bluuebunny/crossref_metadata_2025 huggingface dataset:
Prevalence of Musculoskeletal Injuries in a Security Force Assistance Brigade Before, During, and After Deployment
Authors: Koreerat Nicholas R , Koreerat Christina M
Published: January 2021

Introduction

The Security Force Assistance Brigades (SFABs) are specialized units designed to strengthen allied and partnered nations through advising, supporting, liaising, and assessing in support of U.S. national security interests and combatant commanders’ war fighting objectives. As the 1st SFAB was the pioneer unit, descriptive analysis of the musculoskeletal injures and body regions occurring before, during, and after deployment was previously unavailable, limiting the ability of embedded holistic health and fitness teams to proactively address the unit’s musculoskeletal needs and medical readiness.

Materials and Methods

Physical therapists collected and retrospectively analyzed data from 4597 encounters over 19 months: 4 months before, 9 months during, and 4 months after deployment using descriptive statistics.

Results

Physical therapy encounters averaged 124 per month during pre-deployment preparation, 363 per month during deployment, and 206 per month post-deployment. The most common musculoskeletal injuries identified during pre-deployment were to the lumbar spine (31.8%), knee (18.1%), and shoulder (9.1%). The most common areas of injury during deployment were to the lumbar spine (28.4%), thoracic spine (18.3%), and shoulder (14.0%). The most common post-deployment injuries consulted were to the lumbar spine (21.3), shoulder (19.6%), and knee (17.8%).

Conclusion

Musculoskeletal injuries are a concern that may limit medical readiness in the SFABs in the time of before, during, and after deployment. Low back pain is the primary musculoskeletal injury of the 1st SFAB throughout the entire deployment cycle. Based on these findings, recommendations include embedding injury prevention programs to address low back pain to improve medical readiness. More research is required to assess the effectiveness of these programs in reducing incidents of musculoskeletal injuries before, during, and after deployment cycles.
Menstrual Practices in Operational Military Women
Authors: Phillips Angela K , Wilson Candy
Published: January 2021

Introduction

Women’s sex-specific health care and hygiene needs are part of military readiness for female service members and important for their leaders to ensure unit readiness. Promoting readiness that includes women’s health needs contributes to the overall strength of the military. Because women comprise over 15% of today’s military force and growing in proportion, readiness for military women has obtained increased attention in research and health practice. Menstruation is a sex-specific experience that must be part of the consideration for individual military readiness. Little research has explored the in-garrison readiness of women, particularly for women in high operations tempo settings, when considering menstruation management. The specific aim of this study was to explore how active duty U.S. Air Force women manage their menstruation while living day-to-day in a military culture.

Methods

A qualitatively driven mixed-method design using ethnography was conducted. Data collection included multiple sources: observations, questionnaire data, interviews, and focus groups among a group of Air Force Security Forces women.

Results

Data from questionnaires (n = 16) and interviews or focus groups (n = 10) were analyzed. Themes included knowledge, cop culture, and support. Comprehensive findings demonstrated that women were knowledgeable about menstruation and menstrual suppression, but did not practice it. No women in the study were suppressing menstruation. Military culture had minimal impact on menstrual practices, whereas knowledge, attitudes, and beliefs gained from family and friends was more influential on how women in this study managed menstruation.

Conclusions

This study was the first to use a qualitatively driven mixed-method design to explore military women’s menstrual practices in an operational setting. This study can be used in collaboration with other evidence to promote health of military women through clinical education and support in command environments. Future research should consider other operational settings where women are expected to maintain a high level of readiness.
Rapid Sequence Induction Strategies Among Critically Injured U.S. Military During the Afghanistan and Iraq Conflicts
Authors: Emerling Alec D , Bianchi William , Krzyzaniak Michael , Deaton Travis , Via Darin , Archer Benjamin , Sutherland Jared , Shannon Kaeley , Dye Judy L , Clouser Mary , Auten Jonathan D
Published: January 2021

Introduction

Rapid sequence intubation of patients experiencing traumatic hemorrhage represents a precarious phase of care, which can be marked by hemodynamic instability and pulseless arrest. Military combat trauma guidelines recommend reduced induction dose and early blood product resuscitation. Few studies have evaluated the role of induction dose and preintubation transfusion on hemodynamic outcomes. We compared rates of postintubation systolic blood pressure (SBP) of < 70 mm Hg, > 30% drop in SBP, pulseless arrest, and mortality at 24 hours and 30 days among patients who did and did not receive blood products before intubation and then examined if induction agent and dose influenced the same outcomes.

Materials and Methods

A retrospective analysis was performed of battle-injured personnel presenting to surgical care facilities in Iraq and Afghanistan between 2004 and 2018. Those who received blood transfusions, underwent intubation, and had an Injury Severity Score of  ≥15 were included. Intubation for primary head, facial, or neck injury, burns, operative room intubations, or those with cardiopulmonary resuscitation in progress were excluded. Multivariable logistic regression was performed with unadjusted and adjusted odds ratios for the five study outcomes among patients who did and did not receive preintubation blood products. The same analysis was performed for patients who received full or excessive versus partial induction agent dose.

Results

A total of 153 patients had a mean age of 24.9 (SD 4.5), Injury Severity Score 29.7 (SD 11.2), heart rate 122.8 (SD 24), SBP 108.2 (SD 26.6). Eighty-one (53%) patients received preintubation blood products and had similar characteristics to those who did not receive transfusions. Adjusted multivariate analysis found odds ratios as follows: 30% SBP decrease 9.4 (95% CI 2.3-38.0), SBP < 70 13.0 (95% CI 3.3-51.6), pulseless arrest 18.5 (95% CI 1.2-279.3), 24-hour mortality 3.8 (95% CI 0.7-21.5), and 30-day mortality 1.3 (0.4-4.7). In analysis of induction agent choice and comparison of induction agent dose, no statistically significant benefit was seen.

Conclusion

Within the context of this historical cohort, the early use of blood products conferred a statistically significant benefit in reducing postintubation hypotension and pulseless arrest among combat trauma victims exposed to traumatic hemorrhage. Induction agent choice and dose did not significantly influence the hemodynamic or mortality outcomes.
Modeling the Potential Impact of Norovirus Vaccination Among DoD Forces
Authors: Burgess Colleen , Nelis Lis , Huang Cassie
Published: January 2021

Introduction

Norovirus, a contagious disease that spreads rapidly in close-quartered communities, has a debilitating effect in military settings, affecting troops’ health, productivity, and mission-readiness. This research presents a model of norovirus transmission, testing the vaccination’s effectiveness in military training centers.

Methods

Transmission was modeled using structured ordinary differential equations, including symptomatic and asymptomatic infection, genetic resistance, vaccination, and herd-immunity effects, within a hypothetical cohort of trainees and support staff. The modeled vaccine had an efficacy of 72%, 4 weeks after a single dose in phase 2 clinical trials. The transmission model was calibrated against data from a norovirus outbreak in a university setting. Sensitivity and uncertainty analyses were performed on 22 parameters.

Results

The greatest reduction in norovirus cases resulted from prophylactic environmental decontamination and vaccination of trainee and staff populations. These combined interventions prevented more than 6,800 cases of norovirus over the 10-year simulated period—a 15% reduction over the baseline scenario of no interventions. Implementing vaccination and environmental decontamination with an outbreak response threshold of 0.1%, prevented more than 5,300 infections; raising the threshold to 0.2% to 0.5% significantly reduced effectiveness. Environmental decontamination and contact reduction alone had little impact on overall norovirus cases.

Conclusions

Given vaccine characteristics, the model predicted that up to 15% of norovirus cases occurring in training settings over a 10-year period could be prevented by vaccinating all trainees and staff members immediately upon arrival on-base combined with continuous environmental decontamination. There was an impact on morbidity from implementing vaccination of trainees, alone and in combination with staff members. However, vaccinating staff alone prevented few cases over the simulation period, indicating the importance of trainees in norovirus transmission. Likewise, the negligible impact of environmental decontamination or contact reduction alone highlights the importance of addressing both person-to-person and environmental transmission together to minimize illnesses and training downtime.
Preliminary Data on Trauma Knowledge, Confidence, and Stress During Navy Trauma Training
Authors: Torres Tony , Stakley Jami A , Garcia Elizabeth , Raiciulescu Sorana , Polk Travis M , Stotts Nancy A , Blackman Virginia Schmied
Published: January 2021

Introduction

The Navy Trauma Training Center (NTTC) is a military–civilian partnership that provides advanced trauma training for application across the range of military operations while exposing military medical personnel to high-volume and high-acuity trauma. Few published data evaluate the outcomes of military–civilian partnerships, including NTTC. The purpose of this study is to evaluate the knowledge, confidence, and stress of NTTC participants before, at mid-point, and after completion of the program. Participants include corpsmen (HM), nurses (RNs), physician assistants (PAs), and physicians (MDs).

Materials and Methods

These are preliminary data from an ongoing prospective, observational study with repeated measures. Included are participants that complete NTTC training. Pre-training measures include a demographic questionnaire, trauma knowledge test, Confidence survey, and the Perceived Stress Scale. These same instruments are completed at mid-training and at the conclusion of the NTTC curriculum. Data were analyzed using paired t-tests and linear mixed models.

Results

The sample was composed of 83 participants (49 HM, 18 RNs, 4 PAs, and 12 MDs. Knowledge and confidence increased from baseline to post-NTTC for each clinical role (P < .05). Stress for all roles was low and stable over time (P > .05).

Conclusions

These preliminary data suggest that, as expected, trauma-related knowledge and confidence increase significantly with training at NTTC. Stress was low and stable over time. These data from a small sample of participants indicate NTTC training is increasing participants’ trauma knowledge and confidence to care for trauma casualties. Continued collection of data in the ongoing study will allow us to determine whether these early findings persist in the overall study sample and may help inform the optimal length of training needed.
An Experimental Animal Model that Parallels Neurosensory Assessments of Concussion
Authors: Favorov Oleg , Challener Tim , Tommerdahl Mark
Published: January 2021

Introduction

Tactile-based quantitative sensory assessments have proven successful in differentiating concussed vs. non-concussed individuals. One potential advantage of this methodology is that an experimental animal model can be used to obtain neurophysiological recordings of the neural activity in the somatosensory cortex evoked in response to the same tactile stimuli that are used in human sensory assessments and establish parallels between various metrics of stimulus-evoked cortical activity and perception of the stimulus attributes.

Materials and Methods

Stimulus-evoked neural activity was recorded via extracellular microelectrodes in rat primary somatosensory cortex (S1) in response to vibrotactile stimuli that are used in two particular human sensory assessments (reaction time (RT) and amplitude discrimination). Experiments were conducted on healthy control and brain-injured (BI) rats.

Results

Similar to the effects of mild traumatic brain injuries (mTBI) on human neurosensory assessments, comparable experimentally induced brain injuries in rats resulted in the following: (1) elevation of S1 responsivity to vibrotactile stimulation that depended nonlinearly on stimulus amplitude, significantly reducing its capacity to discriminate between stimuli of different amplitudes; (2) 50% reduction in S1 signal-to-noise ratios, which can be expected to contribute to elevation of RT in BI rats; and (3) 60% increase in intertrial variability of S1 responses to vibrotactile stimulation, which can be expected to contribute to elevation of RT variability in BI rats.

Conclusions

The results demonstrate suggestive similarities between neurophysiological observations made in the experimental rat mTBI model and observations made in post-concussion individuals with regard to three sensory assessment metrics (amplitude discrimination, RT, and RT variability). This is the first successful model that demonstrates that perceptual metrics obtained from human individuals are impacted by mTBI in a manner consistent with neurophysiological observations obtained from rat S1.
End-Effector Contact and Force Detection for Miniature Autonomous Robots Performing Lunar and Expeditionary Surgery
Authors: Psota Eric , Carlson Jay , Rodrigues Armijo Priscila , Flores Laura , Siu Ka-Chun , Oleynikov Dmitry , Farritor Shane , Bills Nathan
Published: January 2021

Introduction

The U.S. Space Force was stood up on December 20, 2019 as an independent branch under the Air Force consisting of about 16,000 active duty and civilian personnel focused singularly on space. In addition to the Space Force, the plans by NASA and private industry for exploration-class long-duration missions to the moon, near-earth asteroids, and Mars makes semi-independent medical capability in space a priority. Current practice for space-based medicine is limited and relies on a “life-raft” scenario for emergencies. Discussions by working groups on military space-based medicine include placing a Role III equivalent facility in a lunar surface station. Surgical capability is a key requirement for that facility.

Materials and Methods

To prepare for the eventuality of surgery in space, it is necessary to develop low-mass, low power, mini-surgical robots, which could serve as a celestial replacement for existing terrestrial robots. The current study focused on developing semi-autonomous capability in surgical robotics, specifically related to task automation. Two categories for end-effector tissue interaction were developed: Visual feedback from the robot to detect tissue contact, and motor current waveform measurements to detect contact force.

Results

Using a pixel-to-pixel deep neural network to train, we were able to achieve an accuracy of nearly 90% for contact/no-contact detection. Large torques were predicted well by a trained long short-term memory recursive network, but the technique did not predict small torques well.

Conclusion

Surgical capability on long-duration missions will require human/machine teaming with semi-autonomous surgical robots. Our existing small, lightweight, low-power miniature robots perform multiple essential tasks in one design including hemostasis, fluid management, suturing for traumatic wounds, and are fully insertable for internal surgical procedures. To prepare for the inevitable eventuality of an emergency surgery in space, it is essential that automated surgical robot capabilities be developed.
New Training System Based on the Discovery of Subperiosteal Transmission of Pressures Between Joint Capsules
Authors: Pitkin Mark
Published: January 2021

Background

A new training and rehabilitation methodology called Sanomechanics® is presented based on a recent discovery of the anatomical system called Floating Skeleton System (FSS) responsible for redistributing contact pressures in the joint capsules and thus minimizing the loads on joint cartilages.

Materials and Methods

The main idea behind the Sanomechanics® methodology (SMM) is that when this system of subperiosteal pressure transmission is disrupted, the overloading of cartilages may occur leading to trauma, osteoarthritis and other related pathologies. Conversely, if functioning of the FSS is adequately restored and continuously maintained, the pathological developments can be effectively stopped.

Results

Analysis of existing training systems using mind-body approach revealed that they are lacking the understanding of a physiological mechanism of their success or failure in training. It is postulated that maintaining/restoration of transmission of pressure between the joint capsules is necessary component of preventing overloading of joint cartilages occurring in military training and operations and in civilian life. Visualization of this concept has been suggested as a key element to the SMM training system.

Conclusions

The FSS provides for a guidance for development of scientific approaches to the training and rehabilitation techniques. The SMM is balanced mind-body training system, which can help U.S. Servicemen and Servicewomen be better prepared for extreme load during their service.
A Pilot Study to Examine Psychological and Neuropsychological Outcomes and a Novel Detoxification Program for Gulf War Illness
Authors: Graves Donald F , Morse Gayle S , Kerr Kathleen , Carpenter David O
Published: January 2021

Introduction

Exposures to environmental toxins have been associated with severe health problems for approximately one-quarter of the nearly 700,000 U.S. soldiers who served in the Gulf War between the years 1990 and 1991. Gulf War illness still affects about 30% of Gulf War veterans (GWV), causing reduced psychological wellness and neuropsychological function.

Method and Materials

This pilot study used a randomized wait-list control design to explore the feasibility and efficacy of a novel detoxification method for GWV exposed to toxicants such as pesticides, nerve gases, and pyridostigmine bromide. Our study included 32 GWV (67% male), with a mean age of 51 (range: 43-70, SD = 6.97), who participated in a 4- to 5-week treatment that was hypothesized to reduce the reported psychological and neuropsychological symptoms. Psychological measures used included tests given for the evaluation of neurocognitive function, including motor function for a dominant hand with the grooved pegboard test; verbal and visual immediate and delayed memory with the Wechsler Memory Scale III abbreviated subtests; executive function domains of attention, speed, and mental flexibility with trail making test parts A and B and Stroop color and word test. Psychological status was measured using the nine subscales of the Symptom Checklist-90-Revised.

Results

Primary outcomes included between-group differences in self-reported psychological measures and a neuropsychological battery at 7-day and 3-month assessments. Baseline comparison revealed improvements in 16 of 19 psychological and neuropsychological measures at 7-day assessment and that 13 remained stable at 3-month assessment.

Conclusions

We conclude that the detoxification procedure provided improvement in psychological and cognitive function for GWV and that future study is warranted.
Efficacy of Cognitive Training When Translated From the Laboratory to the Real World
Authors: Young Leanne R , Zientz Jennifer E , Spence Jeffrey S , Krawczyk Daniel C , Chapman Sandra B
Published: January 2021

Introduction

Research shows that cognitive performance and emotional well-being can be significantly strengthened. A high-performance brain training protocol, Strategic Memory Advanced Reasoning Training (SMART), was developed by cognitive neuroscientists at The University of Texas at Dallas Center for BrainHealth based on 25-plus years of scientific study. Randomized controlled trials with various populations have shown that training and use of nine “SMART” strategies for processing information can improve cognitive performance and psychological health. However, the multi-week intensive training used in the laboratory is not practical for widespread use outside the laboratory. This article examines the efficacy of SMART when translated outside the laboratory to two populations (military/veterans and law enforcement) that received SMART in condensed time frames.

Materials and Methods

In two translation studies with healthy military personnel and veterans, 425 participants received between 6 and 10 hours of SMART over 2 days. In a third translation study, 74 healthy police officers received 9 hours of SMART over 3 days. Training was conducted by clinicians who taught the nine “SMART” strategies related to three core areas—strategic attention, integrated reasoning, and innovation—to groups of up to 25 participants. In all three translation studies, cognitive performance and psychological health data were collected before and immediately following the training. In one of the military/veteran studies, psychological health data were also collected 1 and 4 months following the training.

Results

In both translations to military personnel and veterans, there were improvements in the complex cognitive domains of integrated reasoning (P < .0001) and innovation (P < .0001) immediately after undergoing SMART. In the translation to police officers, there were improvements in the cognitive domains of innovation (P = .02) and strategic attention (P = .005). Participants in all three translations saw statistically significant improvements in self-reported symptoms of psychological health. The improvements continued among a subset of participants who responded to the later requests for information.

Conclusions

The results of translating to these two populations provide evidence supporting the efficacy of SMART delivered in an abbreviated time frame. The improvements in two major domains of cognitive function demonstrate that strategies can be taught and immediately applied by those receiving the training. The immediate psychological health improvements may be transient; however, the continued improvements in psychological health observed in a subset of the participants suggest that benefits may be sustainable even at later intervals.
A high-contrast search for variability in HR 8799bc with VLT-SPHERE
Authors: Biller Beth A , Apai Dániel , Bonnefoy Mickaël , Desidera Silvano , Gratton Raffaele , Kasper Markus , Kenworthy Matthew , Lagrange Anne-Marie , Lazzoni Cecilia , Mesa Dino , Vigan Arthur , Wagner Kevin , Vos Johanna M , Zurlo Alice
Published: January 2021

The planets HR8799bc display nearly identical colours and spectra as variable young exoplanet analogs such as VHS 1256-1257ABb and PSO J318.5-22, and are likely to be similarly variable. Here we present results from a 5-epoch SPHERE IRDIS broadband-H search for variability in these two planets. HR 8799b aperture photometry and HR 8799bc negative simulated planet photometry share similar trends within uncertainties. Satellite spot lightcurves share the same trends as the planet lightcurves in the August 2018 epochs, but diverge in the October 2017 epochs. We consider Δ(mag)b − Δ(mag)c to trace non-shared variations between the two planets, and rule out non-shared variability in Δ(mag)b − Δ(mag)c to the 10–20 ${{\ \rm per\ cent}}$ level over 4–5 h. To quantify our sensitivity to variability, we simulate variable lightcurves by inserting and retrieving a suite of simulated planets at similar radii from the star as HR 8799bc, but offset in position angle. For HR 8799b, for periods <10 h, we are sensitive to variability with amplitude $\gt 5{{\ \rm per\ cent}}$. For HR 8799c, our sensitivity is limited to variability $\gt 25{{\ \rm per\ cent}}$ for similar periods.
Structure-based analyses ofSalmonellaRcsB variants unravel new features of the Rcs regulon
Authors: Huesa Juanjo , Giner-Lamia Joaquín , Pucciarelli M Graciela , Paredes-Martínez Francisco , Portillo Francisco García-del , Marina Alberto , Casino Patricia
Published: January 2021

RcsB is a transcriptional regulator that controls expression of numerous genes in enteric bacteria. RcsB accomplishes this role alone or in combination with auxiliary transcriptional factors independently or dependently of phosphorylation. To understand the mechanisms by which RcsB regulates such large number of genes, we performed structural studies as well as in vitro and in vivo functional studies with different RcsB variants. Our structural data reveal that RcsB binds promoters of target genes such as rprA and flhDC in a dimeric active conformation. In this state, the RcsB homodimer docks the DNA-binding domains into the major groove of the DNA, facilitating an initial weak read-out of the target sequence. Interestingly, comparative structural analyses also show that DNA binding may stabilize an active conformation in unphosphorylated RcsB. Furthermore, RNAseq performed in strains expressing wild-type or several RcsB variants provided new insights into the contribution of phosphorylation to gene regulation and assign a potential role of RcsB in controlling iron metabolism. Finally, we delimited the RcsB box for homodimeric active binding to DNA as the sequence TN(G/A)GAN4TC(T/C)NA. This RcsB box was found in promoter, intergenic and intragenic regions, facilitating both increased or decreased gene transcription.
Peasants, Market Exchange and Economic Agency in North-Western Iberia, c.850–c.1050
Authors: Portass Robert
Published: January 2021

Our understanding of the economic foundations of rural society in early medieval north-western Iberia remains wedded to explanations that emphasize the structural limitations that framed human activity while seeking to attenuate the economic agency of non-elite groups and individuals. This article argues that the early medieval peasantry of north-western Iberia was not the staid caricature presented by much of the historiography, but a much more economically dynamic section of society. To demonstrate this dynamism, it uses charters to analyse peasant productive strategies that went beyond subsistence. These reveal that peasants not only dabbled in the land market but invested in non-movable capital goods, with the result that some peasants produced surpluses for the express purpose of exchange by the tenth century, fundamentally altering the contours of their communities from within. By examining the evidence concerning peasant ownership of watermills, the article sheds new light on causal explanations for phenomena as diverse as social mobility, the possibilities of commercial integration, and the logic of market exchange. It concludes by contending that narratives focused on uncovering the beginnings of growth must more readily concede that its origins are to be found both beyond as well as within seigneurial contexts.
Implementing the PREP2 Algorithm to Predict Upper Limb Recovery Potential After Stroke in Clinical Practice: A Qualitative Study
Authors: Connell Louise A , Chesworth Brigit , Ackerley Suzanne , Smith Marie-Claire , Stinear Cathy M
Published: January 2021

Objective

Predicting motor recovery after stroke is a key factor when planning and providing rehabilitation for individual patients. The Predict REcovery Potential (PREP2) prediction tool was developed to help clinicians predict upper limb functional outcome. In parallel to further model validation, the purpose of this study was to explore how PREP2 was implemented in clinical practice within the Auckland District Health Board (ADHB) in New Zealand.

Methods

In this case study design using semi-structured interviews, 19 interviews were conducted with clinicians involved in stroke care at ADHB. To explore factors influencing implementation, interview content was coded and analyzed using the consolidated framework for implementation research. Strategies identified by the Expert Recommendations for Implementing Change Project were used to describe how implementation was undertaken.

Results

Implementation of PREP2 was initiated and driven by therapists. Key factors driving implementation were as follows: the support given to staff from the implementation team; the knowledge, beliefs, and self-efficacy of staff; and the perceived benefits of having PREP2 prediction information. Twenty-six Expert Recommendations for Implementing Change strategies were identified relating to 3 areas: implementation team, clinical/academic partnerships, and training.

Conclusions

The PREP2 prediction tool was successfully implemented in clinical practice at ADHB. Barriers and facilitators to implementation success were identified, and implementation strategies were described. Lessons learned can aid future development and implementation of prediction models in clinical practice.

Impact

Translating evidence-based interventions into clinical practice can be challenging and slow; however, shortly after its local validation, PREP2 was successfully implemented into clinical practice at the same site in New Zealand. In parallel to further model validation, organizations and practices can glean useful lessons to aid future implementation.
Monitoring in Originate-to-Distribute Lending: Reputation versus Skin in the Game
Authors: Winton Andrew , Yerramilli Vijay
Published: January 2021

Banks face liquidity and capital pressures that favor selling off the loans they originate, but loan sales undermine their monitoring incentives. A bank’s loan default history is a noisy measure of its past monitoring choices, which can serve as a reputation mechanism to incentivize current monitoring. In equilibrium, higher reputation banks monitor (weakly) more intensively; if retention is credible, they generally retain less of the loans they originate. Monitoring is difficult to sustain in periods with uncommonly large spikes in loan demand (“booms”), especially for low-reputation banks, which are more likely to accommodate boom demand and forgo monitoring.
Associations between fluorescence optical imaging and magnetic resonance imaging and symptoms in hand osteoarthritis
Authors: Maugesten Øystein , Ohrndorf Sarah , Slatkowsky-Christensen Barbara , Kvien Tore K , Uhlig Till , Haugen Ida Kristin
Published: January 2021

Objectives

To investigate whether Fluorescence Optical Imaging (FOI) enhancement and MRI-defined synovitis are associated with pain and physical function in hand OA patients.

Methods

Bilateral FOI scans and MRI of the dominant hand were available for 221 patients. Finger joints were examined for tenderness on palpation. Pain in individual finger joints during the last 24 h and last 6 weeks and hand pain intensity by the Australian/Canadian hand index and Numeric Rating Scale were self-reported. On joint level, we applied logistic regression with generalized estimating equations to examine whether FOI enhancement and MRI-defined synovitis were associated with pain in the same joint. On subject level, we applied linear regression to assess whether FOI and MRI sum scores were associated with pain intensity and physical function.

Results

Metacarpophalangeal and thumb base joints were excluded from analyses due to little/no FOI enhancement. Finger joints with FOI enhancement on the composite image had higher odds (95% CI) of pain during the last 6 weeks [grade 1: 1.4 (1.2–1.6); grade 2–3: 2.1 (1.7–2.6)]. Similar results were found for joint pain during the last 24 h and joint tenderness in fingers. Numerically stronger associations were found between MRI-defined synovitis and finger joint pain/tenderness. FOI and MRI sum scores demonstrated no/weak associations with hand pain and physical function.

Conclusion

FOI enhancement and MRI-defined synovitis were associated with pain in the same finger joint. None of the imaging modalities demonstrated consistent associations with pain, stiffness and physical function on subject level.
Genetic and biochemical changes in liver and kidney of Channa punctatus after treatment with 2-naphthalene sulfonate
Authors: Mehra Sukanya , Chadha Pooja
Published: January 2021

2-Naphthalene sulfonate (2NS) is a sulfonated aromatic compound and a momentous intermediate involved in the synthesis of dyes and surfactants. Thus, the present experiment was undertaken to evaluate the variation in biochemical constituents in liver and kidney of fresh water fish, Channa punctatus, after 2NS intoxication. After determination of lethal dose (LD) two sublethal doses, i.e. 0.33 mg/15 g body weight (one-half of LD50) and 0.16 mg/15 g b.w. (one-fourth of LD50) were selected for analyzing oxidative stress, genotoxicity and bioaccumulative potential of 2NS. Highest significant increase in oxidative stress and DNA damage in the exposed groups as compared with control group (P ≤ 0.05) was observed at 96 h. However, decreased values of all the studied parameters after 30 days indicate repair capacity of fish. In order to study the alterations observed in biomolecules including lipids, proteins and nucleic acids, histopathology along with spectroscopic analysis using attenuated total reflection-Fourier transform infrared was also performed for 96 h exposed group. In addition, protein secondary structure analysis was focused in this study, which reveals alterations in α-helix and β-sheet structure after 2NS intoxication. Furthermore, the bioaccumulative potential of 2NS was revealed using high-performance liquid chromatography showing 1.83 and 45.54 μg/ml concentration of 2NS in liver and kidney homogenate, respectively. As the study revealed 2NS as the potential health hazard to aquatic organisms, it entails the augmentation and adoption of pertinent policies regarding the management of such toxic compounds.
The Citrus Microbiome: From Structure and Function to Microbiome Engineering and Beyond
Authors: Zhang Yunzeng , Trivedi Pankaj , Xu Jin , Roper M. Caroline , Wang Nian
Published: January 2021

Individual microbes often have defined relationships with their hosts that include beneficial, commensal, and pathogenic interactions. However, at the community level, plant microbiomes are considered to play a beneficial role in protecting the plant from potential pathogens, acquiring nutrients, and improving growth and production. Citrus is a globally important perennial fruit crop and its production faces many challenges. There has been tremendous interest in exploring the structure and function of the citrus microbiome and engineering the citrus microbiome to address various challenges. In this review, we summarized recent advances in understanding the citrus microbiome, including the composition and function of the microbiome in the rhizosphere, rhizoplane, endorhiza, and core members, and their functional traits. We conducted comparisons of the citrus root-associated microbiome with other plant root-associated microbiomes. We also present a perspective on how incoming pathogens interact with the resident microbial community and their outcomes. Despite the promising potential of the citrus microbiome to combat disease, harnessing the citrus microbiome for beneficial applications remains in its infancy. We envision that rapid development of high-throughput sequencing and multiomics technologies, artificial intelligence, consortia of microbes, genome editing technology, and high-throughput culturing present many exciting opportunities for citrus microbiome research and microbial engineering to improve citrus health and productivity.
Ibuprofen Better than Acetaminophen for Reducing Fever, Pain in Young Children
Authors: Rosenberg Karen
Published: January 2021

According to this study:

In children younger than age two, treatment with ibuprofen was associated with reduced fever and less pain within the first 24 hours compared with acetaminophen.

The incidence of adverse events was low with both treatments.
Is Resident-Driven Inpatient Care More Expensive? Challenging a Long-Held Assumption
Authors: Weinstein Debra F. , Choi Jin G. , Mercaldo Nathaniel D. , Stump Natalie N. , Paras Molly L. , Berube Rhodes A. , Hur Chin
Published: January 2021

Purpose

The financial impact of graduate medical education (GME) on teaching hospitals remains poorly understood, while calls for increased federal support continue alongside legislative threats to reduce funding. Despite studies suggesting that residents are more “economical” than alternative providers, GME is widely believed to be an expensive investment. Assumptions that residents increase the cost of patient care have persisted in the absence of convincing evidence to the contrary. Thus, the authors sought to examine resident influence on patient care costs by comparing costs between a resident-driven service (RS) and a nonresident-covered service (NRS), with attention to clinical outcomes and how potential cost differences relate to the utilization of resources, length of stay (LOS), and other factors.

Method

This prospective study compared costs and clinical outcomes of internal medicine patients admitted to an RS versus an NRS at Massachusetts General Hospital (July 1, 2016–June 30, 2017). Total variable direct costs of inpatient admission was the primary outcome measure. LOS; 30-day readmission rate; utilization related to diagnostic radiology, pharmaceuticals, and clinical labs; and other outcome measures were also compared. Linear regression models quantified the relationship between log-transformed variable direct costs and service.

Results

Baseline characteristics of 5,448 patients on the 2 services (3,250 on an RS and 2,198 on an NRS) were similar. On an RS, patient care costs were slightly less and LOS was slightly shorter than on an NRS, with no significant differences in hospital mortality or 30-day readmission rate detected. Resource utilization was comparable between the services.

Conclusions

These findings undermine long-held assumptions that residents increase the cost of patient care. Though not generalizable to ambulatory settings or other specialties, this study can help inform hospital decision making around sponsorship of GME programs, especially if federal funding for GME remains capped or is subject to additional reductions.
Targeting Causes of Burnout in Residency: An Innovative Approach Used at Hennepin Healthcare
Authors: Quirk Rosemary , Rodin Holly , Linzer Mark
Published: January 2021

Problem

Rates of burnout are high in physicians in the United States. While others have reported on the success of burnout-reduction strategies on practicing physicians and residents, few strategies have approached the problem longitudinally in residents.

Approach

From 2014 to 2019, the authors used a previously developed survey to assess factors related to resident burnout, including sleep, personal time, professional fulfillment, effects on relationships, program recognition, and peer support. At Hennepin Healthcare, a safety-net hospital in Minneapolis, Minnesota, the authors created a reproducible process for collecting data from internal medicine residents annually, and for using evidence-based conceptual frameworks to develop a continuous improvement method to address worklife across training years. Interventions included jeopardy coverage for essential life events, a newsletter celebrating resident achievements, removal of after-hours consult pager call, an extra day off for senior residents on the wards, and care packages distributed to night teams.

Outcomes

Annually from 2014 to 2019, 40/66 (60.6%) to 62/73 residents (84.9%) completed the survey (average response rate was 72.1% over 6 years). Survey results were shared with residents in multiple formats, and feedback was requested, demonstrating that burnout reduction is a priority for program leadership. High professional fulfillment scores were documented every year. Self-reported rates of burnout were between 25% and 35%. Significant improvements were seen in perception of empathy, sleep impairment, and peer support.

Next Steps

The authors developed a plan for minimizing burnout, which includes the following evidence-based domains: workload, control, balance in effort and reward, work–life balance, fairness, values, support, gender equity, moral distress, and moral injury. Additional interventions include protected time for didactics, trauma-informed care training, and addressing workplace racism. The authors aspire to achieve an integrated culture of well-being for residents and faculty; foster an efficient, effective, and fair learning environment; and reduce—and ultimately eliminate—burnout.
The Physician–Investigator Workforce: Looking Ahead
Authors: Andriole Dorothy A. , Wolfson Rachel K.
Published: January 2021

Support of the U.S. health professions investigator workforce is critically important to the continued advancement of health care nationally. Physician–investigators comprise one segment of this health professions investigator workforce, which also includes investigators in the nursing, pharmacy, and dentistry professions, and others. Among physician health professionals in particular, the term “physician–investigator” has been described as encompassing physicians engaged in research in various ways including “clinical researchers” (physicians with clinical duties who do clinical, patient-centered research), “clinician–scientists” (physicians with clinical roles who perform research in laboratories or using computational tools), and “physician–scientists” (physicians focused on research with little or no clinical activity). Broadly defined, physician–investigators are included in various groups of researchers described in several articles recently published in Academic Medicine; these articles provide details on a range of approaches, with supporting outcomes data, being taken to train, support, and retain physicians in the health professions investigator workforce.

The authors of this commentary examine selected literature, including several articles in this issue among others, along with Association of American Medical Colleges data, to offer observations about programs that train physician–investigators. Evidence-informed single-program approaches for early-career researchers can sustain continued research interest and foster the career development of the emerging physician–investigator workforce. Collaborative multi-institutional approaches offer the benefit of multisite work to power outcomes studies and to increase generalizability beyond a specific institutional program. System-wide institutional approaches may be particularly critical in supporting physician–investigators across all career stages. Although the articles discussed in this commentary are largely (although not exclusively) focused on various initiatives and programs designed to develop and sustain the physician–investigator workforce, such initiatives and programs may have value in addressing shared challenges of developing, supporting, and retaining the broader investigator workforce across all health professions.
A Historical Analysis of the Impact of Hegemonic Masculinities on Sexual Assault in the Lives of Ethnic Minority Women
Authors: Ruiz Ashley , Luebke Jeneile , Hawkins Maren , Klein Kathryn , Mkandawire-Valhmu Lucy
Published: January 2021

Women's experiences of sexual assault are rooted in and informed by a history that nurses need to understand in order to provide meaningful and effective care. In this article, we present a comprehensive literature review guided by intersectionality theory to deepen our understanding of the historical role that hegemonic masculinity plays in shaping ethnic minority women's experiences of sexual assault. Final sources included were analyzed using thematic analysis. On the basis of our analyses, we identified 4 themes: social order hierarchies, “othering” dynamics, economic labor divisions, and negative media/mass communication depiction. Our findings contribute to our understanding of these important histories that speak to the trauma of sexual violence inflicted upon the bodies of ethnic minority women, which we can incorporate into nursing education curricula. Incorporating this knowledge would equip nurses and allied health professionals with the necessary knowledge and skills that would enable them to help patients navigate multiple systems of oppression as they engage in help seeking following a sexual assault experience. This knowledge also acknowledges rather than dismisses the historically acceptable use of sexual violence against ethnic minority women. In addition, acknowledging these histories enables us to move forward as a society in engaging in an urgently needed cultural shift to address the hegemonic masculinities that perpetuate violence against women in the United States.
Surgical Site Infection Following Primary Definitive Fusion for Pediatric Spinal Deformity
Authors: Watanabe Kei , Yamaguchi Toru , Suzuki Satoshi , Suzuki Teppei , Nakayama Keita , Demura Satoru , Taniguchi Yuki , Yamamoto Takuya , Sugawara Ryo , Sato Tatsuya , Fujiwara Kenta , Murakami Hideki , Akazawa Tsutomu , Kakutani Kenichiro , Hirano Toru , Yanagida Haruhisa , Watanabe Kota , Matsumoto Morio , Uno Koki , Kotani Toshiaki , Takeshita Katsushi , Ohara Tetsuya , Kawakami Noriaki
Published: January 2021

Study Design.

A retrospective multicenter study.

Objective.

To determine the surgical site infection (SSI) rate, associated risk factors, and causative pathogens in pediatric patients with spinal deformity.

Summary of Background Data.

There have been no extensive investigations of the risk factors for SSI in Japan.

Methods.

Demographic data, radiographic findings, and the incidence of SSI were retrospectively analyzed in 1449 pediatric patients who underwent primary definitive fusion surgery for spinal deformity at any of 15 institutions from 2015 to 2017. SSI was defined according to the US Centers for Disease Control and Prevention guideline.

Results.

The incidence of all SSIs was 1.4% and that of deep SSIs was 0.76%. The most common pathogenic microbes were methicillin-resistant staphylococci (n = 5) followed by gram-negative rods (n = 4), methicillin-sensitive staphylococci (n = 1), and others (n = 10). In univariate analysis, younger age, male sex, a diagnosis of kyphosis, type of scoliosis, American Society of Anesthesiologists (ASA) class ≥3, mental retardation urinary incontinence, combined anterior-posterior fusion, greater magnitude of kyphosis, three-column osteotomy, use of blood transfusion, and number of antibiotic administration were associated with the likelihood of SSI (all P < 0.05). Multivariate logistic regression analysis identified the following independent risk factors for SSI: syndromic scoliosis etiology (vs. idiopathic scoliosis; adjusted odds ratio [OR] 16.106; 95% confidence interval [CI] 2.225–116.602), neuromuscular scoliosis etiology (vs. idiopathic scoliosis; adjusted OR 11.814; 95% CI 1.109–125.805), ASA class 3 (vs. class 2; adjusted OR 15.231; 95% CI 1.201–193.178), and administration of antibiotic therapy twice daily (vs. three times daily; adjusted OR 6.121; 95% CI 1.261–29.718).

Conclusion.

The overall infection rate was low. The most common causative bacteria were methicillin-resistant followed by gram-negative rods. Independent risk factors for SSI in pediatric patients undergoing spinal deformity surgery were scoliosis etiology, ASA class 3, and administration of antibiotic therapy twice daily.

Level of Evidence: 3