bluuebunny/crossref_metadata_2025 huggingface dataset:
CEP hormones at the nexus of nutrient acquisition and allocation, root development, and plant–microbe interactions
Authors: Taleski Michael , Jin Marvin , Chapman Kelly , Taylor Katia , Winning Courtney , Frank Manuel , Imin Nijat , Djordjevic Michael A
Published: November 2023

A growing understanding is emerging of the roles of peptide hormones in local and long-distance signalling that coordinates plant growth and development as well as responses to the environment. C-TERMINALLY ENCODED PEPTIDE (CEP) signalling triggered by its interaction with CEP RECEPTOR 1 (CEPR1) is known to play roles in systemic nitrogen (N) demand signalling, legume nodulation, and root system architecture. Recent research provides further insight into how CEP signalling operates, which involves diverse downstream targets and interactions with other hormone pathways. Additionally, there is emerging evidence of CEP signalling playing roles in N allocation, root responses to carbon levels, the uptake of other soil nutrients such as phosphorus and sulfur, root responses to arbuscular mycorrhizal fungi, plant immunity, and reproductive development. These findings suggest that CEP signalling more broadly coordinates growth across the whole plant in response to diverse environmental cues. Moreover, CEP signalling and function appear to be conserved in angiosperms. We review recent advances in CEP biology with a focus on soil nutrient uptake, root system architecture and organogenesis, and roles in plant–microbe interactions. Furthermore, we address knowledge gaps and future directions in this research field.
Evaluation of Detection and Efficacy of Decontamination of Respiratory Pathogens Including SARS-CoV-2 on Basic Military Trainee Gas Masks
Authors: Foushee Ann Marie DiGeorge , Casey Theresa M , Strickland Amanda , Ochoa Anna , Asin Susana , Lott Lisa , Burdette Alexander J
Published: November 2023

Introduction

Basic military trainee (BMT) gas mask training poses a potential mechanism of severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) transmission. After training, gas masks are decontaminated. Insufficient decontamination can lead to viral transmission in the next training class. To our knowledge, the decontamination process has not been validated for efficacy in removing respiratory pathogens such as SARS-CoV-2.

Materials and Methods

Inactivated strains of SARS-CoV-2, influenza A and B, and Bordetella pertussis were separately inoculated onto gas masks in the emitter area (n = 5). Pathogen detection in swabs collected from gas masks was performed by real-time polymerase chain reaction (RT-PCR) using the BioFire® RP2.1 panel and Biomeme Franklin system. For decontamination efficacy experiments, pathogens were inoculated onto gas masks, and contaminated areas were swabbed before and after decontamination, with detection using both PCR platforms. Lastly, 65 gas masks were swabbed after gas mask training, and again after the trainees and guardians decontaminated the masks, to identify the presence of any respiratory pathogen exhaled onto the gas masks.

Results

All four pathogens were detected by both PCR platforms. The BioFire® FilmArray® was more sensitive than the Biomeme platform. Decontamination resulted in undetectable levels of all three viruses. B. pertussis was detected on one mask after decontamination. Experiments with live B. pertussis validated that decontamination eliminated all viable bacteria from gas masks. For BMT sampling, all masks were negative for SARS-CoV-2. One mask tested positive for coronavirus 229E. Once decontaminated, all masks tested negative.

Conclusions

BMT gas masks can be monitored for the presence of respiratory pathogens using RT-PCR. The decontamination process removed all viable respiratory pathogens tested from the gas masks. This study demonstrates that RT-PCR can be used to conduct pathogen surveillance on BMT gas masks after training and that the current decontamination process is effective to eliminate respiratory viruses including SARS-CoV-2.
Predictors of Sustained Response to Functional Restoration in a Military Population
Authors: Flynn Diane M , Burke Larisa A , Ransom Jeffrey C , McQuinn Honor M , Steffen Alana D , Snow Tyler J , Doorenbos Ardith Z
Published: November 2023

Introduction

The purpose of this study was to determine if improvement in pain impact and functional performance following a functional restoration (FR) program was sustained up to 6 months posttreatment and to identify predictors of sustained improvement.

Materials and Methods

Secondary analysis of data collected during randomized clinical trial. Study population included 108 US active duty service members who completed an FR program, as well as 3- and/or 6-month follow-up assessments. Primary outcome measure was the NIH Research Task Force (pain) impact score (PIS). Secondary outcome was a composite functional performance measure of treadmill, lifting, and carrying tolerances. Variables analyzed to determine their predictive value included demographics; treatment hours; measures of pain intensity, function, mood, sleep, social satisfaction, pain catastrophizing, kinesiophobia, self-efficacy, pain acceptance, patient activation, functional performance, and neuropathic pain.

Results

Mean PIS and functional performance improved significantly immediately following FR, but after 6 months, only improvement in functional performance sustained. Responder analysis showed that 6 months after FR, 42% of participants reported improvement that exceeded the minimal clinically important difference in PIS or functional performance. Predictors of sustained PIS improvement included younger age, absence of neuropathic pain features, less self-rated disability, better baseline functional performance, and worse baseline PIS. Predictors of sustained functional performance improvement included more treatment hours, lower baseline pain catastrophizing, and lower baseline functional performance.

Conclusions

This study supports the investment of treatment time in FR to yield sustained clinically meaningful improvement, as observed in over 40% of this study’s military participants. Pretreatment predictors of sustained response included lower pain catastrophizing and absence of neuropathic pain. Further research is needed to determine if treatments that improve pain catastrophizing and neuropathic pain will result in sustained improvement in pain impact and functional performance following FR program participation.
Development of the Troop Readiness Evaluation With Augmented Reality Return-to-Duty (Troop READY) Platform to Aid in the Detection and Treatment of Military Mild Traumatic Brain Injury
Authors: Rosenfeldt Anson B , Kaya Ryan D , Owen Kelsey , Hastilow Karissa , Scelina Kathryn , Scelina Logan , Miller Koop Mandy , Zimmerman Eric , Alberts Jay L
Published: November 2023

Introduction

Mild traumatic brain injury (mTBI) is prevalent in service members (SMs); however, there is a lack of consensus on the appropriate approach to return to duty (RTD). Head-mounted augmented reality technology, such as the HoloLens 2, can create immersive, salient environments to more effectively evaluate relevant military task performance. The Troop Readiness Evaluation with Augmented Reality Return-to-Duty (READY) platform was developed to objectively quantify cognitive and motor performance during military-specific activities to create a comprehensive approach to aid in mTBI detection and facilitate appropriate RTD. The aim of this project was to detail the technical development of the Troop READY platform, the outcomes, and its potential role in the aiding detection and RTD decision-making post mTBI. The secondary aim included evaluating the safety, feasibility, and SM usability of the Troop READY platform.

Materials and Methods

The Troop READY platform comprises three assessment modules of progressing complexity: (1) Static and Dynamic Mobility, (2) Rifle Qualification Test, and (3) Small Unit Operations Capacity–Room Breach/Clearing Exercise. The modules were completed by 137 active duty SMs. Safety was assessed through monitoring of adverse events. Feasibility was assessed using the self-directed module completion rate. Usability was measured using the Systems Usability Scale.

Results

No adverse events occurred. Completion rates of the three modules ranged from 98 to 100%. In terms of usability, the mean Systems Usability Scale score of all participants was 83.92 (13.95), placing the Troop READY platform in the good-to-excellent category. Objective motor and cognitive outcomes were generated for each module.

Conclusion

The Troop READY platform delivers self-directed, salient assessment modules to quantify single-task, dual-task, and unit-based performance in SMs. The resultant data provide insight into SM performance through objective outcomes and identify specific areas of executive or motor function that may be slow to recover following mTBI.
The Microsoft HoloLens 2 Provides Accurate Biomechanical Measures of Performance During Military-Relevant Activities in Healthy Adults
Authors: Miller Koop Mandy , Rosenfeldt Anson B , Owen Kelsey , Zimmerman Eric , Johnston Joshua , Streicher Matthew C , Albright Alec , Penko Amanda L , Alberts Jay L
Published: November 2023

Introduction

Augmented reality systems, like the HoloLens 2 (HL2), have the potential to provide accurate assessments of mild traumatic brain injury (mTBI) symptoms in military personnel by simulating complex military scenarios while objectively measuring the user’s movements with embedded motion sensors. The aim of this project was to determine if biomechanical measures of marching and squatting, derived from the HL2 motion sensors, were statistically equivalent, within 5%, to metrics derived from the gold-standard three-dimensional motion capture (MoCap) system.

Materials and Methods

Sixty-four adults (18-45 years; 34 males) completed a squatting and a marching task under single- (motor) and dual-task (motor + cognitive) conditions. Positional data from the HL2 and MoCap were simultaneously collected during the tasks and used to calculate and compare biomechanical outcomes. The HL2’s augmented reality capabilities were utilized to deliver the cognitive component of the marching dual task.

Results

Equivalence testing indicated the HL2 and MoCap measures were within 5% in all squatting metrics—trial time, squat duration, squat velocity, squat depth, and dwell time. Marching metrics, including trial time, step count, stepping rate, and step interval, were also equivalent between the two systems. The mean reaction time for responses during the Stroop test was 810 (125) milliseconds per response.

Conclusions

Biomechanical outcomes characterizing performance during two common military movements, squatting and marching, were equivalent between the HL2 and MoCap systems in healthy adults. Squatting and marching are two military-relevant tasks that require strength, motor coordination, and balance to perform, all of which are known to be affected by mTBI. Taken together, the data provide support for using the HL2 platform to deliver military-specific assessment scenarios and accurately measure performance during these activities. Utilizing objective and quantitative measures of motor function may enhance the management of military mTBI and reduce unnecessary risk to service members.
Sustained vs. Intratidal Recruitment in the Injured Lung During Airway Pressure Release Ventilation: A Computational Modeling Perspective
Authors: Cruz Andrea F , Herrmann Jacob , Ramcharran Harry , Kollisch-Singule Michaela , Tawhai Merryn H , Bates Jason H.T , Nieman Gary F , Kaczka David W
Published: November 2023

Introduction

During mechanical ventilation, cyclic recruitment and derecruitment (R/D) of alveoli result in focal points of heterogeneous stress throughout the lung. In the acutely injured lung, the rates at which alveoli can be recruited or derecruited may also be altered, requiring longer times at higher pressure levels to be recruited during inspiration, but shorter times at lower pressure levels to minimize collapse during exhalation. In this study, we used a computational model to simulate the effects of airway pressure release ventilation (APRV) on acinar recruitment, with varying inspiratory pressure levels and durations of exhalation.

Materials and Methods

The computational model consisted of a ventilator pressure source, a distensible breathing circuit, an endotracheal tube, and a porcine lung consisting of recruited and derecruited zones, as well as a transitional zone capable of intratidal R/D. Lung injury was simulated by modifying each acinus with an inflation-dependent surface tension. APRV was simulated for an inhalation duration (Thigh) of 4.0 seconds, inspiratory pressures (Phigh) of 28 and 40 cmH2O, and exhalation durations (Tlow) ranging from 0.2 to 1.5 seconds.

Results

Both sustained acinar recruitment and intratidal R/D within the subtree were consistently higher for Phigh of 40 cmH2O vs. 28 cmH2O, regardless of Tlow. Increasing Tlow was associated with decreasing sustained acinar recruitment, but increasing intratidal R/D, within the subtree. Increasing Tlow was associated with decreasing elastance of both the total respiratory system and transitional subtree of the model.

Conclusions

Our computational model demonstrates the confounding effects of cyclic R/D, sustained recruitment, and parenchymal strain stiffening on estimates of total lung elastance during APRV. Increasing inspiratory pressures leads to not only more sustained recruitment of unstable acini but also more intratidal R/D. Our model indicates that higher inspiratory pressures should be used in conjunction with shorter exhalation times, to avoid increasing intratidal R/D.
Head Flail Corridors From Sled Impact Acceleration Tests for Use in Occupant-Centric Vehicle Design
Authors: Olszko Ardyn , Abraczinskas Alicia , McGovern Shannon , Robinette Allison , Vasquez Kimberly , Chancey Valeta Carol , Brozoski Frederick
Published: November 2023

Introduction

In aircraft crashes, injuries to the head and upper torso are frequently reported, with head injury reported most frequently of all body regions. Because preventing flail of the head and body is of utmost importance for occupant survival, the Aircraft Crash Survival Design Guide (ACSDG), the guide to crashworthy aircraft design, published flail envelopes. However, the ACSDG flail envelopes are based on a single test with an anthropomorphic test device subjected to a frontal acceleration. In this article, human research volunteer (HRV) response data are used to calculate head flail corridors and evaluate the ACSDG flail envelopes.

Materials and Methods

Data from HRV sled tests were obtained from the historical Naval Biodynamics Laboratory collection of the Biodynamics Data Resource. Digitized high-speed film for each test was tracked and processed to represent the head flail response in a format amenable to corridor development. Time-based and position-based head flail corridors were developed for groups of exposure-matched tests and then compared to the ACSDG flail envelopes.

Results

A collection of 714 HRV sled tests conducted in six different impact directions ranging from 3 to 15 g was used to develop time-based and position-based head flail corridors for 39 match groups. The ACSDG vertical limit and anteroposterior limit and curve were not exceeded by the flail corridors, but the lateral limit and curve were exceeded by 4.6 cm to 15.8 cm.

Conclusions

The flail corridors provide a useful baseline for representing the well-restrained occupant response at lower, non-injurious exposure levels and across multiple impact directions. Under these conditions, the ACSDG lateral limit and curve are not adequate. At higher exposure levels or with modified restraints, seating, or equipment, the ACSDG vertical limit and anteroposterior limit and curves may also be inadequate.
Recommendations for a Military Health System Auditory Blast Injury Prevention Standard
Authors: Brokaw Elizabeth B , S. Brungart Douglas , M. Byrne Ryan , A. Flamme Greg , Gupta Raj , Jokel Charles R , Kujawa Sharon G , Lalis Lisa , L. McKinley Richard , Murphy William J , W. Spencer Rachel , J. Smalt Christopher , F. Zagadou Brissi
Published: November 2023

Introduction

Although existing auditory injury prevention standards benefit warfighters, the Department of Defense could do more to understand and address auditory injuries (e.g., hearing loss, tinnitus, and central processing deficits) among service members. The Blast Injury Prevention Standards Recommendation (BIPSR) Process is designed to address the needs of all the Military Services for biomedically valid Military Health System (MHS) Blast Injury Prevention Standards.

Materials and Methods

Through the BIPSR Process, stakeholders provided their intended uses and requested functionalities for an MHS Blast Injury Prevention Standard. The BIPSR Process established a broad-based, non-advocacy panel of auditory injury Subject Matter Expert (SME) Panel with members drawn from industry, academia, and government. The SME Panel selected evaluation factors, weighted priorities, and then evaluated the resulting candidate MHS Auditory Blast Injury Prevention Standards against the evaluation criteria. The SME Panel members provided rationales for their decisions, documented discussions, and used iterative rounds of feedback to promote consensus building among members. The BIPSR Process used multi-attribute utility theory to combine members’ evaluations and compare the candidate standards.

Results

The SME Panel identified and collated information about existing auditory injury datasets to identify gaps and promote data sharing and comprehensive evaluations of standards for preventing auditory blast injury. The panel evaluated the candidate standards and developed recommendations for an MHS Blast Injury Prevention Standard.

Conclusions

The BIPSR Process illuminated important characteristics, capabilities, and limitations of candidate standards and existing datasets (e.g., limited human exposure data to evaluate the validity of injury prediction) for auditory blast injury prevention. The evaluation resulted in the recommendation to use the 8-hour Equivalent Level (LAeq8hr) as the interim MHS Auditory Blast Injury Prevention Standard while the community performs additional research to fill critical knowledge gaps.
DroidChamber: Multilevel Security for Mobile Devices to Support Telemedicine on the Battlefield
Authors: McVearry Kenneth A
Published: November 2023

Introduction

Apps that support telemedicine on the battlefield typically run on classified devices and transmit information over classified networks, whereas the medical data the apps create and transmit are unclassified. Current systems treat these data as classified, so a cross-domain solution is required to transfer the data back to an unclassified domain, which adds delays and costs to the process of transmitting critical data needed to treat injured warfighters. To address this gap, ATC-NY developed DroidChamber, which is a software-based Android system that enables multilevel security and which runs on smartphones and tablets. DroidChamber enables warfighters to execute apps in multiple security domains without risking information leakage.

Materials and Methods

DroidChamber v6 is a collection of mobile device management and security containerization technologies targeting Android 6, and it applies these technologies by leveraging Linux kernel operating-system-level virtualization technologies. DroidChamber v10 takes advantage of Android Work Profiles and Samsung’s Knox technology in Android 10, which provides the ability to provision separate “work” and “personal” profiles that securely isolate applications; apps within each profile can further be isolated through the built-in Android controls and the Knox Application Policy.

Results

DroidChamber is a software-based Android system, so it requires no added hardware to be attached or integrated with an end-user device. DroidChamber’s innovation is isolation of specific Android app resources (e.g., networking) enforced with fine-grained security policies. With DroidChamber, a medic can connect their device to different security domains, giving a wider range of access to medical information in a tactical environment.

Conclusions

DroidChamber improves telemedicine applications by enabling the warfighter to share information without requiring a cross-domain guard that may erroneously block some data. Using DroidChamber, a warfighter can use a single mobile device to manage/transmit data at different security levels, thereby reducing the cost and complexity of a mission.
A Preliminary Description of the Health of Women Navy Divers: An Examination of Linked Medical, Personnel, and Dive Log Data for 47 Women Divers Who Separated Between 2008 and 2018
Authors: Maguire Brian J , Hughes Linda M , Field Sandra L , Nordness Robert
Published: November 2023

Introduction

Although women have always served in the U.S. Armed Forces, it has only been in the last half century that systematic examinations have been done on the health issues experienced by military women. Still, little is known about how occupational health risks among Navy divers might vary between men and women. Our objective was to use available data to examine health issues among all separating divers and then determine how prevalence rates varied between men and women for diagnoses made within the diver’s last year of active duty service.

Materials and Methods

For this retrospective observational study, medical records and personnel data were linked with dive logs at the individual level. We calculated sex-specific prevalence rates and relative risks per 1,000 divers by major diagnostic categories and by specific disease diagnoses.

Results

We identified 47 women among the 4,623 active duty Navy divers (1.0%) who separated between 2008 and 2018. Ages varied between 19 and 54 years (M = 33, SD = 8) for women, compared to men who were 18-65 years (M = 35, SD = 9). When compared to men, women had about six times the rate of diseases of the genitourinary system, twice the rate of respiratory system diseases, and about four times as many diagnoses of disorders of the lacrimal system.

Conclusions

The findings of much higher relative risks for women for conditions such as genitourinary disease, skin conditions, and acute respiratory infections require follow-up research to look for causes and potential risk reduction interventions. Future research must determine specific and relative risks as a necessary precursor to developing, implementing, and testing potentially sex-specific risk reduction and health improvement interventions.
Evidence-Based Strategies to Enhance Weight Management Programs for Adult Military Beneficiaries: A Narrative Review
Authors: Bukhari Asma S , Knowles Wendi L , Reagan Joanna J , Schwartz Julie A , Lindberg Tammy J , Hough Heather L , Wagaman Lisa M , Young Kristen L , Harward Jennifer B , Feeney Kimberly A , Weinstein James L
Published: November 2023

Introduction

Overweight and obesity trends are on the rise among both civilian and military beneficiaries. The purpose of this narrative review was to evaluate nutrition, behavioral, lifestyle, pharmacotherapy, and alternative approaches to weight management (WM) among adults with a focus toward identifying gaps and evidence-based strategies that could support or enhance current and future WM programming among military adult beneficiaries.

Materials and Methods

A trained research team identified publications (January 2013-January 2020) for abstract review using key search terms and inclusion criteria. Two independent researchers conducted both the abstract review and full-paper bias scoring using selected Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) criteria. All eligible studies were assessed for bias and categorized based on key themes. The study was registered in PROSPERO, the international prospective register of systematic reviews.

Results

The research team identified 741 articles, with 278 meeting final inclusion criteria. The mean bias score was 7.5 ± 3.9 (score of 0-13; higher indicating fewer bias factors), with 64% scoring ≥9. Factors contributing to low bias included intervention compliance, dropout rate, and inability to blind participants. The most common published weight-loss interventions included a combination of therapies (59%), diet/supplement (17%), other approaches (12%), behavior change (7%), and exercise (6%). Themes identified to improve WM outcomes included leveraging technology, increasing intervention interactions, community support, emphasis on early weight loss, pharmacotherapy risk–benefit, enhanced behavioral component, resistance exercise, mindfulness, and benefits of quality-of-life measures.

Conclusions

Reviewers identified several validated tools and techniques to augment and update existing WM programming to improve health and weight outcomes. The review affirmed use of individualized dietary patterns and not a “one-size-fits-all approach” as well as incorporating more comprehensive and team-approached treatments to make the best use of tools and strategies to enhance outcomes.
Surgical Team Structure: How Familiarity and Team Size Influence Communication Effectiveness in Military Surgical Teams
Authors: Stucky Christopher H , Kabo Felichism W , De Jong Marla J , House Sherita L , Wymer Joshua A
Published: November 2023

Introduction

Preventable patient harm has persisted in health care despite recent advances to reduce errors. There is increasing recognition that non-technical skills, including communication and relationships, greatly impact interprofessional team performance and health care quality. Team familiarity and size are critical structural components that potentially influence information flow, communication, and efficiency.

Methods

In this exploratory, prospective, cross-sectional study, we investigated the key structural components of surgical teams and identified how surgical team structure shapes communication effectiveness. Using total population sampling, we recruited surgical clinicians who provide direct patient care at a 138-bed military medical center. We used statistical modeling to characterize the relationship between communication effectiveness and five predictors: team familiarity, team size, surgical complexity, and the presence of surgical residents and student anesthesia professionals.

Results

We surveyed 137 surgical teams composed of 149 multidisciplinary clinicians for an 82% response rate. The mean communication effectiveness score was 4.61 (SD = 0.30), the average team size was 4.53 (SD = 0.69) persons, and the average surgical complexity was 10.85 relative value units (SD = 6.86). The surgical teams exhibited high variability in familiarity, with teams co-performing 26% (SD = 0.16) of each other’s surgeries. We found for every unit increase in team familiarity, communication effectiveness increased by 0.36 (P ≤ .05), whereas adding one additional member to the surgical team decreased communication effectiveness by 0.1 (P ≤ .05). Surgical complexity and the influence of residents and students were not associated with communication effectiveness.

Conclusions

For military surgical teams, greater familiarity and smaller team sizes were associated with small improvements in communication effectiveness. Military leaders can likely enhance team communication by engaging in a thoughtful and concerted program to foster cohesion by building familiarity and optimizing team size to meet task and cognitive demands. We suggest leaders develop bundled approaches to improve communication by integrating team familiarity and team size optimization into current evidence-based initiatives to enhance performance.
Systematic Improvements to the Army’s Deployment Cycle Resilience Training Using a Comprehensive, Iterative Process
Authors: Kirk Michelle A , Nolet Jason M , Adrian Amanda L , Knust Susannah K
Published: November 2023

Introduction

To support soldier readiness and mitigate the mental health consequences of deployments, Army regulation mandates soldiers to receive Deployment Cycle Resilience Training (DCRT) throughout their deployment cycle. A recent evaluation revealed several issues with the existing version that threatened the relevancy and usefulness of the training. The present article details the systematic approach taken by the Research Transition Office at the Walter Reed Army Institute of Research to revise the DCRT curriculum and presents the revision updates that are now included in DCRT version 3.

Method

Curriculum developers (n = 2) with subject matter expertise relevant to the project followed an iterative process that was critical to the efficacy of the revisions. Developers used the existing DCRT modules as the curriculum framework and utilized several materials to inform the revisions to include Army doctrine, data from the quality improvement evaluation conducted by the Walter Reed Army Institute of Research, and the current research related to the deployment cycle, resilience, and behavior change. Internal and external stakeholders (n = 31) provided iterative feedback to ensure each of the six modules met DCRT revision objectives.

Results

The revised DCRT curriculum was implemented in August 2021. The resulting revisions included an increase in inclusivity, an emphasis on growth opportunities, an integrative approach to the deployment cycle phases, and greater practical application. Additionally, the curriculum incorporates best practices found to enhance the delivery of resilience-based psychoeducational interventions, specifically within high-risk occupational settings like the military.

Conclusions

The revisions outlined in this article enhance the training quality and potential effectiveness of DCRT, which can positively influence soldier and family readiness and mission success. Furthermore, the deliberate and iterative curriculum revision process can serve as a guide to other curriculum development projects, specifically within the military context. Implementation considerations and potential limitations are provided, and future directions are discussed to include the ongoing evaluation.
The Potential of an Embedded Mental Health Services Program Toward Increasing Health Care–Seeking Behaviors Among U.S. Air Force Aircrew: A Mixed-Methods Study
Authors: Martinez Rachael N , Galloway Kristin , Thompson Christopher
Published: November 2023

Introduction

The U.S. Air Force implemented the Integrated Operational Support model, which involves embedding health care professionals within operational units to meet the health needs of the airmen. This study assessed the extent to which airmen sought out both traditional and embedded mental health services, as well as perceptions of factors that hinder or encourage health care–seeking behaviors.

Materials and Methods

A mixed-methods approach including a web-based occupational psychological health assessment and semi-structured interviews was used to assess airmen’s experiences with seeking mental health care services.

Results

A total of 447 Remotely Piloted Aircraft operators participated in an occupational psychological health assessment (42% response rate) in 2018, and 15 airmen across five high operational tempo, restricted-access installations completed a semi-structured interview (60% participation rate) in 2021. From the occupational assessment, females (33%) sought care from the traditional mental health clinic significantly more than males (21%; χ2 = 5.10, P = .02). However, there were no significant gender differences in seeking embedded mental health services. Respondents who had not sought out help from either the traditional clinic or embedded services were significantly more likely to seek assistance from embedded mental health services (M = 4.29, SD = 2.09) over the traditional clinic (M = 3.92, SD = 1.90), t(205) = 4.94, P < .001. A resounding interview theme was the deep appreciation that airmen expressed for the availability of embedded mental health professionals. Airmen also discussed factors that hinder health care–seeking behaviors with the top-reported factor being the stigma associated with seeking mental health. The top three reported factors that encourage health care–seeking behaviors included leadership and mental health professionals normalizing care, trust in embedded mental health professionals, and ease of access to care.

Conclusions

Findings suggest that having mental health professionals integrated within the unit brings the care straight to the airmen and may reduce the stigma associated with airmen asking for help.
A Novel External Ventricular Drain Sensor to Improve Acquired Brain Injury Monitoring
Authors: Goldblum Zack , Gruen Victoria , Olson DaiWai M , Kanter Giovanni , Moberg Dick
Published: November 2023

Introduction

The insufficiency of current methods to capture the context and environment of neurocritical care can negatively impact patient outcomes. Insertion of an external ventricular drain (EVD) into the ventricles to monitor intracranial pressure (ICP) is a common lifesaving procedure for acquired brain injury patients. Yet, nursing interventions that significantly affect the measured ICP value, such as changing the EVD stopcock position, are poorly documented. Environmental factors like light and noise levels are not monitored as standard of care despite worse outcomes in patients affiliated with sensory sensitivities. Capturing these missing data is an essential first step toward quantifying their effects.

Materials and Methods

Our entry point was the development of a stopcock position sensor (SPS) that attaches to the EVD stopcock and time-synchronously annotates the recorded ICP data with its position. A two-phase, prospective, nonrandomized observational study was conducted to evaluate the efficacy of the SPS. Phase I assessed the SPS using an ex vivo simulation of ICP management. Phase II involved human subjects with the SPS attached to the EVD stopcock while patients were managed per standard of care.

Results

The SPS accurately annotated the ICP data and identified that the EVD drained the cerebrospinal fluid for 94.52% of total patient monitoring time (16.98 h). For only 3.54% of the time, the stopcock directed the cerebrospinal fluid into the pressure transducer for accurate ICP measurement. For the remaining 1.94% of the time, the stopcock was positioned off: No cerebrospinal fluid drainage and no ICP monitoring.

Conclusions

We successfully captured an important aspect of the ICP monitoring context, the EVD stopcock position, and time-synchronized it with the recorded physiology. Our system enables future investigations into the impact that a broad contextual data environment has on physiological measurements and acquired brain injury patient outcomes. In the future, we aim to capture additional contextual data sources and expand the scope to battlefield environments.
Legal Performance-enhancing Drugs Alter Course and Treatment of Rhabdomyolysis-induced Acute Kidney Injury
Authors: Hebert Jessica F , Eiwaz Mahaba B , Nickerson Megan N , Munhall Adam C , Pai Akash A , Groat Tahnee , Andeen Nicole K , Hutchens Michael P
Published: November 2023

Introduction

Rhabdomyolysis-induced acute kidney injury (RIAKI) can interrupt physical training and increase mortality in injured warfighters. The legal performance-enhancing drugs caffeine and ibuprofen, which can cause renal injury, are widely used by service members. Whether caffeine or ibuprofen affects RIAKI is unknown. Cilastatin treatment was recently identified as an experimental treatment to prevent RIAKI at injury. To determine potential interacting factors in RIAKI treatment, we test the hypothesis that caffeine and ibuprofen worsen RIAKI and interfere with treatment.

Materials and Methods

In mice, RIAKI was induced by glycerol intramuscular injection. Simultaneously, mice received caffeine (3 mg/kg), ibuprofen (10 mg/kg), or vehicle. A second cohort received volume resuscitation (PlasmaLyte, 20 mL/kg) in addition to caffeine or ibuprofen. In a third cohort, cilastatin (200 mg/kg) was administered concurrently with drug and glycerol administration. Glomerular filtration rate (GFR), blood urea nitrogen (BUN), urine output (UOP), renal pathology, and renal immunofluorescence for kidney injury molecule 1 were quantified after 24 hours.

Results

Caffeine did not worsen RIAKI; although BUN was modestly increased by caffeine administration, 24-hour GFR, UOP, and renal histopathology were similar between vehicle-treated, caffeine-treated, and caffeine + PlasmaLyte–treated mice. Ibuprofen administration greatly worsened RIAKI (GFR 14.3 ± 19.5 vs. 577.4 ± 454.6 µL/min/100 g in control, UOP 0.5 ± 0.4 in ibuprofen-treated mice vs. 2.7 ± 1.7 mL/24 h in control, and BUN 264 ± 201 in ibuprofen-treated mice vs. 66 ± 21 mg/dL in control, P < .05 for all); PlasmaLyte treatment did not reverse this effect. Cilastatin with or without PlasmaLyte did not reverse the deleterious effect of ibuprofen in RIAKI.

Conclusions

Caffeine does not worsen RIAKI. The widely used performance-enhancing drug ibuprofen greatly worsens RIAKI in mice. Standard or experimental treatment of RIAKI including the addition of cilastatin to standard resuscitation is ineffective in mice with RIAKI exacerbated by ibuprofen. These findings may have clinical implications for the current therapy of RIAKI and for translational studies of novel treatment.
A Common Data Element–Based Adjudication Process for mTBI Clinical Profiles: A Targeted Multidomain Clinical Trial Preliminary Study
Authors: Durfee Kori J , Elbin R J , Trbovich Alicia M , Womble Melissa N , Mucha Anne , Stephenson Katie , Holland Cyndi L , Dollar Christina M , Sparto Patrick J , Collins Michael W , Kontos Anthony P
Published: November 2023

Introduction

The primary purpose of this study was to examine the prevalence and percent agreement of clinician-identified mild traumatic brain injury (mTBI) clinical profiles and cutoff scores for selected Federal Interagency Traumatic Brain Injury Research common data elements (CDEs). A secondary purpose was to investigate the predictive value of established CDE assessments in determining clinical profiles in adults with mTBI.

Materials and Methods

Seventy-one (23 males; 48 females) participants (M = 29.00, SD = 7.60, range 18-48 years) within 1-5 months (M = 24.20, SD = 25.30, range 8-154 days) of mTBI completed a clinical interview/exam and a multidomain assessment conducted by a licensed clinician with specialized training in concussion, and this information was used to identify mTBI clinical profile(s). A researcher administered CDE assessments to all participants, and scores exceeding CDE cutoffs were used to identify an mTBI clinical profile. The clinician- and CDE-identified clinical profiles were submitted to a multidisciplinary team for adjudication. The prevalence and percent agreement between clinician- and CDE-identified clinical profiles was documented, and a series of logistic regressions with adjusted odds ratios were performed to identify which CDE assessments best predicted clinician-identified mTBI clinical profiles.

Results

Migraine/headache, vestibular, and anxiety/mood mTBI clinical profiles exhibited the highest prevalence and overall percent agreement among CDE and clinician approaches. Participants exceeding cutoff scores for the Global Severity Index and Headache Impact Test-6 assessments were 3.90 and 8.81 times more likely to have anxiety/mood and migraine/headache profiles, respectively. The Vestibular/Ocular Motor Screening vestibular items and the Pittsburgh Sleep Quality Index total score were predictive of clinician-identified vestibular and sleep profiles, respectively.

Conclusions

The CDEs from migraine/headache, vestibular, and anxiety/mood domains, and to a lesser extent the sleep modifier, may be clinically useful for identifying patients with these profiles following mTBI. However, CDEs for cognitive and ocular may have more limited clinical value for identifying mTBI profiles.
Application of Nanoconfinement Technology for Highly Effective Monitoring of Chemical Exposure During Military Service
Authors: Materer Nicholas , Apblett Allen , Kadossov Evgueni , Shaikh Shoaib , Teicheira Michael
Published: November 2023

Introduction

There is myriad of volatile compounds to which military personnel are exposed that can potentially have negative effects on their health. Military service occurs in a broad array of environments so it is difficult to predict the hazardous compounds to which the personnel might be exposed. XploSafe is developing passive diffusive samplers to facilitate the sampling and quantification of a wide range of chemical vapor exposures that personnel may be exposed to in the workplace.

Materials and Methods

Passive diffusive samplers were constructed by filling porous Teflon tubes with OSU-6, a nanoporous silica sorbent, to produce sampler tokens.  Three of these tokens were placed within a badge to fabricate passive samplers. Absorption experiments were performed to determine linear exposure regimes, sampling rates, and limits of quantification for 11 compounds, representing 8 chemical classes.

Results

The sampling rates were determined for 11 compounds representing 8 chemical classes. The measured linear ranges for the studied compounds are sufficiently large to allow effective sampling for 8 hours or longer. Accurate dosimetry is possible even with exposure times of days or weeks. The samplers were able to detect the presence of five airborne compounds in a paint booth of a military contractor located in Bristow, Oklahoma, and determine their average exposure concentrations.

Conclusions

OSU-6 based sampler badges were able to detect the presence and quantify the average exposures of five airborne compounds in a paint booth of a military contractor located in Bristow, Oklahoma. Experiments show that these samplers can adsorb and quantify a broad array of different volatile organic compounds whose high sampling rates coupled with high capacity provide both sensitivity and the ability to quantify over a large range of exposures. This technology can meet the requirements for personal samplers to create Individual Longitudinal Exposure Record for each military person.
Near-Infrared Spectroscopy Monitoring to Detect Changes in Cerebral and Renal Perfusion During Hypovolemic Shock, Volume Resuscitation, and Vasoconstriction
Authors: Borg Ulf , Katilius Julia Z , Addison Paul S
Published: November 2023

Introduction

Rapidly changing hemodynamic conditions, such as uncontrolled hemorrhage and the resulting hypovolemic shock, are a common contributor to active duty military deaths. These conditions can cause cerebral desaturation, and outcomes may improve when regional cerebral oxygen saturation (CrSO2) is monitored using near-infrared spectroscopy (NIRS) and desaturation episodes are recognized and reversed. The purpose of this porcine study was to investigate the ability of NIRS monitoring to detect changes in regional cerebral and regional renal perfusion during hypovolemia, resuscitation by volume infusion, and vasoconstriction.

Materials and Methods

Hemorrhagic shock was induced by removing blood through a central venous catheter until mean arterial pressure (MAP) was <40 mmHg. Each blood removal step was followed by a 10-minute stabilization period, during which cardiac output, blood pressure, central venous pressure, blood oxygen saturation, and CrSO2 and regional renal oxygen saturation (RrSO2) were measured. Shock was reversed using blood infusion and vasoconstriction separately until MAP returned to normal. Statistical comparisons between groups were performed using the paired t-test or the Wilcoxon signed-rank test.

Results

Using volume resuscitation, both CrSO2 and RrSO2 returned to normal levels after hypovolemia. Blood pressure management with phenylephrine returned CrSO2 levels to normal, but RrSO2 levels remained significantly lower compared to the pre-hemorrhage values (P < .0001). Comparison of the percent CrSO2 as a function of MAP showed that CrSO2 levels approach baseline when a normal MAP is reached during volume resuscitation. In contrast, a significantly higher MAP was required to return to baseline CrSO2 during blood pressure management with phenylephrine (P < .0001). Evaluation of carotid blood flow and CrSO2 indicated that during induction of hypovolemia, the two measures are strongly correlated. In contrast, there was limited correlation between carotid blood flow and CrSO2 during blood infusion.

Conclusions

This study demonstrated that it is possible to restore CrSO2 by manipulating MAP with vasoconstriction, even in profound hypotension. However, MAP manipulation may result in unintended consequences for other organs, such as the kidney, if the tissue is not reoxygenated sufficiently. The clinical implications of these results and how best to respond to hypovolemia in the pre-hospital and hospital settings should be elucidated by additional studies.
Optimizing Virtual Health Technologies Through a Performance-based Readiness Model: Lessons From the Field Deployment of National Emergency Tele-Critical Care Network
Authors: Hill James J , Wild David J , Schmidt Patricia M
Published: November 2023

Introduction

The advancement of the Army’s National Emergency Tele-Critical Care Network (NETCCN) and planned evolution to an Intelligent Medical System rest on a digital transformation characterized by the application of analytic rigor anchored and machine learning.

The goal is an enduring capability for telecritical care in support of the Nation’s warfighters and, more broadly, for emergency response, crisis management, and mass casualty situations as the number and intensity of disasters increase nationwide. That said, technology alone is unlikely to solve the most pressing issues in operational medicine and combat casualty care.

Materials and Methods

A total performance system (TPS) creates opportunities to address vulnerabilities and overcome barriers to success. As applied during the NETCCN project, the TPS captures the best performance-centric information and know-how, increasing the potential to save lives, improve readiness, and accomplish missions.

Results

The purpose of this project was to apply a performance-based readiness model to aid in the evaluation of Army telehealth technologies. Through various user-facing surveys, polls, and reporting techniques, the project aimed to measure the perceived value of telehealth technologies within a sample of the project team member population. By providing a detailed approach to the collection of lessons learned, researchers were able to determine the importance of information and methods versus a focus on technology alone. The use of an emoji-based feedback assessment indicated that most lessons learned were helpful to the project team.

Conclusions

Through the NETCCN TPS, we have been able to address product-related measures, knowledge of product efficacy, project metrics, and many implementation considerations that can be further investigated by setting and engagement type. Through the Technology in Disaster Environments learning accelerator, it was possible to rapidly acquire, process, organize, and disseminate best practices and learnings in near real time, providing a critical feedback and improvement loop.