted.

Methods

We extended and optimized our previous recombinant adenovirus 5 (rAd5)–based vaccine platform characterized by in vivo amplified and CD40-mediated specific responses to generate MERS-CoV S1 subunit-based vaccine. We generated rAd5 constructs expressing CD40-targeted S1 fusion protein (rAd5-S1/F/CD40L), untargeted S1 (rAd5-S1), and Green Fluorescent Protein (rAd5-GFP), and evaluated their efficacy and safety in human dipeptidyl peptidase 4 transgenic (hDPP4 Tg+) mice.

Results

Immunization of hDPP4 Tg+ mice with a single dose of rAd5-S1/F/CD40L elicited as robust and significant specific immunoglobulin G and neutralizing antibodies as those induced with 2 doses of rAd5-S1. After MERS-CoV challenge, both vaccines conferred complete protection against morbidity and mortality, as evidenced by significantly undetectable/reduced pulmonary viral loads compared to the control group. However, rAd5-S1– but not rAd5-S1/F/CD40L–immunized mice exhibited marked pulmonary perivascular hemorrhage post–MERS-CoV challenge despite the observed protection.

Conclusions

Incorporation of CD40L into rAd5-based MERS-CoV S1 vaccine targeting molecule and molecular adjuvants not only enhances immunogenicity and efficacy but also prevents inadvertent pulmonary pathology after viral challenge, thereby offering a promising strategy to enhance safety and potency of vaccines.
Strong restrictions on the trait range of co-occurring species in the newly created riparian zone of the Three Gorges Reservoir Area, China
Authors: Zhang Aiying , Cornwell Will , Li Zhaojia , Xiong Gaoming , Fan Dayong , Xie Zongqiang
Published: March 2019

Aims

Community assembly links plant traits to particular environmental conditions. Numerous studies have adopted a trait-based approach to understand both community assembly processes and changes in plant functional traits along environmental gradients. In most cases these are long-established, natural or semi-natural environments. However, increasingly human activity has created, and continues to create, a range of new environmental conditions, and understanding community assembly in these ‘novel environments’ will be increasingly important.

Methods

Built in 2006, the Three Gorges Dam, largest hydraulic project in China, created a new riparian area of 384 km2, with massively altered hydrology. This large, newly created ecosystem is an ideal platform for understanding community assembly in a novel environment. We sampled environment variables and plant communities within 103 plots located in both the reservoir riparian zone (RRZ) and adjacent non-flooded and semi-natural upland (Upland) at the Three Gorges Reservoir Area. We measured six traits from 168 plant species in order to calculate community-level distribution of trait values. We expected that the altered hydrology in RRZ would have a profound effect on the community assembly process for the local plants.

Important Findings

Consistent with previous work on community assembly, the distribution of trait values (range, variance, kurtosis and the standard deviation of the distribution neighbor distances) within all plots was significantly lower than those from random distributions, indicating that both habitat filtering and limiting similarity simultaneously shaped the distributions of traits and the assembly of plant communities. Considering the newly created RRZ relative to nearby sites, community assembly was different in two main ways. First, there was a large shift in the mean trait values. Compared to Upland communities, plant communities in the RRZ had higher mean specific leaf area (SLA), higher nitrogen per unit leaf mass (Nmass), and lower maximum height (MH). Second, in the RRZ compared to the Upland, for the percentage of individual plots whose characteristic of trait values was lower than null distributions, the reductions in the community-level range for SLA, Nmass, nitrogen per unit leaf area (Narea) and phosphorus per unit leaf area (Parea) were much larger, suggesting that the habitat filter in this newly created riparian zone was much stronger compared to longer established semi-natural upland vegetation. This stronger filter, and the restriction to a subset of plants with very similar trait values, has implications for predicting riparian ecosystems’ responses to the hydrological alterations and further understanding for human’s effect on plant diversity and plant floras.
The Hebrew Translations of Euclid's Elements By Moses IBN Tibbon and by Jacob Ben Makhir–A Study of Differences in Book I
Authors: Elior Ofer
Published: March 2019

This study investigates differences between the Hebrew translation of Euclid's Elements made by Moses Ibn Tibbon and completed in 1270, and the Hebrew translation of the same work produced by Ibn Tibbon's nephew, Jacob ben Makhir, and completed in 1289. Focusing on Book I, the study shows that these differences extend to technical terms and make Ben Makhir's translation more accurate and more nuanced than Ibn Tibbon's. The greater accuracy of Ben Makhir's translation pertains also to his Hebrew formulations. Furthermore, apparent in his formulations is an attempt to make the Hebrew Elements more concise than the Arabic. On the basis of these findings, it is argued that Ben Makhir's translation is a reworking of Ibn Tibbon's, made with the aim of making the latter more succinct as well as more precise. A critical edition and an English translation of Ben Makhir's preface to his translation are presented in the Appendix.
The Israeli Defense Forces Point of Injury Antimicrobial Treatment Protocol – A New Protocol and Review of the Literature
Authors: Glick Yuval , Furer Ariel , Glick Karina , Yitzhak Avraham , Brosh Tal
Published: March 2019

Introduction

Combat wound infection is a common and serious complication, leading to significant morbidity and mortality. In 2005, a point of injury antimicrobial protocol was published by the Israel Defense Forces, in which Moxifloxacin was chosen. During 2016–2017, a revision of this protocol was performed and concluded with the publication of an updated protocol. The purpose of this report is to present this process and the revised protocol, together with a review of the literature.

Methods

We searched “Medline” and “Google Scholar” for studies dealing with antimicrobial prophylaxis in trauma, for militaries’ point of injury antimicrobial protocol protocols and for established surgical antimicrobial prophylaxis protocols.

Results

Point of injury antimicrobial protocol is aimed at preventing early infection and its complications. The choice of Moxifloxacin for this purpose may not be optimal since Moxifloxacin spectrum might be overly broad, there is scant evidence supporting it for this indication, and the available preparation does not meet distinctive technical requirements. Contrarily, Ceftriaxone seemed to have suitable microbiological, pharmacological and technical features.

Conclusion

Point of injury antimicrobial protocol should be used especially when evacuation and definitive surgical treatment are delayed. According to present scientific data and operational needs, Ceftriaxone was chosen for most penetrating injuries, with Metronidazole addition for penetrating abdominal and cranial trauma.
Army Body Composition Program Study Results Concerning: Enrollees Are More Over Fat Than Expected
Authors: Meyer Stephanie , Cole Renee
Published: March 2019

Introduction

Whether implementation of the Army Body Composition Program (ABCP) is meeting readiness objectives is unknown.

Objective

This study sought to primarily describe the extent of Active Duty Soldiers’ over-fatness when attending the initial ABCP nutrition class at an Army Nutrition clinic in Washington State; and secondarily to describe the proportion of these Soldiers meeting metabolic syndrome (MS) criteria.

Methods

Soldiers (189) in this cross-sectional study completed the following: a questionnaire developed for this study, anthropometric measurements, body fat assessment via AR 600–9 standards, and a laboratory blood draw for fasting glucose and lipid panel.

Results

Soldiers were predominantly male (76%), obese (BMI 32 kg/m2 for males and 30 kg/m2 for females), exceeded body fat standards by 3.8% for males and 7.3% for females, and 16% had three or more risk factors meeting MS diagnostic criteria. Waist circumference was the predominant MS risk factor for males and females.

Conclusion

Soldiers in this study had higher body fat percentages than expected with a majority of Soldiers classified as obese. Achieving and maintaining ABCP standards may be more challenging for obese Soldiers. To maintain Soldier readiness, commanders should consider intervening earlier when signs of weight gain are observed.
Percutaneous Peripheral Nerve Stimulation for Pain Reduction and Improvements in Functional Outcomes in Chronic Low Back Pain
Authors: Cohen Steven , Gilmore Christopher , Kapural Leonardo , Hanling Steven , Plunkett Anthony , McGee Meredith , Boggs Joseph
Published: March 2019

Chronic low back pain represents one of the most common sources of disability and a significant healthcare burden for the U.S. military. Present treatments for chronic back pain are often ineffective, poorly tolerated, invasive, destructive, and/or associated with complications and lead to the progression to invasive surgical procedures. There have been multiple calls for the development of a minimally invasive system that is effective without the risks or complications of existing surgical therapies, which could prevent the need for surgery and the recurrence of pain. The goal of this study was to evaluate a novel, minimally invasive approach using a percutaneous peripheral nerve stimulation (PNS) system designed to provide pain relief without surgery, to reduce complications, and provide a less-invasive treatment option. In nine subjects, percutaneous PNS improved participants’ function, as evidenced by clinically and statistically significant reductions in pain, disability, and pain interference. Subjects also experienced reductions in opioid and non-opioid analgesic medication usage and reported improvements in quality of life with treatment. There were no serious or unanticipated adverse events. These results demonstrate the potential of percutaneous PNS as a non-surgical therapy to treat chronic back pain without opioids.
Self-Reported Sleep, Anxiety, and Cognitive Performance in a Sample of U.S. Military Active Duty and Veterans
Authors: Rice Valerie J B , Schroeder Paul J
Published: March 2019

Unhealthy sleep can interfere with U.S. military service members affective and cognitive functioning, and increase accident and injury risks. This study examined the relationship between U.S. active duty and veterans’ (n = 233) self-reported sleep (Pittsburgh Sleep Quality Index), anxiety (Zung Self-Rating Anxiety Scale), and cognitive performance (Automated Neuropsychological Assessment Metric). Statistical analyses included Pearson product moment correlations and multivariate analysis of variance, with Tukey-b post-hoc tests, with a p < 0.05 significance level. Higher education, abstinence from sleep aids, longer time in active duty service, and being on active duty were correlated with better sleep and lower anxiety. Greater sleep disturbance, poor sleep quality, and sleepiness-related daytime dysfunction were associated with greater anxiety and slower response times, and lower response accuracy. Statistically controlling for anxiety diminished the magnitude and significance of the correlations between sleep and cognitive performance, suggesting that reducing anxiety will improve sleep and diminish cognitive performance effects. These findings suggest the need for addressing both sleep and anxiety for those with diagnosed sleep disorders, as well as using a procedural systems approach to decrease anxiety during missions that demand outstanding cognitive performance.
Pilot Study of a Novel Swine Model for Controlling Junctional Hemorrhage Using the iTClamp in Conjunction With Hemostatic Agents
Authors: Stuart Sean M , Zarow Gregory , Walchak Alexandra , McLean Julie , Roszko Paul
Published: March 2019

Exsanguinating hemorrhage is a primary cause of battlefield death. The iTClamp is a relatively new device (FDA approval in 2013) that takes a different approach to hemorrhage control by applying mechanism wound closure. However, no previous studies have explored the feasibility of utilizing the iTClamp in conjunction with hemostatic packing. To fill this important gap in the literature, a novel swine model was developed, and a total of 12 trials were performed using QuikClot Combat Gauze or XSTAT sponges in conjunction with the iTClamp to treat arterial injuries through 5 cm or 10 cm skin incisions in the groin, axilla, or neck. First-attempt application success rate, application time, and blood loss were recorded. Hemostasis was achieved on all wounds, though reapplication was required in one Combat Gauze and three XSTAT applications. Application averaged ~50% slower for Combat Gauze (M = 41 seconds, 95%CI: 22–32 seconds) than for XSTAT (M = 27 seconds, 95%CI: 35–47 seconds). XSTAT application was faster than Combat Gauze for each wound location and size. The 10 cm wounds took ~10 seconds (36%) longer to close (M = 27 seconds, 95%CI: 35–47 seconds) than the 5 cm wounds (M = 27 seconds, 95%CI: 35–47 seconds). Blood loss was similar for Combat Gauze (M = 51 mL, 95%CI: 25–76 mL) and XSTAT (M = 60 mL, 95%CI: 30–90 mL). Blood loss was roughly twice as great for 10 cm wounds (M = 73 mL, 95%CI: 47–100 mL) than for 5 cm wounds (M = 38 mL, 95%CI: 18–57 mL). This pilot study supports the feasibility of a novel model for testing the iTClamp in conjunction with hemostatic packing towards controlling junctional hemorrhage.
Mass Properties Comparison of Dismounted and Ground-Mounted Head-Supported Mass Configurations to Existing Performance and Acute Injury Risk Guidelines
Authors: Estep Patrick N , Bonts Emily G , Shivers Bethany L , Wurzbach John M , Novotny Brian L , Rybarczyk Kyle , Chancey Valeta Carol
Published: March 2019

In order to limit the aviator’s exposure to potentially unsafe helmet configurations, the U.S. Army Aeromedical Research Laboratory (USAARL) developed the USAARL Head-supported mass (HSM) Performance Curve and Acute Injury Risk Curve as guidelines for Army aviation HSM. These Curves remain the only established guidelines for Army HSM, but have limited applicability outside of the aviation environment. Helmet developers and program managers have requested guidelines be developed for the dismounted, ground-mounted, and airborne operating environments that consider currently fielded and proposed HSM configurations. The aim of this project was to measure mass properties (mass and center of mass offset) of currently fielded and proposed HSM configurations and compare them against the existing USAARL HSM Curve guidelines. Mass properties were collected for 71 unique dismounted and ground-mounted HSM configurations. None of the 71 HSM configurations met the Acute Injury Risk Curve recommendations, and only 11 of the 71 configurations met Performance Curve recommendations. While some helmets fell within acceptable limits, the addition of night vision goggles and protective masks pushed all configurations outside of the recommended guidelines. Future guidelines will need to be expanded to consider the operating environment, movement techniques, and primary mechanism of injury.
An Association Between Herpes Zoster Vaccination and Stroke Reduction Among Elderly Individuals
Authors: Klaric John S , Beltran Thomas A , McClenathan Bruce M
Published: March 2019

Herpes zoster (HZ, shingles) affects individuals (60+ years) by reactivation of varicella virus from primary infection. Approximately one-third of the general population will develop HZ and are at increased risk of stroke. Our objective was describing possible associations between self-reported HZ vaccination and stroke with the Centers for Disease Control and Prevention’s Behavioral Risk Factors Surveillance System, a cross-sectional nationwide telephone survey. Non-institutionalized U.S. adults answered items concerning health risk behaviors. 2014 survey data were from 265,568 adults 50–79 years old. Multivariable Cox regressions adjusted for standard demographics, body mass index, and coronary heart disease showed that HZ-vaccinated individuals had lower risk of reporting stroke those not vaccinated (hazard ratio [HR] = 1.73). After stratification of participants into six 5-year age groups, adjusted weighted binary logistic regressions were conducted for each age group with stroke as outcome. The HZ-vaccinated group aged 65–69 years reported stroke approximately 50% less than those unvaccinated (adjusted Odds Ratio [aOR] = 1.51; 99% confidence interval [CI]:1.21,1.88). Secondary analyses indicated that this benefit was among HZ-vaccinated whites (aOR = 1.6, 95%CI:1.4,2.0), but not African Americans or Hispanics. These possible protective effects are not detected 10 years after recommended vaccine uptake. Limitations include not following participants longitudinally and that time between stroke and vaccination could not be determined.
Biomechanics of Blast TBI With Time-Resolved Consecutive Primary, Secondary, and Tertiary Loads
Authors: Przekwas Andrzej , Garimella Harsha T , Tan X Gary , Chen Z J , Miao Yuyang , Harrand Vincent , Kraft Reuben H , Gupta Raj K
Published: March 2019

Blast-induced traumatic brain injury (bTBI) has become a signature casualty of recent military operations. In spite of significant clinical and preclinical TBI research, current understanding of injury mechanisms and short- and long-term outcomes is limited. Mathematical models of bTBI biomechanics may help in better understanding of injury mechanisms and in the development of improved neuroprotective strategies. Until present, bTBI has been analyzed as a single event of a blast pressure wave propagating through the brain. In many bTBI events, the loads on the body and the head are spatially and temporarily distributed, involving the primary intracranial pressure wave, followed by the head rotation and then by head impact on the ground. In such cases, the brain microstructures may experience time/space distributed (consecutive) damage and recovery events. The paper presents a novel multiscale simulation framework that couples the body/brain scale biomechanics with micro-scale mechanobiology to study the effects of micro-damage to neuro-axonal structures. Our results show that the micro-mechanical responses of neuro-axonal structures occur sequentially in time with “damage” and “relaxation” periods in different parts of the brain. A new integrated computational framework is described coupling the brain-scale biomechanics with micro-mechanical damage to axonal and synaptic structures.
Perceptions and Response to Conservative Treatment of Low Back Pain in Soldiers During Initial Entry Training: A Convergence Mixed Methods Study
Authors: Schoonover Cortney M , Turner Stephen L , Woods Yvette , Smith-Forbes Enrique , Rhon Daniel I
Published: March 2019

Low back pain (LBP) is a common condition suffered by military personnel. Psychosocial factors play a role in LBP prognosis and can be addressed with self-management tools. This study’s purpose was to (1) describe clinical changes in psychosocial factors of LBP following a self-management intervention and (2) explore the LBP experience of military trainees. Ten participants in Initial Entry Training (IET) were included in this mixed methods study. A self-management intervention of exercises and psychosocial education was provided. Quantitative instruments assessing psychosocial factors were delivered at baseline and 6 weeks. Qualitative data were gathered after treatment and analyzed using a phenomenological approach. Low levels of psychosocial risk factors were reported. Patient satisfaction (COPM-Satisfaction subscale) was the only outcome that achieved statistical significance at 6 weeks (p = 0.037). Three themes emerged from the qualitative results: the influence of the military culture on recovery from LBP, the LBP experience of a trainee, and promoting the self-management of LBP. While this cohort of IET soldiers exhibited low levels of psychosocial risk factors, qualitative reports indicate that LBP has a negative impact on participation in training, academics, and interpersonal relationships. The constraints of military training make seeking care and applying treatment strategies challenging.
IV DripAssist: An Innovative Way to Monitor Intravenous Infusions Away From an Outlet?
Authors: Couperus Kyle , Kmiecik Karl , Kang Christopher
Published: March 2019

Intravenous (IV) administration of fluids and medications are a significant part of patient treatment. In austere environments, typical methods of counting drops from gravity drips or infusion pumps both have limitations such as accuracy, weight, and need for power. The DripAssist device calculates drip rates by counting drops in IV tubing drip chambers and may provide a useful patient safety monitor adjunct. The protocol was IRB approved, prospective, and designed as a pilot study involving 28 Madigan Army Medical Center Emergency Department personnel. After a brief didactic introduction to the device for clinical staff with no prior experience using the device, participants were timed setting three normal saline infusions at rates of 250 mL/h, 125 mL/h and 83 mL/h with 15gtt/mL tubing. Participants filled out a survey on perceived ease of use and utility of the device compared to pumps and manual counting. Most participants felt the DripAssist device was easy to understand and set up, but nurses and physician assistants were more likely than medics to perceive a benefit versus IV pumps or gravity drips. The DripAssist device may offer a safe, low-weight, functional tool which could improve care in a variety of resource-limited environments. However, additional studies using the device during actual field exercises would be beneficial.
Evaluation of the Commercial, Off-the-Shelf (COTS) King-Devick Eye Tracking System
Authors: Onge Paul St , Temme Leonard A , McAtee Aaron , O’Brien Kevin J , Byrd Brigid K
Published: March 2019

Concussion biomarkers are important guides for diagnosis and return-to-duty decisions. Recent literature describes the King-Devick (KD) test as a sensitive sports-related concussion screener. This test involves timing an individual reading aloud 120 digits printed on three test cards. The test is commonly considered to evaluate the effects of concussion and other factors on reading-related eye movements (EMs). However, the extent to which the KD test reflects EMs remains a matter of conjecture since the test reports only reading speed and number of errors. An off-the-shelf, computerized KD with eye tracking system recently became commercially available. Two early model KD with eye tracking systems were purchased in 2015 and evaluated before deploying them for research. The evaluation consisted of two studies; one with 20 volunteers assessing the comparability of the two systems and the other with 5 volunteers to quantify the systems’ stability and repeatability over 5 successive days. The results showed that several of the systems’ reported EM response parameters lacked face validity; consequently, the systems could not be used for scientific research. This conclusion emphasizes the importance of systematic test and evaluation of new equipment before it is used for research.
A Reusable Perfused Human Cadaver Model for Surgical Training: An Initial Proof of Concept Study
Authors: Held Jenny M , McLendon Robert B , McEvoy Christian S , Polk Travis M
Published: March 2019

Objectives

Today’s surgical trainees have less exposure to open vascular and trauma procedures. Lightly embalmed cadavers may allow a reusable model that maximizes resources and allows for repeat surgical training over time.

Methods

This was a three-phased study that was conducted over several months. Segments of soft-embalmed cadaver vessels were harvested and perfused with tap water. To test durability, vessels were clamped, then an incision was made and repaired with 5-0 polypropylene. Tolerance to suturing and clamping was graded. In a second phase, both an arterial-synthetic graft and an arterial-venous anastomosis were performed and tested at 90 mmHg perfusion. In the final phase, lower extremity regional perfusion was performed and vascular control of a simulated injury was achieved.

Results

Seven arteries and six veins from four cadavers were explanted. All vessels accommodated suture repair over 6 weeks. There was minor leaking at all previous clamp sites. In the anastomotic phase, vessels tolerated grafting, clamping, and perfusion without tearing or leaking. Regional perfusion provided a life-like training scenario.

Conclusions

Explanted vessels of soft-embalmed cadavers show adequate durability over time with realistic vascular surgery handling characteristics. This shows promise as initial proof of concept for a reusable perfused cadaver model. Further study with serial regional and whole-body perfusion is warranted.
Applications of Future Technologies to Detect Skill Decay and Improve Procedural Performance
Authors: Linde Amber S , Miller Geoffrey T
Published: March 2019

Medical simulation training has progressed in its use of incorporating various technologies to provide quality training interfaces from novices to experts. The purpose of this paper is to explore modeling, simulation and visualization training technology interfaces to improve precision learning, rigorous, objective assessment, and performance improvement feedback for clinical procedural skill training and sustainment. Technologies to include augmented reality (AR), haptic technology and computer vision will be defined and clarified. It is believed that by exploring the combination of using AR, haptics and computer vision technologies it is possible to develop a fully immersive learning system that can automate mentoring while detecting and measuring gross and fine motor skills. Such a system can be used to predict or delay the onset of skills decay (SD) by capturing rigorous, objective measures, and human performance metrics that can provide feedback to individual performers for skills improvement in real time.
Enhanced Survival in Mice Exposed to Ionizing Radiation by Combination of Gamma-Tocotrienol and Simvastatin
Authors: Pathak Rupak , Kumar Vidya Prasanna , Hauer-Jensen Martin , Ghosh Sanchita Purohit
Published: March 2019

Ionizing radiation exposure is a major concern for active military service members, as well as civilian population. Considering that the exposure is not predictable, it is imperative that strategies to counteract radiation damage must be discovered. Recent in vitro studies performed in our laboratory demonstrated that the vitamin E analog gamma-tocotrienol (GT3) in combination with cholesterol-lowering drugs (Statins), synergistically induced endothelial thrombomodulin, an anticoagulant with radio-protective efficacy. It was hypothesized that the combination of treatment with both GT3 along with Statins would provide better radiation protection in vivo than each drug individually. CD2F1 mice were injected subcutaneously with either vehicle or single dose of GT3 (200 mg/kg body weight) 24 hours before irradiation followed by oral or subcutaneous administration of various doses of simvastatin (25, 50, and 100 mg/kg body weight) before exposure to lethal doses (11.5 and 12 Gy) of Cobalt-60 (60Co) gamma-irradiation. The combined treatment group exhibited enhanced radiation lethality protection substantially, accelerated white blood cell recovery, and augmented restoration of bone marrow cellularity when compared to the animals treated with either drug exclusively. This information clearly suggests that combined treatment could be used as a safeguard for military personnel from exposure to harmful ionizing radiation.
Predictive Power of Head Impact Intensity Measures for Recognition Memory Performance
Authors: Leeds Daniel D , D’Lauro Christopher , Johnson Brian R
Published: March 2019

Subconcussive head injuries are connected to both short-term cognitive changes and long-term neurodegeneration. Further study is required to understand what types of subconcussive impacts might prove detrimental to cognition. We studied cadets at the US Air Force Academy engaged in boxing and physical development, measuring head impact motions during exercise with accelerometers. These head impact measures were compared with post-exercise memory performance. Investigators explored multiple techniques for characterizing the magnitude of head impacts. Boxers received more head impacts and achieved lower performance in post-exercise memory than non-boxers. For several measures of impact motion, impact intensity appeared to set an upper bound on post-exercise memory performance – stronger impacts led to lower expected memory performance. This trend was most significant when impact intensity was measured through a novel technique, applying principal component analysis to boxer motion. Principal component analysis measures also captured more distinct impact information than seven traditional impact measures also tested.
Natural History and Management of Incidentally Discovered Focal Brain Lesions Indeterminate for Tumor in Children
Authors: Zaazoue Mohamed A , Manley Peter E , Kapur Kush , Ullrich Nicole J , Silvera V Michelle , Goumnerova Liliana C
Published: March 2019

BACKGROUND

The incidental discovery of brain lesions in children has increased due to greater utilization of neuroimaging. Standardized surveillance and management guidelines following the discovery of such lesions remain nonexistent.

OBJECTIVE

To study the natural history and management of incidental brain lesions in children.

METHODS

A retrospective analysis of pediatric patients who were treated at our institution between 2000 and 2016 with incidentally detected brain lesions that were indeterminate for neoplasm on MRI.

RESULTS

We identified 445 patients with incidental brain abnormalities of whom 144 had lesions indeterminate for neoplasm. Average age at diagnosis was 11.2 (SD = 4.14) yr and average follow-up was 3.8 yr (range 1-13.2 yr). Lesions showed no progression in 112 patients (77.8%), whereas progression was detected in 31 patients (21.5%). Mean time to progression was 32.3 months (SD = 24.4). A change in management was made in 13/144 patients (9%), which included surgical resection (n = 11), biopsy (n = 1), and lumbar puncture (n = 1). Lesion size, location, multiplicity, new-onset symptoms, associated contrast enhancement, or edema were not predictive of radiologic progression. Larger lesions and those with contrast enhancement or edema were significantly more likely to undergo surgery (P < .001 each). Median geometric diameter of lesions that did not undergo surgery was 6.5 mm, whereas that of surgically resected lesions was 12.5 mm (P < .001).

CONCLUSION

Most incidental brain lesions indeterminate for neoplasm have an indolent, benign course. For asymptomatic patients with radiologically stable lesions, we recommend conservative management with MRI and clinical surveillance at 6, 12, 24, 36, and 60 mo after detection.
Non-severe eosinophilic granulomatosis with polyangiitis: long-term outcomes after remission-induction trial
Authors: Puéchal Xavier , Pagnoux Christian , Baron Gabriel , Lifermann François , Geffray Loïk , Quémeneur Thomas , Saraux Jean-Luc , Wislez Marie , Cottin Vincent , Ruivard Marc , Limal Nicolas , Aouba Achille , Bonnotte Bernard , Néel Antoine , Agard Christian , Cohen Pascal , Terrier Benjamin , Le Jeunne Claire , Mouthon Luc , Ravaud Philippe , Guillevin Loïc ,   French Vasculitis Study Group investigators, Holy Benahary , Florence Gény , Pascal Godmer , Cédric Landron , Jean Christophe Lega , Véronique Le Guern , Alfred Mahr , Arsène Mékinian , Denis Mulleman , Jean-Marc Naccache , Louis Olagne , Diallo Alpha Oumar , Sylvain Palat , Vincent Poindron , Alexis Régent , Virginie Rieu , Anne Marie Ruppert , Pascale Soria
Published: March 2019

Objective

In a previous controlled trial, 1-year adjunction of AZA to glucocorticoids (GC) for patients with non-severe, newly diagnosed eosinophilic granulomatosis with polyangiitis (EGPA) failed to lower remission failure, vasculitis relapse and isolated asthma/rhinosinus exacerbation rates, or cumulative GC use at month (M) 24. The aim of this study was to analyse longer-term outcomes to determine whether subsequent vasculitis relapse or isolated asthma/rhinosinus exacerbation (IARE) rates differed.

Methods

After M24, patients were followed prospectively, being treated based on physicians’ best judgment. Flares and reasons for increased GC dose or immunosuppressant use were recorded, and reviewed according to randomization group to distinguish vasculitis relapses from IAREs according to EGPA Task Force recommendations.

Results

Fifty EGPA trial participants were followed for a median (interquartile range) of 6.3 (5.4–7.6) years; two (4%) died 11 months post-inclusion. By M24, vasculitis had relapsed in 21/49 (43%) patients and 14/50 (28%) had IAREs. Another patient died 4.8 years post-inclusion (infection). Among nine patients with subsequent vasculitis relapses, three had a major relapse and three had their first relapse after M24; among 25 patients with later IAREs, 17 occurred after M24. At 5 years, respective vasculitis relapse and IARE rates were 48% (95% CI 34.0, 62.6) and 56% (95% CI 41.7, 70.8), with no between-arm differences (P = 0.32 and 0.13). No entry clinical or biological parameter was associated with these outcomes during follow-up.

Conclusion

These results confirmed that 1-year AZA and GC induction obtained good overall survival but no long-term benefit for non-severe EGPA patients. Vasculitis relapses, occurring mostly during the first 2 years, and IAREs, occurring throughout follow-up, require other preventive treatments.

Trial registration

ClinicalTrials.gov, https://clinicaltrials.gov, NCT00647166.