bluuebunny/crossref_metadata_2025 huggingface dataset:
Self-Administration of Exercise and Dietary Supplements in Deployed British Military Personnel During Operation TELIC 13
Authors: Boos Christopher , Wheble GAC , Campbell MJ , Tabner KC , Woods DR
Published: March 2013

Objectives

Recent operational experience has led to the identification of several potentially serious adverse events related to the use of dietary and exercise supplements among British Army personnel. This study aimed to establish the point prevalence of dietary and exercise supplement usage in British soldiers on Op TELIC during January 2009.

Methods

A cross-sectional questionnaire-based study of British military personnel located at the Contingency Operating Base (COB), in Basra, was performed during the sixth week of Op TELIC 13.

Results

From 1544 questionnaires (target population) issued, a total of 1017 (65.9%) completed questionnaires were evaluated. The mean population age was 29.5 years (range 18-58) of which 87.4% were male. 417/1017 persons (41.0%) admitted to a history of supplement use of which 32.0% were current users and 9.4% were previous users. Of these current users, 66.0% started taking them on their current deployment. The most commonly taken supplements were whey protein (18.8%), amino acids (17.9%), and creatine (13.2%). There were 14 persons (1.4%) who admitted to current use of anabolic steroids. The most-frequently given reasons for taking supplements were either to ‘increase muscle bulk’ (40.4%) or to aid training and recovery (20.8%).

Conclusions

This is the first study to investigate the use of exogenous nutritional supplements within the British Military and has identified their widespread use during operational deployment. The use of anabolic steroids is particularly worrying, given both their illegality and their well-recognised and deleterious health effects. There is a need for greater awareness and education regarding potential benefits and dangers of supplement use in order to maximise any potential benefits and minimise clinical risk.
Training Australian military health care personnel in the primary care of maxillofacial wounds from improvised explosive devices
Authors: BE Reed , RG Hale
Published: March 2013

Severe facial wounds frequently result from improvised explosive devices (IEDs) as the face is still vulnerable despite advances in personal protection of soldiers. In contrast to the poor outcomes with civilian maxillofacial trauma management methods initially employed by the US Army for maxillofacial wounds from IEDs, advances in wound management methods for such injuries by the US Army have resulted in significant improvements in appearance and function. This article describes the features of a short course in the primary management of combat related maxillofacial wounds for deployed health care personnel who may not be facial specialists, including contemporary treatment techniques for those confronting wounds from IEDs which are explained in this course.
Five months of surgery in the Multinational Field Hospital in Afghanistan with an emphasis on Oral and Maxillofacial injuries
Authors: Breeze Johno , AM Monaghan , MD Williams , RNW Clark , AJ Gibbons
Published: March 2013

The aim of this review was to assess the workload of theatres in the role 3 Multinational Field Hospital in Kandahar, Afghanistan and to identify what period of day most emergency admissions arrived. During the period 05 August 2006 to 21 December 2006, 288 operations were performed on 259 patients and comprised 393 individually quantifiable procedures. 98% of these operations were to treat acute injuries. Oral and Maxillofacial surgeons were involved in 24% of operations. 63% of procedures done at these operations involved upper or lower limbs, 19% the head and neck and 18% involved the torso. An analysis of emergency admissions in November 2006 showed thatmost occurred between 18.00 andmidnight. Although theatre timetabling made provision for this, whenever possible, elective surgery was scheduled for the following morning when emergency injury admissions were at their lowest.
Detecting Post-Deployment Mental Health Problems in Primary Care
Authors: Coetzee Rikus H , Simpson RG , Greenberg N
Published: March 2013

Post-deployment mental health problems are a source of potential concern for health professionals and politicians in military forces in the world; the UK Armed Forces are no exception. This article examines practical ways in which General Practitioners in Primary Care can enhance their ability to detect post-deployment mental health problems and offers suggestions on immediate management and assessment, based on contemporary evidence and clinical experience.
Hoffman II External Fixator Techniques – A Work-Around to use Small Pins in Large Clamps
Authors: Rodger Mike , Standley D , Kazel M
Published: March 2013

We describe a novel technique to allow use of small pins in medium pin size clamps. Slipping a second 3 mm pin into the same clamp hole as the first allows the 5 mm clamp to bite securely on a 3 mm pin. This enables construction of an external fixator frame utilising 3 mm and 5 mm pins, as required to span the elbow, wrist and ankle. This extends the capabilities of the 5 mm clamp and reduces the need for extra materiel such as sets containing clamps to connect 3 mm pins to standard size rods.
Pre-Hospital Anaesthesia
Authors: Dawes RJ , Mellor Adrian
Published: March 2013

This review presents the history of Pre-hospital anaesthesia, it’s evidence base, required training and examines current arguments focusing on best practice such as who should undertake the procedure and how identifying appropriate patients, utilizing new techniques and drugs may benefit the Pre-hospital practitioner in optimum delivery of this important procedure.
Field Intensive Care - Weaning and Extubation
Authors: Thornhill R , Tong JL , Birch K , Chauhan R
Published: March 2013

Injury following ballistic trauma is the most prevalent indication for providing organ system support within an ICU in the field. Following damage control surgery, postoperative ventilatory support may be required, but multiple factors may influence the indications for and duration of invasive mechanical ventilation. Ballistic trauma and surgery may trigger the Systemic Inflammatory Response Syndrome (SIRS) and are important causative factors in the development of Acute Lung Injury (ALI) and Acute Respiratory Distress Syndrome (ARDS). However, their pathophysiological effect on the respiratory system is unpredictable and variable. Invasive mechanical ventilation is associated with numerous complications and the return to spontaneous ventilation has many physiological benefits. Following trauma, shorter periods of ICU sedation-amnesia and a protocol for early weaning and extubation, may minimize complications and have a beneficial effect on their psychological recovery. In the presence of stable respiratory function, appropriate analgesia and favourable operational and transfer criteria, we believe that the prompt restoration of spontaneous ventilation and early tracheal extubation should be a clinical objective for casualties within the field ICU.
Traumatic Pneumorrhachis
Authors: Haldane Andrew
Published: March 2013

Pneumorrhachis or intraspinal air is an increasingly encountered phenomenon in the management of severe trauma. The case of a 23-year-old soldier, who sustained a gunshot wound to the chest, is presented and the subsequent discussion illustrates that while often benign this phenomenon may indicate serious occult injury.
Paediatric Anaesthesia in Afghanistan: a Review of the Current Experience
Authors: Nordmann Giles R
Published: March 2013

This paper describes the author’s experience of the paediatric patient load on the UK medical services in Afghanistan. Over a 3 month period there was a mean of 2.9 paediatric trauma admissions per week, mean age was 6.8 years with gunshot wound or explosive injury being the mechanisms of injury in 77% of the trauma admissions. Overall these children represented 10.8% of the surgical workload. Some of the issues of paediatric anaesthesia in this environment are discussed including paediatric equipment, resuscitation for paediatric massive haemorrhage and regional anaesthesia. The need to formally recognise the problem in training and equipping deployed medical personnel to deal with this challenge is examined.
Operational Anaesthesia for the Management of Traumatic Brain Injury
Authors: Park CL , Moor P , Birch K , Shirley PJ
Published: March 2013

The primary brain insult that occurs at the time of head injury, is determined by the degree of neuronal damage or death and so cannot be influenced by further treatment. The focus of immediate and ongoing care from the point of wounding to intensive care management at Role 4 should be to reduce or prevent any secondary brain injury. The interventions and triage decisions must be reassessed at every stage of the process, but should focus on appropriate airway management, maintenance of oxygenation and carbon dioxide levels and maintenance of adequate cerebral perfusion pressure. Early identification of raised intracranial pressure and appropriate surgical intervention are imperative. Concurrent injuries must also be managed appropriately. Attention to detail at every stage of the evacuation chain should allow the headinjured patient the best chance of recovery.
Simulation, Human Factors and Defence Anaesthesia
Authors: Mercer SJ , Whittle C , Siggers B , Frazer RS
Published: March 2013

Simulation in healthcare has come a long way since it’s beginnings in the 1960s. Not only has the sophistication of simulator design increased, but the educational concepts of simulation have become much clearer. One particularly important area is that of non-technical skills (NTS) which has been developed from similar concepts in the aviation and nuclear industries. NTS models have been developed for anaesthetists and more recently for surgeons too. This has clear value for surgical team working and the recently developed Military Operational Surgical Training (MOST) course uses simulation and NTS to improve such team working. The scope for simulation in Defence medicine and anaesthesia does not stop here. Uses of simulation include pre-deployment training of hospital teams as well as Medical Emergency Response Team (MERT) and Critical Care Air Support Team (CCAST) staff. Future projects include developing Role 1 pre-deployment training. There is enormous scope for development in this important growth area of education and training.
Current Epidural Practice – Results of a Survey of Military Anaesthetists
Authors: Woods KL , Aldington Lt Col
Published: March 2013

Objectives

As epidurals are now used for pain relief on deployment a survey was conducted to look at the current epidural practice of UK military anaesthetists. The aim was to identify any potential issues with regard to equipment and training to allow future development of pre-deployment training.

Methods

An internet based survey was carried out. All military anaesthetists were sent an e-mail containing a link to the survey and the results of those who responded were analysed.

Results

A total of 49 surveys were completed. 78% of respondents carried out epidurals more than once a month, in a wide range of specialities. There was considerable variation in methods of securing epidurals and in drug choice amongst respondents.

Conclusions

The results of this survey show that whilst epidurals are commonly carried out amongst military anaesthetists during their UK practice, there is significant variation within the practice. Areas have been identified for development of educational courses, for example methods of securing epidurals, and these have already been acted upon.
High Altitude Pulmonary Oedema
Authors: Hall DP , Duncan K , Baillie J Kenneth
Published: March 2013

High altitude pulmonary oedema (HAPE) is an important and preventable cause of death at high altitudes. However, little is known about the global incidence of HAPE, in part because most cases occur in remote environments where no records are kept. Furthermore, despite international efforts to achieve consensus, there is wide disparity in the diagnostic criteria in clinical and research use. We have reviewed the literature on the incidence and epidemiology of HAPE.

There is broad agreement between studies that HAPE incidence at 2500m is around 0.01%, and increases to 1.9% at 3600m and 2.5-5% at 4300m. Risk factors for HAPE include rate of ascent, intensity of exercise and absolute altitude attained, although an individual pre-disposition to developing the condition is also well described and suggests an underlying genetic susceptibility. It is increasingly recognised that clinically-detectable HAPE is an extreme of a continuous spectrum of excess pulmonary fluid accumulation, which has been demonstrated in asymptomatic individuals.

There is a continued need to ensure awareness of the diagnosis and treatment of HAPE among visitors to high altitude. It is likely that HAPE is preventable in all cases by progressive acclimatisation, and we advocate a pragmatic “golden rules” approach. Our understanding of the epidemiology and underlying genetic susceptibility to HAPE may be advanced if susceptible individuals register with the International HAPE Database:http://www.altitude.org/hape.php.

HAPE has direct relevance to military training and operations and is likely to be the leading cause of death at high altitude.
Changes to Colour Vision on Exposure to High Altitude
Authors: Davies Andrew J. , Morris DS , Kalson NS , Wright AD , Imray CHE , Hogg CR
Published: March 2013

Objectives

Several studies have shown deterioration in colour vision at altitudes above 3,000m. These studies have been conducted in photopic (bright daylight) conditions, whereas many military operations take place in mesopic (dim light) conditions. Data suggests that the tritan colour vision axis (blue cones, TA) are more susceptible to hypoxic insult than protan axis (red cones, PA). The objective of this study was to examine colour vision at high altitude, in mesopic conditions, and using a novel method of assessment to discriminate between the tritan and protan axis.

Methods

We examined 42 eyes (21 subjects, mean age 44, range 22-71), at sea level and within 12-36 hours of exposure to 3300m. This was done in a darkened room, with refractive error correction. Colour vision was studied using Chroma Test™, a software programme that analyzes colour contrast threshold (CCT) of both TA and PA. We planned to repeat CCT measurement at 4,392m, but technology failure prevented this. Non-parametric paired data was examined using the Wilcoxon signed rank test.

Results

There was found to be no change to either the PA (p=0.409) or the TA (p=0.871) upon ascent. Within the PA 16 eyes had a lower CCT at high altitude, whilst 26 were higher. In the TA 20 eyes had a lower CCT and 22 were higher. At sea level, mean CCT for PA was 4.21 (SD 2.29) TA was 7.06 (SD 1.77). At 3,300m mean CCT for PA was 4.36 (SD 2.86) and TA was 6.93 (SD 2.39).

Conclusions

This experiment revealed no changes to colour vision with exposure to 3,300m. This may be below the threshold altitude for cone dysfunction, alternatively colour vision deterioration may be less significant in mesopic conditions.
A Review of Military Research into Alcohol Consumption
Authors: Verrall Neil
Published: March 2013

Alcohol consumption is a part of military history. The impacts in terms of both short-term and long-term consequences require modern militaries to develop and instigate a duty of care for its personnel, which informs the military’s ‘cradle to the grave’ approach in addressing alcohol consumption and other risky health behaviours (e.g. smoking, driving, sex, drugs, obesity, etc.). Thus, in recent years there have been numerous studies that have either focused on, or included, measures of alcohol consumption among various military populations. Therefore, a synthesis of this research is warranted in order to provide a contemporary understanding of this topic. This review addresses the military research regarding alcohol consumption. It reviews the methodological issues associated with the breadth of research, as well as commenting on a range of factors that need to be considered when interpreting and comparing the different research studies; for example, (1) when comparing findings across military to civilian and pan-military populations, (2) deployment-related research, (3) military groups at risk, and (4) the impact on readiness, operational effectiveness and force sustainability.
The Use of Exercise and Dietary Supplements Among British Soldiers in Afghanistan
Authors: Boos Christopher , Simms P , Morris F R , Fertout M
Published: March 2013

Background and Objectives

Recently published case reports, coupled with a large observational study of 1017 deployed servicemen to Iraq (January 2009), has highlighted the issue and potential concerns regarding the unregulated use of dietary and exercise supplements within the British military. Consequently, an exploratory pilot study was undertaken to assess whether the findings of the previous Iraq study were applicable to current deployed British servicemen in Afghanistan.

Methods

This was a voluntary questionnaire-based study targeted at individuals attending a health promotion fair in Camp Bastion, Afghanistan in June 2010.

Results

From 150 questionnaires handed out there were 87 completed questionnaires (58% return). The mean age was 28.0 (SD 7.1; range of 18-50 years) with 89.7% being male. From the total of 87 persons 46.0% were self-declared current smokers with 37.9% admitting to drinking > 6 caffeinated drinks per day. Forty nine persons (56.3%) admitted to a history of supplement use with 35 (40.2% compared with 32.0% in 2009 in Iraq) declaring current use. The average duration of supplement use among current users was 3.0 (2.0-9.0) months. The main sources of supplement supply were via local NAAFI purchase (57.1%), internet purchase (40.0%) and via their local chemist (2.9%). The main types of supplement used were proteins / amino acids (85.7%), creatine (34.3%), chromium (31.4%), stimulants (17.1%), hydroxycut (5.7 %), and testosterone boosters (1.2%) with no persons admitting to the use of ephedra or anabolic steroids.

Conclusions

A significant proportion of the British servicemen employed on operations in Afghanistan who were sampled, admitted to current dietary and exercise supplement use whilst on deployment. The results of this small study suggest that their use on operations may be increasing. Smoking rates and caffeine consumption, on deployment, remain high in the British military. A larger detailed study with greater representation among soldiers deployed to forward operating bases would be helpful to fully appreciate the scale of supplement use.
Massive Transfusion
Authors: Doughty HA , Woolley T , Thomas GOR
Published: March 2013

Massive Transfusion is a part of Damage Control Resuscitation. The aim of transfusion therapy is to restore oxygen delivery to poorly perfused tissues and to treat the acute coagulopathy of trauma. The severity and complexity of modern injuries have led to the use of swift, protocol-driven care with the use of ‘Shock Packs’ and management of metabolic complications. The pro- active treatment of the coagulopathy has been termed Haemostatic Resuscitation. The delivery of this transfusion capability has required an increasingly sophisticated logistic and laboratory response. New operational capabilities have included cold chain solutions; laboratory management information systems; platelet apheresis and ROTEM®. This investment in the massive transfusion capability has delivered rapid resuscitation. It has also enabled clinicians to direct individualised transfusion support following initial resuscitation i.e. goal directed therapy. Future technical solutions should further support the pre- hospital delivery of transfusion while addressing the logistic tail. However, the key to success is the knowledge and skills of frontline staff to deliver safe and appropriate blood transfusion.
Right Turn Resuscitation: Frequently Asked Questions
Authors: Tai NRM , Russell Robert
Published: March 2013

In this article the process of operating room resuscitation – commonly known as Right Turn Resuscitation (RTR) when conducted in the medical treatment facility at Camp Bastion - is described. The place of RTR within the concepts of damage control resuscitation and surgery is discussed along with activation criteria and protocols. The medical leadership, team roles, advantages and disadvantages are reviewed. Finally, studies describing the impact of RTR and operating room resuscitation are briefly described.
Limb Salvage of Severely Injured Extremities After Military Wounds
Authors: Brown Kate V , Henman P , Stapley S , Clasper JC
Published: March 2013

Severely wounded extremities following battlefield injuries present a surgical dilemma to military surgeons of whether to attempt salvage or amputate the limb. There are many considerations to be made, including local and systemic patient factors, other wounded personnel and logistical constraints. Attempts have been made previously to form objective scoring criteria so as to remove possible subjectivity in this decision-making process. Furthermore, paediatric patients present their own particular dilemmas. This paper examines these various matters and, with contemporaneous evidence, presents recommendations for management.
Medical Contribution to the Comprehensive Approach
Authors: Fletcher J M
Published: March 2013

The coordination of the Military, Diplomatic and Economic/Development levers of power, the so-called “hard” and “soft” powers, to bring about the strategic aims of governments, supported by Non-Governmental Organisations and international organisations, is commonly known as the Comprehensive Approach (CA). The CA is now part of both NATO and UK military doctrine and concepts development. This article describes how medical branch HQ Allied Rapid Reaction Corp, as part of the HQs work to operationalise the CA, has sought and developed training opportunities to improve individual skill-sets to enable the branch to better contribute to the CA process.
Continuous Improvement in Healthcare Support to Operations
Authors: Bricknell Martin CM , Cordell RF
Published: March 2013

This paper discusses the emerging concept of Continuous Improvement in Healthcare Support to Operations (CIHSO) recently introduced within NATO. It starts by summarising the developments in NATO policy regarding clinical governance and how this has evolved into CIHSO before examining the operational aspects of CIHSO within thePlan-Refine-Execute(PRE) process of operational planning process. It then looks at the components of a CIHSO system as it might apply to the deployed military healthcare system covering the functions of medical and tactical evacuation, deployed hospital care and executing medical operations. The last stage of PRE should includeassessmentthrough the tracking of key performance indicators of the military medical system. The UK and American systems of assurance for the deployed trauma system are reviewed as part of the clinical aspect of CIHSO, as well as consideration some of the emerging issues in the management of CIHSO in a multinational environment.
Bullying and the UK Armed Forces
Authors: Coetzee Rikus H , Atkins S , Gould M
Published: March 2013

There are certain characteristics of the culture and environment in the Armed Forces that may be conducive to bullying. In this article we examine the cultural and environmental factors that may encourage such behaviour and those that act as deterrents for victims to come forward. We will look at the scope of this problem within the UK Armed Forces specifically, before more generally considering the psychological impact of bullying. There appears to be an overall downward trend in bullying within the UK Armed Forces and a positive increase in complaints as more victims step forward. We conclude by highlighting some areas for further development.
Contact Irritant Dermatitis in Kenya
Authors: Nelson Toby , Raitt S
Published: March 2013

Kenya is one of the British Army’s main training areas outside of the UK and the flora and fauna present the physicians with several challenges. A 22 year old infantry soldier presented with a vesicular, linear painful rash across his chest caused by the chemical excreted from the Staphylinid or rove beetle, known locally as the Nairobi fly. Treatment included topical antibiotic and steroid creams to good effect. This report highlights the recognition, treatment and complications of the Nairobi Fly.
Outbreak of Zoonotic Cutaneous Leishmaniasis with Local Dissemination in Balkh, Afghanistan
Authors: Bailey Mark S , Caddy AJ , McKinnon KA , Fogg LF , Roscoe M , Bailey JW , O’Dempsey TJ , Beeching NJ
Published: March 2013

Objectives:

In Afghanistan zoonotic cutaneous leishmaniasis (CL) due to Leishmania major has been less widely reported than anthroponotic CL due to L. tropica. However, an outbreak of zoonotic CL occurred amongst a group of British soldiers at a military camp near Mazar-e-Sharif in the Balkh province of northern Afghanistan in 2004.

Methods:

A study was performed to assess the epidemiology, clinical features, parasitology results, treatment outcomes and environmental health measures associated with this incident.

Results:

Twenty (17%) of 120 soldiers developed CL due to L. major and the risk of infection increased with the proximity of their accommodation to an area of recently cleared scrub, where many wild rodents were observed. Most cases had features of local dissemination, including secondary lesions from the pseudo-Koebner phenomenon, sporotrichoid lymphatic spread, lymphadenopathy and satellite papules or milia formation around healing lesions. Several cases responded poorly to fluconazole and low dose (10 mg/kg) sodium stibogluconate, which were considered suitable treatments at the time. Environmental health measures at the military camp were found to be deficient.

Conclusions:

Zoonotic CL due to L. major is a significant threat for foreign troops based in Balkh, Afghanistan and may present with unusually severe clinical features and be resistant to previously recommended treatments.
Dermatology on Operation HERRICK
Authors: Driver Jamie , Simpson R , Wall C , Nelson TG
Published: March 2013

Objectives:

To identify the dermatological conditions affecting British troops in Afghanistan, understand how they are treated and identify potential areas for improvement.

Methods:

Data was collected from the Defence Analytical Services and Advice agency and the Operational Emergency Department Attendance Register via the Disease and Non Battle Injury working group. Additional data was collected from J4 – Medical Permanent Joint Headquarters. Treatment information from Clinical Guidelines on Operations (CGOs), Medics’ protocols, and primary care module composition was reviewed.

Results:

Dermatological conditions accounted for 1 in 5 attendances to a Role 1 Medical Treatment Facility during the study period. They were consistently in the top five reasons for working days lost, and had a comparatively high hospital admission rate (0.3/1000 Population at Risk (PAR)/month) and a repatriation rate similar to other medical specialties such as respiratory and neurology (0.1/1000 PAR/month). Treatment appeared to be adequate based on declining return attendance numbers, although CGOs were found to lack dermatological protocols and medic protocols were eight years old and not specific to the current operational requirements.

Conclusions:

Although treatments are working for dermatological conditions, areas for optimisation of health care have been identified, such as updating medic protocols to include campaign specific information and latest guidelines in the CGOs. Pre-deployment dermatologist-devised treatment plans and tele-consults may also help keep soldiers with pre-existing skin complaints in theatre.
Management of Splenic Injury
Authors: Hancock GE , Farquharson A L
Published: March 2013

Traumatic splenic injury is a potentially life-threatening complication of both blunt and penetrating trauma to the abdomen and thorax. The spleen is susceptible to injury in the presence or absence of damage to surrounding viscera and can lead to haemodynamic instability and hypovolaemic shock. This review examines the classification, investigation and management of this condition with both non-operative and operative techniques.
Behavioural activation for the treatment of depression in military personnel
Authors: Whybrow Dean
Published: March 2013

Introduction

Depression is a common mental health problem in both civilian and military populations. Access to evidence based psychological therapies for treating common mental health problems such as depression may not be adequate at present. Behavioural Activation (BA) represents a National Institute for Clinical Excellence recommended, evidence-based treatment for depression. The aim of this review was to review the literature to determine how BA could work as a therapeutic approach for military personnel with depression.

Method

Five specialty-specific electronic databases were searched using the key words ‘behavioural activation’, ‘activity scheduling’ and ‘depression’. Emerging themes were drawn out of the literature using a long table approach to thematic analysis.

Results

Seven themes were identified: Clinical Effectiveness, Cultural Competence, Co-morbidity, Cost Effectiveness, Alternatives to Face-to-Face Therapy, Training and Patient Experience.

Conclusions

Group based BA is a cost effective option that may build upon service personnel's cultural affinity to teamwork and peer support. Brief training workshops and supervision could be provided to military mental health nurses to deliver group based BA. However service delivery may also be enhanced by enabling some nurses to specialise as Cognitive Behavioural Psychotherapists. More research is needed to understand whether this pragmatic, two pronged approach to training would result in the sustained dissemination of evidence based practice.
Radial forearm flaps as durable soft tissue coverage for local nationals being treated in the field hospital setting
Authors: Hanna KH , Jeffery SLA
Published: March 2013

The current conflict in Afghanistan has seen the increasing use of Improvised Explosive Devices (IED) in insurgency attacks. In addition to the coalition forces killed and injured from these devices, local national civilians are also injured. Injuries often include amputations, open fractures and large areas of skin affected by fragmentation. Local national access to long-term care after an IED injury is limited, and often when the patient leaves a coalition hospital this concludes the care the patient will receive. Definitive, durable treatment options are needed for these patients. In the IED-injured patient with open extremity wounds and open metacarpal fractures, pedicled radial forearm flaps offer a suitable soft tissue coverage option. Four cases are reported on IED- injured Afghan patients treated at a Role 3 hospital facility.
Forest harvesting impacts on mortality of an endangered lichen at the landscape and stand scales
Authors: Cameron Robert P. , Neily Tom , Clapp Harold
Published: March 2013

Industrial forestry can negatively affect biodiversity, and rare or endangered species are particularly vulnerable. Boreal felt lichen (Erioderma pedicellatum (Hue) P.M.Jørg.) is a globally critically endangered species, and its population in Nova Scotia has been reduced through harvesting of its host tree balsam fir (Abies balsamea (L.) Mill.). We hypothesized that forest harvesting adjacent to and within the landscape of boreal felt lichen could increase the risk of mortality by negatively affecting microclimate of its habitat. Autologistic regression models were used to measure probability of mortality (death or disappearance) with harvesting history at the stand and landscape scales. Erioderma pedicellatum mortality and 17-year tree harvesting history derived from satellite data were used in the model. Modeling at the stand scale suggested that the probability of E. pedicellatum mortality increased as the area of tree harvesting increased. At the landscape scale, the model suggested that probability of E. pedicellatum mortality increased as the area of harvest within 500 m increased. Adjacent tree harvesting may increase solar radiation, wind, and temperature, which could have a negative effect on E. pedicellatum survival. We recommend maintaining uncut buffer zones around E. pedicellatum and limiting the size of harvest blocks and amount of harvesting in the landscape over a given time period to help conserve this endangered species.
Physiological focus on the erythropoietin–hepcidin–ferroportin axis
Authors: D’Anna María Cecilia , Roque Marta Elena
Published: March 2013

To analyze the interconnection between erythropoiesis and iron metabolism, one of the issues raised in this study was to know iron bioavailability under physiopathological conditions. Our aim was to understand the functional axis response composed of erythropoietin (Epo)—hepcidin—ferroportin (FPN), when 2 dysfunctional states coexist, using an animal model of iron overload followed by hypoxia. FPN and prohepcidin were assessed by immunohistochemistry using rabbit anti-mouse FPN polyclonal and prohepcidin monoclonal antibodies. Goat-labeled polymer − horseradish peroxidase anti-rabbit EnVision + System (DAB) was used as the secondary antibody. Epo levels were measured by ELISA. Tissue iron was studied by Prussian blue iron staining. Erythropoietic response was assessed using conventional hematological tests. Iron overload increased prohepcidin that remained high in hypoxia, coexisting with high levels of Epo in hypoxia, with or without iron overload. In hypoxia, FPN was clearly evident in reticuloendothelial macrophages, more than in hypoxia with iron overload. Interestingly, duodenal FPN was clearly identified on the basolateral membrane in hypoxia, with or without iron overload. Our data indicate that 2 signals could induce the cell-specific response as follows: (i) iron signal, induced prohepcidin, which reduced reticuloendothelial FPN and reduced iron availability; and (ii) hypoxia signal, stimulated Epo, which affected iron absorption by stabilizing duodenal FPN and allowed iron supply to erythropoiesis independently of store size.
Oxidative stress and cardiovascular health: therapeutic potential of polyphenols
Authors: Khurana Sandhya , Piche Matthew , Hollingsworth Amanda , Venkataraman Krishnan , Tai T.C.
Published: March 2013

Reactive oxygen species (ROS) are important in normal cellular function and physiology. However, oxidative stress resulting from an accumulation of ROS has a detrimental impact on cellular function, and ROS has been implicated in the pathogenesis of a number of diseases, including cardiovascular diseases. This review provides a summary of the impact of ROS on cardiovascular health and diseases, highlighting the therapeutic use of antioxidants. In addition, this review summarizes the health benefits of polyphenols, and the recent progress on understanding the cellular and physiological actions by which polyphenols may impart their beneficial properties on cardiovascular health.
CAN WE RELATE TIME-REVERSAL VIOLATION TO NEW PHYSICS PROCESSES IN WEAK HADRONIC DECAYS?
Authors: AJALTOUNI Z. J. , DI SALVO E.
Published: March 2013

This review paper stresses the possible connection between time-reversal violation and new physics processes beyond the standard model. In particular, this violation is proposed as an alternative to CP violation in the search for such unkown processes. Emphasis is put on the weak decays of heavy hadrons, especially beauty ones. Specific methods for extracting useful parameters from experimental data are elaborated in order to test TR symmetry. These methods could be used successfully in the analysis of the LHC data.
Fostering creativity in CS1 by hosting a computer science art show
Authors: Porter Leo , Simon Beth
Published: March 2013

Computer science is ultimately about creating. Most people enter the field of computer science with a desire to create something new, whether that is "software" (of whatever type), web applications, mobile applications, video games, self-driving cars, etc. However, creativity is probably not a term the common public widely associates with computing. To address this misconception, we developed and directed campus-wide Computer Science Art Shows to be run in conjunction with Media Computation-based CS1 classes. The Computer Science Art Show enables students to showcase their work to their peers while simultaneously highlighting the opportunity to create in computer science. This article describes the art show, details how to integrate the class homework problems into the show, and provides guidance to potential show directors.
Progress on Website Accessibility?
Authors: Hanson Vicki L. , Richards John T.
Published: March 2013

Over 100 top-traffic and government websites from the United States and United Kingdom were examined for evidence of changes on accessibility indicators over the 14-year period from 1999 to 2012, the longest period studied to date. Automated analyses of WCAG 2.0 Level A Success Criteria found high percentages of violations overall. Unlike more circumscribed studies, however, these sites exhibited improvements over the years on a number of accessibility indicators, with government sites being less likely than topsites to have accessibility violations. Examination of the causes of success and failure suggests that improving accessibility may be due, in part, to changes in website technologies and coding practices rather than a focus on accessibility per se.
HTML Automatic Table Layout
Authors: Marriott Kim , Moulder Peter , Hurst Nathan
Published: March 2013

Automatic layout of tables is required in online applications because of the need to tailor the layout to the viewport width, choice of font, and dynamic content. However, if the table contains text, minimizing the height of the table for a fixed maximum width is NP-hard. Thus, more efficient heuristic algorithms are required. We evaluate the HTML table layout recommendation and find that while it generally produces quite compact layout it is brittle and can lead to quite uncompact layout. We present an alternate heuristic algorithm. It uses a greedy strategy that starts from the widest reasonable layout and repeatedly chooses to narrow the column for which narrowing leads to the least increase in table height. The algorithm is simple, fast enough to be used in online applications, and gives significantly more compact layout than is obtained with HTML’s recommended table layout algorithm.
A novel low-power embedded object recognition system working at multi-frames per second
Authors: Nikitakis Antonis , Papaioannou Savvas , Papaefstathiou Ioannis
Published: March 2013

One very important challenge in the field of multimedia is the implementation of fast and detailed Object Detection and Recognition systems. In particular, in the current state-of-the-art mobile multimedia systems, it is highly desirable to detect and locate certain objects within a video frame in real time. Although a significant number of Object Detection and Recognition schemes have been developed and implemented, triggering very accurate results, the vast majority of them cannot be applied in state-of-the-art mobile multimedia devices; this is mainly due to the fact that they are highly complex schemes that require a significant amount of processing power, while they are also time consuming and very power hungry. In this article, we present a novel FPGA-based embedded implementation of a very efficient object recognition algorithm called Receptive Field Cooccurrence Histograms Algorithm (RFCH). Our main focus was to increase its performance so as to be able to handle the object recognition task of today's highly sophisticated embedded multimedia systems while keeping its energy consumption at very low levels. Our low-power embedded reconfigurable system is at least 15 times faster than the software implementation on a low-voltage high-end CPU, while consuming at least 60 times less energy. Our novel system is also 88 times more energy efficient than the recently introduced low-power multi-core Intel devices which are optimized for embedded systems. This is, to the best of our knowledge, the first system presented that can execute the complete complex object recognition task at a multi frame per second rate while consuming minimal amounts of energy, making it an ideal candidate for future embedded multimedia systems.
Rigorous rental memory management for embedded systems
Authors: Jeong Jinkyu , Kim Hwanju , Hwang Jeaho , Lee Joonwon , Maeng Seungryoul
Published: March 2013

Memory reservation in embedded systems is a prevalent approach to provide a physically contiguous memory region to its integrated devices, such as a camera device and a video decoder. Inefficiency of the memory reservation becomes a more significant problem in emerging embedded systems, such as smartphones and smart TVs. Many ways of using these systems increase the idle time of their integrated devices, and eventually decrease the utilization of their reserved memory.

In this article, we propose a scheme to minimize the memory inefficiency caused by the memory reservation. The memory space reserved for a device can be rented for other purposes when the device is not active. For this scheme to be viable, latencies associated with reallocating the memory space should be minimal. Volatile pages are good candidates for such page reallocation since they can be reclaimed immediately as they are needed by the original device. We also provide two optimization techniques, lazy-migration and adaptive-activation. The former increases the lowered utilization of the rental memory by our volatile page allocations, and the latter saves active pages in the rental memory during the reallocation.

We implemented our scheme on a smartphone development board with the Android Linux kernel. Our prototype has shown that the time for the return operation is less than 0.77 seconds in the tested cases. We believe that this time is acceptable to end-users in terms of transparency since the time can be hidden in application initialization time. The rental memory also brings throughput increases ranging from 2% to 200% based on the available memory and the applications' memory intensiveness.
Replacement Paths and Distance Sensitivity Oracles via Fast Matrix Multiplication
Authors: Weimann Oren , Yuster Raphael
Published: March 2013

A
distance sensitivity oracle
of an
n
-vertex graph
G
= (
V
,
E
) is a data structure that can report shortest paths when edges of the graph fail. A query (
u
∈
V
,
v
∈
V
,
S
⊆
E
) to this oracle returns a shortest
u
-to-
v
path in the graph
G
′
= (
V
,
E
∖
S
). We present randomized (Monte Carlo) algorithms for constructing a distance sensitivity oracle of size
Õ
(
n
3−α
) for |
S
| =
O
(lg
n
/lg lg
n
) and any choice of 0 <
α
< 1. For real edge-lengths, the oracle is constructed in
O
(
n
4−α
) time and a query to this oracle takes
Õ
(
n
2−2(1−α)/|S|
) time. For integral edge-lengths in {−
M
,...,
M
}, using the current
ω
< 2.376 matrix multiplication exponent, the oracle is constructed in
O
(
Mn
3.376−α
) time with
Õ
(
n
2−(1−α)/|S|
) query, or alternatively in
O
(
M
0.681
n
3.575−α
) time with
Õ
(
n
2−2(1−α)/|S|
) query.

Distance sensitivity oracles generalize the
replacement paths
problem in which
u
and
v
are known in advance and |
S
| = 1. In other words, if
P
is a shortest path from
u
to
v
in
G
, then the replacement paths problem asks to compute, for every edge
e
on
P
, a shortest
u
-to-
v
path that avoids
e
. Our new technique for constructing distance sensitivity oracles using fast matrix multiplication also yields the first subcubic-time algorithm for the replacement paths problem when the edge-lengths are small integers. In particular, it yields a randomized (Monte Carlo)
Õ
(
Mn
2.376
+
M
2 3
n
2.584
)-time algorithm for the replacement paths problem assuming
M
≤
n
0.624
.

Finally, we mention that both our replacement paths algorithm and our distance sensitivity oracle can be made to work, in the same time and space bounds, for the case of failed vertices rather than edges, that is, when
S
is a set of vertices and we seek a shortest
u
-to-
v
path in the graph obtained from
G
by removing all vertices in
S
and their adjacent edges.
Speed Scaling with an Arbitrary Power Function
Authors: Bansal Nikhil , Chan Ho-Leung , Pruhs Kirk
Published: March 2013

This article initiates a theoretical investigation into online scheduling problems with speed scaling where the allowable speeds may be discrete, and the power function may be arbitrary, and develops algorithmic analysis techniques for this setting. We show that a natural algorithm, which uses Shortest Remaining Processing Time for scheduling and sets the power to be one more than the number of unfinished jobs, is 3-competitive for the objective of total flow time plus energy. We also show that another natural algorithm, which uses Highest Density First for scheduling and sets the power to be the fractional weight of the unfinished jobs, is a 2-competitive algorithm for the objective of fractional weighted flow time plus energy.
Inflammatory Myofibroblastic Tumour of the Skull Base
Authors: Maire Jean-Philippe , Eimer Sandrine , San Galli François , Franco-Vidal Valérie , Galland-Girodet Sigolène , Huchet Aymeri , Darrouzet Vincent
Published: March 2013

Inflammatory myofibroblastic tumors (IMTs) are rare benign clinical and pathological entities. IMTs have been described in the lungs, abdomen, retroperitoneum, and extremities but rarely in the head and neck region. A 38-year-old man presented with headache, right exophthalmia, and right 6th nerve palsy. A CT scan revealed enlargement of the right cavernous sinus and osteolytic lesions of the right sphenoid and clivus. MR imaging showed a large tumor of the skull base which was invading the sella turcica, right cavernous sinus, and sphenoidal sinus. A biopsy was performed and revealed an IMT. Corticosteroids were given for 3 months but were inefficient. In the framework of our pluridisciplinary consultation, fractionated conformal radiotherapy (FRT) was indicated at a low dose; 20 Gy in 10 fractions of 2 Gy over 12 days were delivered. Clinical response was complete 3 months after FRT. Radiological response was subtotal 6 months after FRT. Two years later, the patient is well.
Some New Recurrence Relations Concerning Jacobi Functions
Authors: Mejjaoli Hatem , Ould Ahmed Salem Ahmedou
Published: March 2013

The aim of this paper is to obtain some new recurrence relations for the “modified” Jacobi functionsΦλα,β. Based on an asymptotic relationship between the Jacobi function and the Bessel function, the expression of Bessel function in terms of elementary functions follows as particular cases.
The Algebraic Riccati Matrix Equation for Eigendecomposition of Canonical Forms
Authors: Nouri M. , Talatahari S.
Published: March 2013

The algebraic Riccati matrix equation is used for eigendecomposition of special structured matrices. This is achieved by similarity transformation and then using the algebraic Riccati matrix equation to the triangulation of matrices. The process is the decomposition of matrices into small and specially structured submatrices with low dimensions for easy finding of eigenpairs. Here, we show that previous canonical forms I, II, III, and so on are special cases of the presented method. Numerical and structural examples are included to show the efficiency of the present method.