bluuebunny/crossref_metadata_2025 huggingface dataset:
Explosive death in direct and indirectly coupled oscillators: Review
Authors: Sharma Aashima , Sharma Amit
Published: November 2023

The transition in the dynamical behavior in the coupled system has several applications in science. The phase transitions of synchronization and oscillation suppression have both been thoroughly researched for a very long time. The second-order transition, which is continuous and reversible, is demonstrated by the standard results in the vast majority of cases in the coupled system. Recently, the first-order transitions reported in oscillation suppression have been reported in the complex network of the coupled oscillators through direct and indirect interaction. Explosive death is a transition that is not only abrupt but also irreversible in its parameters. We currently have a very good grasp of first order transition in oscillation death in networked systems and a variety of significant contributions and advancements have substantially improved it. Here, we aim to provide a review on the explosive death in various direct and indirect coupled oscillator scenarios while reviewing the previous findings.
Applicability of the equilibrium adsorption isotherms and the statistical tools on to them: a case study for the adsorption of fluoride onto Mg-Fe-CO3 LDH
Authors: Mahajan Tanuj , Paikaray Susanta , Mahajan Pooja
Published: November 2023

The demand for a low-cost, easy-to-use, low-maintenance system of adsorbents for detoxifying wastewater effluents is growing. A proper understanding of adsorption mechanisms, their controls, and adsorbate-adsorbent behavior is essential. Thus, the current study deals with the required understanding of linear equilibrium adsorption isotherm models. The adsorption data of different concentrations of fluoride onto Mg-Fe-CO3 LDH is fitted to isotherm models. The two-parameter models discussed are Langmuir, Freundlich, Temkin, and Dubinin-Radushkevich, whereas the three-parameter model cited is Redlich-Peterson. To identify the best-fitting model(s) in an equilibrium isotherm study to quantitatively represent the relevant sorption system, various error functions and statistical tools, such as average relative error deviation (ARED), sum of square errors (ERRSQ or SSE), hybrid relative error function (HYBRID), Marquardt’s percent standard error deviation (MPSD), sum of absolute errors (EABS), sum of normalized errors (SNE), correlation coefficient of Pearson (r), coefficient of determination (r2), chi-square test (χ2), student’s T-test and F-test were applied. It is found that the Temkin model best fits the isotherm data, and the sorption process occurs over multiple layers as per the Freundlich isotherm and was found to be more promising than Langmuir’s monolayer sorption process. The exothermic physisorption course for the adsorbate-absorbent interactions is deduced from the isotherm parameters.
Little evidence of avoided yield loss in US corn when short-term forecasts correctly predict extreme heat
Authors: Miller Steve J , Clarke Evelyn , Logan Mathews S
Published: November 2023

Successful agricultural adaptation to extreme heat has the potential to avert large crop losses and improve food security. Because adaptation is costly, accurate weather forecasts have the potential to improve targeting of adaptation efforts. To understand the role of short-term (1–7 day) forecasts in reducing heat-related yield loss, we analyze a novel dataset combining corn yields, short-term weather forecasts, and weather realizations in the United States from 2008 to 2021. We find no evidence that forecasts facilitate avoidance of heat-related yield losses on average, and only limited benefits when we allow for forecast benefits to vary with irrigation prevalence. While our results paint a pessimistic picture of in-season adaptation to heat, forecasts may be more valuable for other crops and regions, especially given continuing investment in adaptation technologies.
Characterization and process understanding of tropical cyclone-induced floods derived from observations in Shenzhen, China
Authors: Liu Jingru , Tian Zhan , Dobbie Steven , Ross Andrew N , Sun Laixiang , Ye Qinghua
Published: November 2023

Coastal cities like Shenzhen are confronting escalating flood risks under the combined impact of climate change and rapid urbanization, especially the tropical cyclones (TC)-induced flood. Incorporating the impact of climate change and urbanization on the flood, this study constructed a new TC-induced flood model on western Shenzhen embedded with a unique statistical approach. Based on extensive historical data and machine learning techniques, the temporal characteristics and changes of flooding were revealed. The results reveal an increase in the frequency of TC-induced floods between 1964–2022, especially after the 1990s, which is attributed to a decrease in the distance of the location of the maximum intensity of TCs (observed within an 800 km range of the study area) relative to the land, averaging a reduction of 11.4 km per decade. This shift towards land is likely due to changes in the locations of TC genesis. Furthermore, the ‘rainfall sea level’ threshold for western Shenzhen was accordingly derived from the results of modelling, which would enable decision-makers to quickly assess TC-induced flood risks. The study’s proposed methods offer alternative approaches for predicting TC-induced floods in regions where the gathering of hydro-meteorological data is challenging or where economic and technological resources are limited.
Estimating blurless and noise-free Ir-192 source images from gamma camera images for high-dose-rate brachytherapy using a deep-learning approach
Authors: Nakanishi Kohei , Yamamoto Seiichi , Yabe Takuya , Yogo Katsunori , Noguchi Yumiko , Okudaira Kuniyasu , Kawachi Naoki , Kataoka Jun
Published: November 2023

Objective. Precise monitoring of the position and dwell time of iridium-192 (Ir-192) during high-dose-rate (HDR) brachytherapy is crucial to avoid serious damage to normal tissues. Source imaging using a compact gamma camera is a potential approach for monitoring. However, images from the gamma camera are affected by blurring and statistical noise, which impact the accuracy of source position monitoring. This study aimed to develop a deep-learning approach for estimating ideal source images that reduce the effect of blurring and statistical noise from experimental images captured using a compact gamma camera. Approach. A double pix2pix model was trained using the simulated gamma camera images of an Ir-192 source. The first model was responsible for denoising the Ir-192 images, whereas the second model performed super resolution. Trained models were then applied to the experimental images to estimate the ideal images. Main results. At a distance of 100 mm between the compact gamma camera and the Ir-192 source, the difference in full width at half maximum (FWHM) between the estimated and actual source sizes was approximately 0.5 mm for a measurement time of 1.5 s. This difference has been improved from approximately 2.7 mm without the use of DL. Even with a measurement time of 0.1 s, the ideal images could be estimated as accurately as in the 1.5 s measurements. This method consistently achieved accurate estimations of the source images at any position within the field of view; however, the difference increased with the distance between the Ir-192 source and the compact gamma camera. Significance. The proposed method successfully provided estimated images from the experimental images within errors smaller than 0.5 mm at 100 mm. This method is promising for reducing blurring and statistical noise from the experimental images, enabling precise real-time monitoring of Ir-192 sources during HDR brachytherapy.
Mouse TMC4 is involved in the detection of chloride taste of salts
Authors: Narukawa Masataka , Masago Aya , Murata Momo , Saito Yoshikazu , Kasahara Yoichi , Abe Keiko , Asakura Tomiko
Published: November 2023

Licking behavior with various salts in transmembrane channel-like 4 (Tmc4) knockout (KO) mice was observed. In Tmc4 KO mice, a significant decrease in sensitivity to chloride salts, such as NaCl, KCl, and NH4Cl, was observed, while no significant decrease in sensitivity to Na-gluconate was observed. This finding suggests that TMC4 may be involved in the detection of chloride taste.
Acceptability Criteria of Precision Medicine: Lessons From Patients’ Experiences With the GUIDE-IBD Trial Regarding the Use of Mobile Health Technology
Authors: Erdmann Anke , Schrinner Florian , Rehmann-Sutter Christoph , Franke Andre , Seidler Ursula , Schreiber Stefan , Bozzaro Claudia
Published: November 2023

Background

Research about mobile health technologies for inflammatory bowel diseases reveals that these devices are mainly used to predict or self-report disease activity. However, in the near future these tools can be used to integrate large data sets into machine learning for the development of personalized treatment algorithms. The impact of these technologies on patients’ well-being and daily lives has not yet been investigated.

Methods

We conducted 10 qualitative interviews with patients who used the GUIDE-IBD mHealth technology. This is a special smartphone app for patients to record patient-reported outcomes and a wearable to track physical activity, heart rate, and sleep quality. For data analysis, we used interpretative phenomenological analysis. This method is ideally suited for studying people’s lived experiences.

Results

The analysis of the data revealed 11 themes that were mentioned by at least 3 participants. These themes were: Self-tracking with wearable devices as normality; variable value of the data from the wearable; risk of putting people under pressure; stimulus to reflect on their own well-being and illness; risk of psychological distress; discussion about app data in the medical consultation is very brief or nonexistent; easier to be honest with an app than with a doctor; questionnaires do not always adequately capture the patient’s condition; need for support; the possibility to look at the data retrospectively; and annoyed by additional tasks.

Conclusions

Patients identified benefits, risks, and potentials for improvement, which should be considered in the further development of the devices and patient-reported outcome scales, and in the implementation of usual care.
Morphology-based classification of the flying capacities of aquatic insects: A first attempt
Authors: Gerber Rémi , Piscart Christophe , Roussel Jean-Marc , Bergerot Benjamin
Published: November 2023

Flight is a key feature of the reproduction and dispersal of emerging aquatic insects. However, morphological measurements of insect flight are mostly available for terrestrial taxa and dragonflies, while aquatic insects have been poorly investigated. We analyzed 7 flight-related morphological parameters of 32 taxa belonging to 5 orders of emerging aquatic insects (Ephemeroptera, Trichoptera, Plecoptera, Diptera, and Megaloptera) with different life history traits related to flight (dispersal strategy, voltinism, adult lifespan, and swarming behavior). After correcting for allometry, we used an a priori-free approach to cluster the individuals according to their flight-related morphology. Then, we explored the levels of agreement between these clusters, taxonomy, and several life history traits of the taxa. All orders were scattered among several clusters, suggesting a large range of flight capacities, particularly for Diptera. We found swarming taxa in each cluster, showing that morphological adaptations to swarming are not identical in all aquatic insects. The clusters did not match the expected dispersal capacity of the taxa as derived from the literature or databases. Heavy wide-winged insects notably gathered taxa traditionally described as good or weak dispersers. Flight capacities based on morphology partly matched with the taxonomy and life-history traits of aquatic insect imagoes. Other parameters such as flight propensity, energy stores, and wing kinematics should help refine their flying and dispersal capacity.
Parental job loss and the role of unemployment duration and income changes for children’s education
Authors: Jensen Simon Skovgaard , Lindemann Kristina , Weiss Felix
Published: November 2023

This article studies the impact of parental job loss, subsequent unemployment duration, and income changes on the results of the final exam in lower secondary education and on the decision to pursue an academic track in Denmark. Drawing on administrative register data we use sibling fixed effects models as well as a before-after-test design to investigate the shorter-term effects of parental job loss. The results show that there are hardly any effects of parental job losses on children’s exam results, while we find a reduction in the transition to the academic upper secondary track, both for maternal and paternal job losses. We find no systematic evidence that the negative effects would be larger if the job loss is followed by a longer period of unemployment or by a loss of income, and no evidence for a moderating role of parental education.
StSN2 interacts with the brassinosteroid signaling suppressor StBIN2 to maintain tuber dormancy
Authors: Liu Shifeng , Cai Chengcheng , Li Luopin , Wen He , Liu Jie , Li Liqin , Wang Qiang , Wang Xiyao
Published: November 2023

After harvest, potato tubers undergo an important period of dormancy, which significantly impacts potato quality and seed vigor. StSN2 has been reported as a key gene for maintaining tuber dormancy; in this study, we explored the molecular mechanism by which StSN2 maintains dormancy. StBIN2 was first identified as a candidate protein that interacts with StSN2 by co-immunoprecipitation/mass spectrometry, and both qPCR and enzyme activity experiments showed that StSN2 can promote the StBIN2 expression and activity. In addition, the interaction between StSN2 and StBIN2 was verified by yeast two-hybrid, luciferase complementation experiments and co-immunoprecipitation. Bioinformatics analysis and site-directed mutagenesis confirmed the critical role of cysteine residues of StBIN2 in its binding to StSN2. Similar to that of StSN2, overexpression of StBIN2 extended the dormancy of potato tuber. Interaction between StSN2 and StBIN2 increased the activity of the StBIN2 enzyme, inhibited the expression of StBZR1, and suppressed BR signaling. On the contrary, this interaction promoted the expression of StSnRK2.2/2.3/2.4/2.6 and StABI5, key genes of ABA signaling, and the phosphorylation of StSnRK2.3, thereby promoting ABA signaling. Altogether, our results indicate that StSN2 interacts with StBIN2 through key cysteine residues and StBIN2 maintains tuber dormancy by affecting ABA and BR signaling. Findings of this research offer new insights into the molecular mechanism by which StSN2 maintains potato tuber dormancy through interaction with StSIN2 and provide guidance for potato improvement.
Re-thinking the allocation of roles under the GDPR in the context of cloud computing
Authors: Fischer Cyril
Published: November 2023

• Cloud computing is a well-established and flourishing phenomenon, whose key activity on personal data is the storage thereof. This study analyses the allocation of the controller–processor roles under the General Data Protection Regulation (GDPR) to the cloud computing actors in the context of the storage of personal data. It examines the current controller–processor model and suggests a joint controllership interpretation to the EU regulators, as a more appropriate allocation of roles in the context of cloud computing.

• We argue that the prevailing controller–processor interpretation stems from the current primacy of the purpose criterion, as well as the recognition of consent as a criterion to allocate controllership. This article suggests that cloud providers control some of the essential means of the storage of personal data, thereby shifting part of the control from cloud customers to cloud providers.

• If the joint controllership approach was to be followed by the EU regulators, this article argues that it would better reflect the economic and technical reality, and provide a more appropriate responsibility and liability framework for cloud providers and customers, which in turn would enhance the level of protection that data subjects should benefit from under the GDPR.
Diplomatic Gender Patterns and Symbolic Status Signaling: Introducing the GenDip Dataset on Gender and Diplomatic Representation
Authors: Niklasson Birgitta , Towns Ann E
Published: November 2023

This research note introduces a new dyadic dataset on gender and diplomatic representation and shows its potential to address questions about international status, gender patterns in international politics, and more. The GenDip dataset includes the names and gender classification of all bilateral ambassadors heading embassies 1968–2019 (74,549), structured as dyad/decade for 1968–1998 and dyad/lustrum for 1998–2019. Cross-fertilizing the quantitative study of status with qualitative studies on women's symbolic meaning for the status of states, we illustrate the utility of this data by showing that the gender of ambassadors is implicated in status hierarchies among states. For instance, states with a reputation as strongly patriarchal are more likely than others to post their female ambassadors to states with an international gender equality profile, for status and to signal policy alignment. We also show that shares of female ambassadors vary considerably among sending states, in unexpected ways, identifying the need for more research explaining why. This dataset enables new, crucial questions to be asked of international relations, mapping gender changes in diplomacy over time and place and explaining their causes and effects.
Normalization of drug and therapeutic concepts with Thera-Py
Authors: Cannon Matthew , Stevenson James , Kuzma Kori , Kiwala Susanna , Warner Jeremy L , Griffith Obi L , Griffith Malachi , Wagner Alex H
Published: November 2023

Objective

The diversity of nomenclature and naming strategies makes therapeutic terminology difficult to manage and harmonize. As the number and complexity of available therapeutic ontologies continues to increase, the need for harmonized cross-resource mappings is becoming increasingly apparent. This study creates harmonized concept mappings that enable the linking together of like-concepts despite source-dependent differences in data structure or semantic representation.

Materials and Methods

For this study, we created Thera-Py, a Python package and web API that constructs searchable concepts for drugs and therapeutic terminologies using 9 public resources and thesauri. By using a directed graph approach, Thera-Py captures commonly used aliases, trade names, annotations, and associations for any given therapeutic and combines them under a single concept record.

Results

We highlight the creation of 16 069 unique merged therapeutic concepts from 9 distinct sources using Thera-Py and observe an increase in overlap of therapeutic concepts in 2 or more knowledge bases after harmonization using Thera-Py (9.8%-41.8%).

Conclusion

We observe that Thera-Py tends to normalize therapeutic concepts to their underlying active ingredients (excluding nondrug therapeutics, eg, radiation therapy, biologics), and unifies all available descriptors regardless of ontological origin.
Racial disparities in prostate cancer mortality: a model-based decomposition of contributing factors
Authors: Gulati Roman , Nyame Yaw A , Lange Jane M , Shoag Jonathan E , Tsodikov Alex , Etzioni Ruth
Published: November 2023

To investigate the relative contributions of natural history and clinical interventions to racial disparities in prostate cancer mortality in the United States, we extended a model that was previously calibrated to Surveillance, Epidemiology, and End Results (SEER) incidence rates for the general population and for Black men. The extended model integrated SEER data on curative treatment frequencies and cancer-specific survival. Starting with the model for all men, we replaced up to 9 components with corresponding components for Black men, projecting age-standardized mortality rates for ages 40-84 years at each step. Based on projections in 2019, the increased frequency of developing disease, more aggressive tumor features, and worse cancer-specific survival in Black men diagnosed at local-regional and distant stages explained 38%, 34%, 22%, and 8% of the modeled disparity in mortality. Our results point to intensified screening and improved care in Black men as priority areas to achieve greater equity.
Data gaps and opportunities for modeling cancer health equity
Authors: Trentham-Dietz Amy , Corley Douglas A , Del Vecchio Natalie J , Greenlee Robert T , Haas Jennifer S , Hubbard Rebecca A , Hughes Amy E , Kim Jane J , Kobrin Sarah , Li Christopher I , Meza Rafael , Neslund-Dudas Christine M , Tiro Jasmin A
Published: November 2023

Population models of cancer reflect the overall US population by drawing on numerous existing data resources for parameter inputs and calibration targets. Models require data inputs that are appropriately representative, collected in a harmonized manner, have minimal missing or inaccurate values, and reflect adequate sample sizes. Data resource priorities for population modeling to support cancer health equity include increasing the availability of data that 1) arise from uninsured and underinsured individuals and those traditionally not included in health-care delivery studies, 2) reflect relevant exposures for groups historically and intentionally excluded across the full cancer control continuum, 3) disaggregate categories (race, ethnicity, socioeconomic status, gender, sexual orientation, etc.) and their intersections that conceal important variation in health outcomes, 4) identify specific populations of interest in clinical databases whose health outcomes have been understudied, 5) enhance health records through expanded data elements and linkage with other data types (eg, patient surveys, provider and/or facility level information, neighborhood data), 6) decrease missing and misclassified data from historically underrecognized populations, and 7) capture potential measures or effects of systemic racism and corresponding intervenable targets for change.
Black Family Forest Owners in the Southeastern United States: A Case Study in Six Counties
Authors: Robillard Amanda , Johnson Gaither Cassandra , Schelhas John , Butler Brett J
Published: November 2023

The USDA Forest Service, National Woodland Owner Survey asks family forest owners (FFOs) about their attitudes and intentions regarding their forestland. Historically, the number of responses from Black or African American FFOs has been very low, but it is uncertain whether this is because of nonresponse bias or that there are relatively few Black FFOs. To get a better understanding of these FFOs and to test a method to increase response rates, an intensified survey effort was conducted in three southern states: Alabama, North Carolina, and South Carolina. Analyses indicate that Black FFOs have slightly different objectives, activities, and ownership structure for their forestland than their White counterparts, who have traditionally represented the majority of FFOs.

Study Implications: By conducting an experiment to increase response rates from Black family forest owners to the National Woodland Owner Survey, we find traditional methodology is not effective. More importantly, we see this group has moderately different responses than their White counterparts. This has wide ranging implications for landowner assistance programs and other initiatives that have been designed on the premise that we are accurately capturing responses from all woodland owners.
Outcomes for Arthroplasties in Military Health: A Retrospective Analysis of Direct Versus Purchased Care
Authors: Haag Austin , Hosein Sharif , Lyon Samuel , Labban Muhieddine , Wun Jolene , Herzog Peter , Cone Eugene B , Schoenfeld Andrew J , Trinh Quoc-Dien
Published: November 2023

Introduction

The Department of Defense is reforming the military health system where surgeries are increasingly referred from military treatment facilities (MTFs) with direct care to higher-volume civilian hospitals under purchased care. This shift may have implications on the quality and cost of care for TRICARE beneficiaries. This study examined the impact of care source and surgical volume on perioperative outcomes and cost of total hip arthroplasties (THAs) and total knee arthroplasties (TKAs).

Materials and Methods

We examined TRICARE claims for patients who underwent THA or TKA between 2006 and 2019. The 30-day readmissions, complications, and costs between direct and purchased care were evaluated using the logistic regression model for surgical outcomes and generalized linear models for cost.

Results

We included 71,785 TKA and THA procedures. 11,013 (15.3%) were performed in direct care. They had higher odds of readmissions (odds ratio, OR 1.29 [95% CI, 1.12-1.50]; P < 0.001) but fewer complications (OR 0.83 [95% CI, 0.75-0.93]; P = 0.002). Within direct care, lower-volume facilities had more complications (OR 1.27 [95% CI, 1.01-1.61]; P = 0.05). Costs for index surgeries were significantly higher at MTFs $26,022 (95% CI, $23,393-$28,948) vs. $20,207 ($19,339-$21,113). Simulating transfer of care to very high-volume MTFs, estimated cost savings were $4,370/patient and $20,229,819 (95% CI, $17,406,971-$25,713,571) in total.

Conclusions

This study found that MTFs are associated with lower odds of complications, higher odds of readmission, and higher costs for THA and TKA compared to purchased care facilities. These findings mean that care in the direct setting is adequate and consolidating care at higher-volume MTFs may reduce health care costs.
Ultrasound-Activated Piezoelectric Polyvinylidene Fluoride–Trifluoroethylene Scaffolds for Tissue Engineering Applications
Authors: Bryan Andrew E , Krutko Maksym , Westphal Jennifer , Sheth Maulee , Esfandiari Leyla , Harris Greg M
Published: November 2023

Severe peripheral nervous system (PNS) injuries have limited options for therapeutic solutions to regain functional recovery. This can be attributed in part to the lack of regeneration pathways promoted by recapitulating chemical, physical, and electrical cues to direct nerve guidance. To address this, we examined ultrasonic stimulation of a piezoelectric polyvinylidene fluoride–triflouroethylene (PVDF-TrFE) scaffold as a potentially clinically relevant therapy for PNS regeneration. Owing to the piezoelectric modality of PVDF-TrFE, we hypothesize that ultrasound stimulation will activate the scaffold to electrically stimulate cells in response to the mechanical deformation mediated by sound waves. Biocompatible PVDF-TrFE scaffolds were fabricated to be used as an ultrasound-activated, piezoelectric biomaterial to enhance cellular activity for PNS applications. NIH-3T3 fibroblasts were cultured on PVDF-TrFE nanofibers and stimulated with low-, medium-, or high-powered ultrasound. 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyl-2H-tetrazolium bromide (MTT) assays were performed on fibroblasts to measure the metabolic activity of the cells following stimulation. MTT assays showed that ultrasound-stimulated fibroblasts on PVDF-TrFE scaffolds had increased metabolic activity as power was increased, whereas on plain polystyrene, an opposite trend was observed where cells had a decreased metabolic activity with ascending levels of ultrasound power. Ultrasound-stimulated PVDF-TrFE nanofibers hold exciting potential as a therapy for PNS injuries by promoting increased metabolic activity and proliferation. The ability to noninvasively stimulate implantable piezoelectric nanofibers to promote mechanical and electrical stimulation for nerve repair offers a promising benefit to severe trauma patients.
Integrating Battlefield Documentation into Virtual Reality Medical Simulation Training: Virtual Battlefield Assisted Trauma Distributed Observation Kit (BATDOK)
Authors: Sarma Karthik V , Barrie Michael G , Dorsch John R , Andre Tanner W , Polson Jennifer S , Ribeira Rosie J , Andre Tyler B , Ribeira Ryan J
Published: November 2023

Introduction

Clinical documentation is an essential component of the provision of medical care, enabling continuity of information across provider and site handoffs. This is particularly important in the combat casualty care setting when a single casualty may be treated by four or more or five completely disparate teams across the roles of care. The Battlefield Assisted Trauma Distributed Observation Kit (BATDOK) is a digital battlefield clinical documentation system developed by the Air Force Research Laboratory to address this need. To support the deployment of this tool, we integrated BATDOK into a commercially available virtual reality (VR) medical simulation platform used by the U.S. Air Force and Defense Health Agency personnel in order to provide an immersive simulation training experience which included battlefield documentation.

Methods

A multidisciplinary team consisting of medical educators, VR simulation engineers, emergency physicians and pararescuemen, and BATDOK developers first developed a specification for a virtual BATDOK capability, including a detailed listing of learning objectives, critical interfaces and task plans, and sensor integrations. These specifications were then implemented into the commercially available Virtual Advancement of Learning for Operational Readiness VR Medical Simulation System and underwent developmental testing and evaluation during pararescueman training exercises at the Air Force Special Operations Command Special Operations Center for Medical Integration and Development.

Results and Conclusions

The BATDOK capability was successfully implemented within the VR Medical Simulation System. The capability consisted of a virtual tablet with replicated interfaces and capabilities based on the developed specifications. These capabilities included integrated point-of-care ultrasound capability, multi-patient management, vitals sign monitoring with sensor pairing and continuous monitoring, mechanism of injury documentation (including injury pattern documentation), intervention logging (including tourniquets, dressing, airways, lines, tubes and drains, splints, fluids, and medications), and event logging. The capability was found to be operational and in alignment with learning objectives and user acceptance goals.
Impact of Blast Overpressure on the Pharmacokinetics of Various Antibiotics in Sprague Dawley Rats
Authors: Rios Kariana E , Selig Daniel J , Pavlovic Radmila , Alamneh Yonas , Vuong Chau , Nadeau Robert John , Pannone Kristina M , Deluca Jesse P , Long Joseph B , Sajja Venkatasivasai S , Tyner Stuart , Antonic Vlado , Getnet Derese , Bobrov Alexander G
Published: November 2023

Introduction

Combat injuries are complex and multimodal. Most injuries to the extremities occur because of explosive devices such as improvised explosive devices. Blast exposure dramatically increases the risk of infection in combat wounds, and there is limited available information on the best antibiotic treatments for these injuries. We previously demonstrated that mice exposed to blast displayed a delayed clearance of cefazolin from the plasma and liver; further semi-mechanistic modeling determined that cefazolin concentrations in the skin of these mice were reduced. Our objective was to investigate the effects of blast on the pharmacokinetics of antibiotics of different types used for the treatment of combat wounds in the rat model.

Materials and Methods

Male Sprague Dawley rats were exposed to blast overpressure followed by injection of a bolus of animal equivalent doses of an antibiotic (cefazolin, cefepime, ertapenem, or clindamycin) into the tail vein at 1-hour post-blast exposure. Blood was collected at predetermined time points via repeated sampling from the tail vein. Animals were also euthanized at predetermined time points, at which time liver, kidney, skin, and blood via cardiac puncture were collected. Antibiotic concentrations were determined by ultra-performance liquid chromatography–tandem mass spectrometry.

Results

Blast-exposed rats exhibited a similar rate of clearance compared to non-blasted rats in the blood, liver, kidney, and skin, which is inconsistent with the data regarding cefazolin in blast-exposed mice.

Conclusions

Our results in rats do not recapitulate our previous observation of delayed cefazolin clearance in mice following the blast overpressure exposure. Although using rats permitted us to collect multiple blood samples from the same animals, rats may not be a suitable model for measuring the pharmacokinetics of antibiotics following blast. The interpretation of the results may be challenging because of variation in data among rat subjects in the same sample groups.
Pelvis-Sacrum-Lumbar Spine Injury Characteristics From Underbody Blast Loading
Authors: Yoganandan Narayan , Baisden Jamie , Moore Jason , Pintar Frank , Vedantam Aditya , Shabani Saman , Barnes David , Loftis Kathryn
Published: November 2023

Introduction

Combat-related injuries from improvised explosive devices occur commonly to the lower extremity and spine. As the underbody blast impact loading traverses from the seat to pelvis to spine, energy transfer occurs through deformations of the combined pelvis-sacrum-lumbar spine complex, and the time factor plays a role in injury to any of these components. Previous studies have largely ignored the role of the time variable in injuries, injury mechanisms, and warfighter tolerance. The objective of this study is to relate the time or temporal factor using a multi-component, pelvis-sacrum-lumbar spinal column complex model.

Materials and Methods

Intact pelvis-sacrum-spine specimens from pre-screened unembalmed human cadavers were prepared by fixing at the superior end of the lumbar spine, pelvis and abdominal contents were simulated, and a weight was added to the cranial end of the fixation to account for torso effective mass. Prepared specimens were placed on the platform of a custom vertical accelerator device and aligned in a seated soldier posture. An accelerometer was attached to the seat platen of the device to record the time duration to peak velocity. Radiographs and computed tomography images were used to document and associate injuries with time duration.

Results

The mean age, stature, weight, body mass index, and bone density of 12 male specimens were as follows: 65 ± 11 years, 1.8 ± 0.01 m, 83 ± 13 kg, 27 ± 5.0 kg/m2, and 114 ± 21 mg/cc. They were equally divided into short, medium, and long time durations: 4.8 ± 0.5, 16.3 ± 7.3, and 34.5 ± 7.5 ms. Most severe injuries associated with the short time duration were to pelvis, although they were to spine for the long time duration.

Conclusions

With adequate time for the underbody blast loading to traverse the pelvis-sacrum-spine complex, distal structures are spared while proximal/spine structures sustain severe/unstable injuries. The time factor may have implications in seat and/or seat structure design in future military vehicles to advance warfighter safety.
Behavioral Health–related Reasons for Permanent Duty Limitation Profiles in the U.S. Army: Population-Based Data from 2017 to 2019
Authors: Carreno-Davidson Jamie T , Faller Theresa N , Richardson Melissa D , Roy Tanja C
Published: November 2023

Introduction

When warfighters are unable to fight, they are formally removed from battle through temporary or permanent duty limitation profiles. This study uses a population-based data repository to characterize permanent behavioral health (BH)–related profiles across the army for an identified 2-year period. The absolute risk of a permanent duty limitation for specific BH categories was also examined.

Materials and Methods

This study utilized a retrospective population-based design to identify all new BH diagnoses across the U.S. Army. Service members identified as having a new BH diagnosis were tracked for 12 months following the diagnosis to determine the recommendation of a permanent duty limitation profile.

Results

From 2017 to 2018, 16% (n = 102,440) of service members received a “new” BH diagnosis. Less than 10% (9.5%; n = 9,752) of soldiers diagnosed with a BH disorder were issued a permanent BH-related duty profile within 12 months of the initial diagnosis. The absolute risk of a permanent profile was highest for soldiers diagnosed with a psychotic or delusional disorder (42%; n = 324) followed by dissociative or somatoform disorders (26%; n = 178) and eating disorders (23%; n = 108).

Conclusions

Military regulations dictating medical readiness and retention standards reflect both the standards required for mission readiness and a layer of medical protection for the service member. This study provides important information on the relationship between a new BH diagnosis and the likelihood that a service member will be referred for a retirement evaluation.
Acclimation Protocol to Minimize Stress in Immobilized Rats During Non-Invasive Multimodal Sensing of the Autonomic Nervous System
Authors: Kirby Ana Karina , Pancholi Sidharth , Suresh Shruthi , Anderson Zada , Chesler Caroline , Everett IV Thomas H , Duerstock Bradley S
Published: November 2023

Introduction

Rodent models are often used in spinal cord injury investigations to measure physiological parameters but require rats to be restrained during data collection to prevent motion and stress-induced artifacts.

Materials and Methods

A 4-week acclimation protocol was developed to reduce sympathetic activity during experimentation to collect clean data. Physiological parameters were analyzed throughout the acclimation protocol using surface-based electrodes and an implanted sensor. The sensor was used to extract systolic blood pressure, skin nerve activity, and heart rate variability parameters.

Results

Our protocol exposed a minimal increase in sympathetic activity during experimentation despite long periods of restraint. The data suggest that the acclimation protocol presented successfully minimized changes in physiological parameters because of prolonged restraint.

Conclusions

This is necessary to ensure that physiological recordings are not affected by undue stress because of the process of wearing the sensor. This is important when determining the effects of stress when studying dysautonomia after spinal cord injury, Parkinson’s disease, and other neurological disorders.
Fiscal Year 2018 National Defense Authorization Act, Section 734, Weapon Systems Line of Inquiry: Overview and Blast Overpressure Tool—A Module for Human Body Blast Wave Exposure for Safer Weapons Training
Authors: Spencer Rachel W , Brokaw Elizabeth , Carr Walter , Chen Zhijian J , Garfield Bradley A , Garimella Harsha T , Gharahi Hamidreza , Iampaglia Joseph , Lalis Lisa , Przekwas Andrzej , Skotak Maciej , Xynidis Michael A , Dominijanni Andrew , Dias George , Danley Lura , Gupta Raj K
Published: November 2023

Introduction

Experiences by service members in recent conflicts and training environments illuminate concerns about the possible effects of blast overpressure (BOP) exposure on brain health. Section 734 of the National Defense Authorization Act for Fiscal Year (FY) 2018 (Public Law 115-91) requires that the Secretary of Defense conducts a longitudinal medical study on blast pressure exposure of members of the Armed Forces during combat and training, and the Assistant Secretary of Defense for Health Affairs was assigned responsibility for fulfilling requirements. The study’s goal is to improve DoD’s understanding of the impact of BOP exposure from weapon systems on service members’ brain health and inform policy for risk mitigation, unit readiness, and health care decisions. This article focuses on the activities of the Weapon Systems Line of Inquiry (LOI) and the development of a prototype BOP Tool.

Materials and Methods

The DoD established the Section 734 Workgroup, which developed a program structure with five LOIs. The Weapon Systems LOI coordinated, collated, and analyzed information on BOP resulting from heavy weapons and blast events to inform strategies, and accounted for emerging research on health effects and performance. Ongoing research was leveraged to develop a BOP Tool as a standalone module and for integration into the Range Managers Toolkit.

Results

The effort identified opportunities for the DoD to improve the clarity of communications about BOP exposure, risk, and safety; establish methods to leverage emerging research; and develop a prototype BOP Tool to predict exposure loads when firing heavy weapons in training.

Conclusions

It is recommended that the DoD revises requirements and policy to improve and standardize safety guidance throughout research, development, testing, and evaluation; acquisition; and training. The validated BOP Tool allows users to generate a scenario to predict BOP exposure and allows service members to modify them during planning for safer training.
A Randomized Controlled Trial of Precision Nutrition Counseling for Service Members at Risk for Metabolic Syndrome
Authors: McCarthy Mary S , Colburn Zachary T , Yeung Ka Yee , Gillette Laurel H , Hung Ling-Hong , Elshaw Evelyn
Published: November 2023

Introduction

Metabolic syndrome (MetS) is a threat to the active component military as it impacts health, readiness, retention, and cost to the Military Health System. The most prevalent risk factors documented in service members’ health records are high blood pressure (BP), low high-density lipoprotein cholesterol, and elevated triglycerides. Other risk factors include abdominal obesity and elevated fasting blood glucose. Precision nutrition counseling and wellness software applications have demonstrated positive results for weight management when coupled with high levels of participant engagement and motivation.

Materials and Methods

In this prospective randomized controlled trial, trained registered dietitians conducted nutrition counseling using results of targeted sequencing, biomarkers, and expert recommendations to reduce the risk for MetS. Upon randomization, the treatment arm initiated six weekly sessions and the control arm received educational pamphlets. An eHealth application captured diet and physical activity. Anthropometrics and BP were measured at baseline, 6 weeks, and 12 weeks, and biomarkers were measured at baseline and 12 weeks. The primary outcome was a change in weight at 12 weeks. Statistical analysis included descriptive statistics and t-tests or analysis of variance with significance set at P < .05.

Results

Overall, 138 subjects enrolled from November 2019 to February 2021 between two military bases; 107 completed the study. Demographics were as follows: 66% male, mean age 31 years, 66% married, and 49% Caucasian and non-Hispanic. Weight loss was not significant between groups or sites at 12 weeks. Overall, 27% of subjects met the diagnostic criteria for MetS on enrollment and 17.8% upon study completion. High deleterious variant prevalence was identified for genes with single-nucleotide polymorphisms linked to obesity (40%), cholesterol (38%), and BP (58%). Overall, 65% of subjects had low 25(OH)D upon enrollment; 45% remained insufficient at study completion. eHealth app had low adherence yet sufficient correlation with a valid reference.

Conclusions

Early signs of progress with weight loss at 6 weeks were not sustained at 12 weeks. DNA-based nutrition counseling was not efficacious for weight loss.
A Case-Control Analysis of Bone Stress Injury on Advancement and Health Care Utilization in US Air Force Basic Military Trainees
Authors: Gardner Cubby L , Raps Stephanie J , Bedford Theresa , Fisher Reid A
Published: November 2023

Introduction

Every year, approximately 35,000 recruits enter the United States Air Force Basic Military Training (BMT). Musculoskeletal problems are particularly vexing for BMT because a broad array of differentials render definitive diagnosis burdensome and while most sufferers will fully recover, healing often requires protracted training delays resulting in increased unrecoverable training costs to the program. The purpose of this study is to conduct a case-control study of basic military trainees entering service from 2012 to 2015 to assess detectable differences in demographics, retention, and health care utilization.

Materials and Methods

This is a retrospective case-control study of existing data and records obtained from existing and active information record systems for individuals who attended BMT between the years 2012 and 2015. Cohort assignment was based on incidence of first stress fracture diagnosis (i.e., having a select diagnosis code in one’s medical record) relative to arrival at BMT. Health care utilization is operationalized as medical encounter frequencies and associated international classification of disease (ICD) codes occurring for all patients from BMT recruit date of arrival to 6 months post-graduation (i.e., 180 days).

Results

The primary dataset includes 132,359 distinct individuals, of which 129,637 (98%) had no history of stress fracture diagnosis and 1,487 (1%) of which have a diagnosis of stress fracture more than 60 days after arrival at BMT; these are assigned to the CONTROL group. There are 1,235 (0.9%) assigned to the CASE group. CASE members presented with 30.1 unique ICD-10 codes post-graduation compared to 6.3 in the CONTROL group. Six of the top thirteen ICD-10 codes were musculoskeletal in nature and all presented significantly higher rates for the CASE group.

Conclusions

Trainees who suffered a bone stress injury (BSI) during the United States Air Force BMT advanced in rank on par with trainees who did not, but BSI sufferers exhibited greater health care utilization than those who did not suffer BSI. The cost to replace a trainee unable to complete BMT is considerable; however, it is also important to consider the reduction in resiliency and readiness to the Department of Defense and the financial burdens from increased health care utilization. The 2-fold increase in BSI presentation in the graduated control group reflects that more needs to be done for all populations to identify better proactive efforts to foundationally support wellness and prevention rather than accept injury as the status quo.
Application of the 2022 ACR/EULAR criteria for Takayasu arteritis to previously diagnosed patients based on the 1990 ACR criteria
Authors: Ha Jang Woo , Pyo Jung Yoon , Ahn Sung Soo , Song Jason Jungsik , Park Yong-Beom , Lee Sang-Won
Published: November 2023

Objectives

Recently, a joint group of the American College of Rheumatology (ACR) and the European Alliance of Associations for Rheumatology (EULAR) proposed new criteria for Takayasu arteritis (TAK) (the 2022 ACR/EULAR criteria). This study applied the 2022 ACR/EULAR criteria to patients with previously diagnosed TAK based on the 1990 ACR criteria and investigated the concordance rate between the two criteria according to the four imaging modalities.

Methods

This study reviewed the medical records of 179 patients who met the 1990 ACR criteria for TAK. The imaging modalities included conventional angiography, computed tomography angiography, fluorodeoxyglucose-positron emission tomography, and magnetic resonance angiography.

Results

Regardless of the imaging modalities, the concordance rate between the two criteria was 85.5% when including all patients, whereas it increased to 98.1% when only patients aged ≤60 years were included. Among the four imaging modalities, computed tomography angiography exhibited the highest concordance rate between the two criteria (85.6%). The concordance rate among patients aged >60 years was 95.7%. Only one patient aged 50–60 years was reclassified as having both TAK and giant cell arteritis.

Conclusions

The concordance rate was 85.5% regardless of the imaging modalities and increased to 86.9% on simultaneous computed tomography angiography and fluorodeoxyglucose-positron emission tomography imaging.