bluuebunny/crossref_metadata_2025 huggingface dataset:
The multiple origins of sexual size dimorphism in global amphibians
Authors: Pincheira‐Donoso Daniel , Harvey Lilly P. , Grattarola Florencia , Jara Manuel , Cotter Sheena C. , Tregenza Tom , Hodgson Dave J.
Published: November 2020

Aim

Body size explains most of the variation in fitness within animal populations and is therefore under constant selection from ecological and reproductive pressures, which often promote its evolution in sex‐specific directions, leading to sexual size dimorphism (SSD). Several hypotheses have been proposed to explain the vast diversity of SSD across species. These hypotheses emphasize: (a) the mate competition benefits to larger male size (sexual selection); (b) the benefits of larger female size for fecundity (fecundity selection); (c) the simultaneous benefits of niche divergence for males and females to reduce intersexual competition for ecological resources (natural selection); and (d) the underlying impact of geographical variation in climatic pressures expected to shape large‐scale patterns of SSD in synergy with the above selection pressures (e.g., intensification of fecundity selection as breeding seasons shorten). Based on a new, global‐scale amphibian dataset, we address the shortage of large‐scale, integrative tests of these four hypotheses.

Location

Global.

Time period

Extant.

Major taxa studied

Class Amphibia.

Methods

Using a > 3,500 species dataset spanning body size, ecological, life‐history, geographical and climatic data, we performed phylogenetic linear models to address the sexual, fecundity, ecological and climatic hypotheses of SSD.

Results

Evolution of SSD is discordant between anurans and salamanders. Anuran SSD is shaped by climate (male‐biased SSD increases with temperature seasonality) and by nesting site. In salamanders, SSD converges across species that occupy the same types of microhabitats (“ecodimorphs”), whereas reproductive or climatic pressures have no effects on their SSD. These contrasts are associated with latitudinal gradients of SSD in anurans, but not in salamanders.

Main conclusions

Amphibian SSD is driven by ecological and climatic pressures, whereas no roles for sexual or fecundity selection were detected. We show that macroevolutionary processes determined by different forms of selection lead to latitudinal patterns of trait diversity, and the lack of them.
Fossils explained 78
Authors: Donovan Stephen K.
Published: November 2020

The coastal town of Margate in north Kent, south‐east England, is geologically well known, with extensive cliffs of chalk with locally common Upper Cretaceous fossils. But to the ichnologist the modern beach is at least as fascinating, with a trinity of borings in chalk clasts and mollusc shells posing interesting questions relevant to palaeoecology and taphonomy.
Overall renewal of skin lipids with Vetiver extract for a complete anti‐ageing strategy
Authors: De Tollenaere Morgane , Chapuis Emilie , Lapierre Laura , Bracq Marine , Hubert Jane , Lambert Carole , Sandré Jérome , Auriol Daniel , Scandolera Amandine , Reynaud Romain
Published: November 2020

Objective

Skin lipids are essential in every compartment of the skin where they play a key role in various biological functions. Interestingly, their role is central in the maintenance of hydration which is related to skin barrier function and in the skin structure through adipose tissue. It is well described today that skin lipids are affected by ageing giving skin sagging, wrinkles and dryness. Thereby, developing cosmetic actives able to reactivate skin lipids would be an efficient ant‐ageing strategy. Due to the strong commitment of our scientists to innovate responsibly and create value, they designed a high value active ingredient named here as Vetiver extract, using a ground‐breaking upcycling approach. We evidenced that this unique extract was able to reactivate globally the skin lipids production, bringing skin hydration and plumping effect for mature skin.

Method

In order to demonstrate the global renewal of lipids, we evaluated the lipids synthesis on cutaneous cells that produce lipids such as keratinocytes, sebocytes and adipocytes then on Reconstructed Human Epidermis and skin explants. We evaluated the expression of proteins involved in ceramides transport and barrier cornification. We then evaluated hydration and sebaceous parameters on a panel of mature volunteers.

Results

We firstly demonstrated that Vetiver extract induced sebum production from human sebocytes cells lines but also improved its quality as observed by the production of specific antimicrobial lipids. Secondly, we demonstrated that Vetiver extract was able to restore skin barrier with the increase of skin lipids neosynthesis on Reconstructed Human Epidermis and skin explants. We also evidenced that Vetiver extract stimulated the lipids transport and epidermal cornification. Finally, Vetiver extract showed a significant effect on adipogenesis and maturation of adipocytes at in vitro and ex vivo models. We confirmed all these activities by showing that Vetiver extract improved sebum production and brought hydration through an increase of lipids content and their conformation. Vetiver extract induced an improvement of skin fatigue and a plumping effect by acting deeply on adipose tissue.

Conclusion

In conclusion, we developed an active ingredient able to bring anti‐ageing effect for mature skin by a global increase of skin lipids.
Thermoset IM‐LSI‐based C/C‐SiC: Influence of flow direction and weld lines on microstructure and mechanical properties
Authors: Stiller Jonas , Nestler Daisy , Ahmad Husam , Päßler Erik , Wagner Guntram , Kroll Lothar
Published: November 2020

The production of ceramic matrix composites (CMC) based on C/C‐SiC is still very cost‐intensive and therefore only economical for a few applications. The fabrication of the preforms involves many costs that need to be reduced. In this work, the shaping of the CFRP‐preforms is realized by thermoset injection molding, which enables large‐scale production. The polymeric matrix used is a multi‐component matrix consisting of novolak resin, curing agent and lubricant. Six millimeter chopped carbon fiber with a proportion of 50 wt.% were used as a reinforcement. These ingredients are processed by an industrial equipment for compounding and injection molding in order to manufacture a CFRP demonstrator representing a brake disc. Test specimens are cut out of the demonstrator in different directions in order to investigate influences of flow direction and weld lines on microstructural and mechanical properties. Afterward, the CFRP samples were converted to C/C‐SiC composites by the liquid silicon infiltration process. The article addresses the flow behavior of the compound during the injection molding and the building of the weld lines in the demonstrator. In addition, results of the directional dependence of the microstructural and mechanical properties within the fabricated disc in the different production steps are presented.
Inflammation driven tumor‐like signaling in prostatic epithelial cells by sexually transmitted Trichomonas vaginalis
Authors: Kushwaha Bhavana , Devi Archana , Maikhuri Jagdamba P , Rajender Singh , Gupta Gopal
Published: November 2020

Objectives

To identify the sequence of inflammation‐driven signaling cascades and other molecular events that might cause tumor‐like transformation of prostatic cells.

Methods

Cytokine array analysis, Reactome and STRING analysis, immunoblotting, and immunocytochemistry were used to investigate the molecular mechanisms governing inflammation‐driven adverse changes in human prostatic cells caused by the sexually transmitted infection, Trichomonas vaginalis, resulting in prostatitis, benign prostatic hyperplasia and prostate cancer.

Results

Array analysis showed upregulation of 23 cytokines within 24 h of infection of human prostatic epithelial RWPE‐1 cells with the parasite, in vitro. Reactome and STRING analysis of array data identified interleukin‐6, interleukin‐8, nuclear factor kappa B, signal transducer and activator of transcription 3 and cyclooxygenase 2 as chief instigators of prostatic anomaly, which were found to be significantly upregulated by immunofluorescence and western blotting analyses. STRING further connected these instigators with macrophage migration inhibitory factor, PIM‐1 and prostate‐specific antigen; which was confirmed by their marked stimulation in infected prostatic cells by immunoblotting and immunocytochemistry. Upregulated proliferation markers, such as Ki67, proliferating cell nuclear antigen and B‐cell lymphoma 2, suggested tumor‐like signaling in infected RWPE‐1 cells, which was further supported by downregulation of E‐cadherin, upregulation of vimentin and activation of focal adhesion kinase. Prostate tumor DU145 cells were more sensitive to parasite invasion, and showed rapid upregulation with nuclear translocation of sensitive parameters, such as nuclear factor kappa B, signal transducer and activator of transcription 3, and macrophage migration inhibitory factor. The migration of DU145 cells augmented when incubated in spent media from parasite‐infected RWPE‐1 cells.

Conclusion

The initiation of inflammation driven tumor‐like cell signaling in parasite‐infected human prostatic epithelial cells is apparent, with the prostate tumor (DU145) cells being more sensitive to T. vaginalis than normal (RWPE‐1) prostatic cells.
I Trust You with My Child: Parental Attitudes to Local Authorities in Cases of Disobedient Children in 18th Century Denmark
Authors: Koefoed Nina Javette
Published: November 2020

During the 18th century, a series of new institutions appeared in the provinces of Denmark. Their purpose was to discipline beggars and vagrants and to teach them not only to work, but also the Word of God. These tugt workhouses also became institutions for the reform of disobedient children behaving in an “un‐Christian” manner. Children were often placed here at the initiative of their parents. The article argues that the trust placed by parents in the state authorities in this way can be understood within the framework of Luther's social teaching, especially his doctrine of the three estates and the understanding of the nature of authority and of mutual obligation that is represented there.
A Case for Multisite Second Language Acquisition Research: Challenges, Risks, and Rewards
Authors: Moranski Kara , Ziegler Nicole
Published: November 2020

Multisite research (MSR) offers the key advantages of greater statistical power and external validity via larger and more diverse participant pools. In second language acquisition (SLA) research, recent developments in meta‐analysis have created a robust foundation for MSR. Although logistical and financial obstacles can complicate expansion beyond a single site, we show that MSR's benefits can justify the investment of resources. We begin by outlining how developments in meta‐analytic research, replication, and access to data and materials have created an especially opportune moment for MSR. Next, we discuss the methodology for a classroom study on metacognitive instruction as an illustrative case, outlining the major elements of its design and implementation. Finally, we review how four issues critical to MSRs (funding, compliance, logistics, and analysis) were addressed in our example study, including a discussion on multilevel modeling. We conclude with a discussion of how the field can build upon existing research to advance multisite work.
Pediatric acute compartment syndrome due to surgical positioning: A case report
Authors: Teng Howard C. , Arslan‐Carlon Vittoria
Published: November 2020

Pediatric acute compartment syndrome from surgical positioning may be difficult to recognize. Increasing anxiety and analgesic requirements can suggest developing compartment syndrome. We present a case of compartment syndrome after a non‐orthopedic surgery.
Development and validation of a high school STEM self‐assessment inventory
Authors: Peters Burton Erin , Behrend Tara S. , Matray Shari , Hudson Clarissa , Ford Michael
Published: November 2020

The development of inclusive STEM high schools that have no academic admission requirements has been a national goal in the United States. However, there is no umbrella organization that gives guidance for structuring such schools. The purpose of this study was to develop and validate a self‐assessment using critical components of successful inclusive STEM high schools for school personnel and educational researchers who wish to better understand their STEM programs and identify areas of strength. A multi‐phase methodology was employed. In the first step, eight in‐depth case studies were generated, and common themes were identified. In the second step, inventory items were iteratively generated and tested for reliability and validity, using a sample of 78 teachers and researchers in five schools. In the third step, the inventory was field‐tested in a single school. The OSPRI inventory demonstrates strong content validity and reliability. Teachers and researchers generally responded similarly, although some differences emerged that are indicative of their respective experiences and perspectives. School stakeholders and educational researchers can use this inventory, in whole or in part, to better understand their STEM programs and establish a future agenda that best capitalizes on their strengths.
Cui Bono? Partisanship and Attitudes Toward Refugees
Authors: Hanania Richard
Published: November 2020

Objective

This paper tests the hypothesis that the expected partisan affiliation of refugee populations partially explains why white conservatives and white liberals have different attitudes toward refugee resettlement in the United States.

Method

This was tested with a preregistered survey experiment that examined how attitudes toward refugee resettlement changed depending on the racial and political characteristics of a theoretical refugee population.

Results

Conservative opposition to refugee resettlement can be weakened if conservatives are given reasons to believe those refugees will support the Republican Party. At the same time, liberal support for refugees drops when they receive the same information.

Conclusion

Although white conservatives and white liberals exhibit different levels of racial prejudice, and this has consequences for their immigration and refugee policy preferences, their beliefs about how newcomers influence domestic partisan politics are also consequential.
Flipped Classroom With Simulation Assists Students Learning the Vector Knowledge
Authors: Siu-Ping Ng , Chak-Him Fung
Published: November 2020

AbstractVectors are critically important in mathematics and physics because it forms the basis of the university curriculum, yet it is a challenging task for high-school students. In this study, test papers were distributed to 18 Grade 11 high-school students in Mainland China, while interviews were conducted on four students and one school leader. The analysis of pre- and post-test scores and interviews reveals that flipped classroom with Physics Education Technology (PhET) simulation promotes students’ learning performance with t(17)=5.818, р<.001. In particular, visualization and dragging enhance understanding of the basic concepts of the topic. Not requiring interaction between teachers and students, flipped classroom with PhET simulation contributes to students’ learning progress especially when the traditional face-to-face lecture is not available due to special circumstances such as spreading the novel coronavirus (COVID-19). It may also serve as a prototype of artificial intelligence(AI) in education.
Unpacking the learning on consultant-led ward rounds: Lessons from ethnography in paediatrics
Authors: Enright Helen Patricia , Gray Amy
Published: November 2020

Introduction: Consultant-led ward round education in a busy paediatric setting is a complex process and is often ad hoc. We aimed to observe ward rounds to better understand the education opportunities available.Methods: Drawing on Argyris and Schön's (1974) theory of action, we used an ethnographic approach to observe 30 general medical ward rounds over a 3-month period, from September to December 2016. For this study we analysed the learning opportunities and the content that is explicitly taught in relation to the domains of professional practice that we espouse to teach.Results: There were many layers of learning potential observed in ward round practice. These included clinical learning, communication, professional skills and identity and institutional cultural context. Clinical learning was prioritised; however, other learning domains remained implicit and were often ignored.Discussion: Our findings highlight great complexity in ward round learning and teaching. There was significant missed educational potential in the ward round environment as well as a need for a major shift in educational focus from clinical to other professional domains. Following Argyris and Schön (1974), it is necessary to examine what we espouse against our actual educational practice. This can inform a planned or structured approach to exploit the maximum potential of ward round learning and teaching.Conclusions: Ward round education is a priority that benefits from observation, reflection and development of new models of practice. If we are not conscious of what we are teaching on rounds, and how this is occurring, we risk losing opportunities to draw on all of the learning potential available.
Impostor Syndrome and Compassion Fatigue among postgraduate allied health students: a pilot study
Authors: Schmulian Dunay , Redgen Wendy , Fleming Jenny
Published: November 2020

Aim: This study explored the prevalence of compassion fatigue and impostor syndrome risk in Australian university students in two allied health disciplines.Methods: In July 2018, anonymous surveys were collected from 72 graduate allied health students (76.4% female, 50% aged under 25 years old). The Professional Quality of Life (ProQOL) scale was used to measure compassion fatigue, with participant scores categorised into “not at risk”, “low to average risk” or “high risk” using the cut-offs outlined in the ProQOL manual. The Young Impostor Scale (YIS) was used to screen for the presence of imposter syndrome.Results: More than a third of respondents (37.5%) had symptoms of impostor syndrome, and 15.3% were at risk for compassion fatigue. Presence of compassion fatigue and/ or imposter syndrome was analysed across age range, gender, living arrangement and student status (domestic or international), revealing females were more likely to screen positive for imposter syndrome (45.5%) than males (11.8%). Results from the ProQOL and YIS were combined to identify 57% of participants to be at risk of one or both of these potentially detrimental states.Conclusion: The results of this study suggest the importance of prioritising imposter syndrome and compassion fatigue in future student mental health research. Specifically, attention should include a critical evaluation of the assessment measures and approaches available. Longitudinal monitoring of imposter syndrome and its interplay with other conditions, such as compassion fatigue, across allied health professions would be valuable in developing a theoretical framework to support interventional studies.
Mechanical analysis of a flexible microelectronic system under twisting stress
Authors: Kim Cha-Hee , Kim Jae-Min , Seo Seung-Ho , Lee Jae-Hak , Song Jun-Yeob , Lee Won-Jun
Published: November 2020

We modeled flexible microelectronic systems, in which a thinned silicon die is flip-chip bonded to a flexible substrate, and analyzed the stress and strain distribution generated during twisting deformation. Because of the presence of the rigid silicon die, the strain distribution of the system model was significantly different from that of the substrate model. Unlike the substrate model, there is no significant difference in the von Mises strain according to the position in both the molding layer and the substrate in the system model. Therefore, the results of modeling or testing only flexible substrate cannot be directly applied to predict the behavior of flexible microelectronic systems. The copper bumps revealed stress above the ultimate strength as well as the yield strength. Therefore, the copper bump would be the most mechanically weak component in the operation of the face-down flexible microelectronic system during twisting. By replacing copper bumps with polymer bumps, the maximum stress in the bumps can be significantly reduced from 282 to 47 MPa, and the maximum mechanically safe twisting angle was also improved from approximately 40° to 80°. Therefore, in flexible electronic systems where twisting deformation is applied, polymer bumps are a better bonding method than the conventional copper bumps.
Urban noise measurements in the City of Buenos Aires during the mandatory quarantine
Authors: Said Germán , Arias Agustín , Carilli Leonardo , Stasi Agustín
Published: November 2020

During preventive and mandatory social isolation decreed by the Argentine National Government to contain the spread of COVID-19, the city of Buenos Aires has experienced a marked decrease in vehicular traffic. To study this new scenario, the Acoustic Impact Department of the Environmental Protection Agency carried out a series of uninterrupted urban noise measurements for one week in five measurement points. The results were compared with those obtained before quarantine and with the maximum permissible limits according to current legislation. Although considerable decreases in sound energy have been obtained, it was not possible to determine global values of noise level reduction since the results were of different magnitudes in each location and period.
Posterior microphthalmos with pigmentary retinopathy
Authors: C Parameswarappa Deepika , Dogra Avantika
Published: November 2020

We report a case of 19-year-old man with gradual diminution of vision in both eyes since childhood. His best-corrected visual acuity was 20/160, N16 in the right eye and 20/200, N16 in the left eye. Slit-lamp biomicroscopic examination revealed normal cornea, anterior segment, intraocular pressure and lens. Fundus of both eyes showed crowded optic disc with pigmentary changes. Ancillary tests were performed to aid in the diagnosis. A-scan ultrasound revealed short axial lengths with normal corneal diameter, anterior chamber depth and lens thickness. Optical coherence tomography of both eyes showed inner retinal layer folds. Electroretinogram of both eyes showed extinguished photopic as well as scoptopic responses. A diagnosis of posterior microphthalmos with pigmentary retinopathy was made. The patient was counselled regarding nature of the disease and the condition was managed with low vision aids.
Secondary pulmonary alveolar proteinosis in GATA-2 deficiency (MonoMAC syndrome)
Authors: Raziq Fazal I , Abubaker Ahmed , Smith Eric , Uddin Mohammed
Published: November 2020

We present here a case of a 29-year-old woman with a medical history of GATA-2 deficiency, who was under treatment forMycobacterium avium intracellularepneumonia. She presented with worsening dyspnoea with cough and fever. It was initially thought she had pneumonia but she was later diagnosed with Pulmonary Alveolar Proteinosis (PAP).
Mental health conditions after snakebite: a scoping review
Authors: Bhaumik Soumyadeep , Kallakuri Sudha , Kaur Amanpreet , Devarapalli Siddhardha , Daniel Mercian
Published: November 2020

Introduction

Snakebite is a neglected tropical disease. Snakebite causes at least 120 000 death each year and it is estimated that there are three times as many amputations. Snakebite survivors are known to suffer from long-term physical and psychological sequelae, but not much is known on the mental health manifestations postsnakebite.

Methods

We conducted a scoping review and searched five major electronic databases (Ovid MEDLINE(R), Global Health, APA PsycINFO, EMBASE classic+EMBASE, Cochrane Central Register of Controlled Trials), contacted experts and conducted reference screening to identify primary studies on mental health manifestations after snakebite envenomation. Two reviewers independently conducted titles and abstract screening as well as full-text evaluation for final inclusion decision. Disagreements were resolved by consensus. We extracted data as per a standardised form and conducted narrative synthesis.

Results

We retrieved 334 studies and finally included 11 studies that met our eligibility criteria. Of the 11 studies reported, post-traumatic stress disorder (PTSD) was the most commonly studied mental health condition after snakebite, with five studies reporting it. Estimate of the burden of PTSD after snakebite was available from a modelling study. The other mental health conditions reported were focused around depression, psychosocial impairment of survivors after a snakebite envenomation, hysteria, delusional disorders and acute stress disorders.

Conclusion

There is a need for more research on understanding the neglected aspect of psychological morbidity of snakebite envenomation, particularly in countries with high burden. From the limited evidence available, depression and PTSD are major mental health manifestations in snakebite survivors.
Infectious diseases in German military personnel after predominantly tropical deployments: a retrospective assessment over 13 years
Authors: Schawaller Marius , Wiemer D , Hagen R M , Frickmann H
Published: November 2020

Objectives

Military deployments to the tropics are associated with specific infection risks. To add to the available epidemiological information, infectious disease risks in German military personnel returning from predominantly tropical deployments were assessed.

Methods

Since 2006, German soldiers returning from predominantly tropical deployments have been offered the opportunity of returnee screenings at the Department of Tropical Medicine and Infectious Diseases of the Bundeswehr Hospital Hamburg. Case files and diagnostic results recorded between 2006 and 2018 were retrospectively assessed to identify deployment-associated infectious disease risks.

Results

Along with high enteric colonisation rates with apathogenic protozoa and resistantEnterobacteriaceae, direct or indirect proof of infections among the 764 assessed cases comprisedPlasmodiumspp (n=37),Giardia duodenalis(n=21),Schistosomaspp (n=14),Yersinia enterocolitica(n=5),Strongyloides stercoralis(n=3),Campylobacter jejuni(n=1),Leishmaniaspp (n=1) andSalmonella enterica(n=1), as well as latent infections withMycobacterium tuberculosiscomplex (n=8). The infections were mainly imported from the African region and Eastern Mediterranean region and high proportions of cases lacked typical symptoms. Reported side effect rates of antimalarial chemoprophylaxis for mefloquine (n=121), atovaquone/proguanil (n=49) and doxycycline (n=6) were 36.3%, 19.3% and 11.8%, respectively, while non-compliance rates were 12.9%, 13.0% and 5.9%, respectively.

Conclusions

Considerable rates of infections with sometimes atypical or absent symptoms confirm a need for returnee screenings after tropical deployments. High reported side effect rates for mefloquine support its replacement by atovaquone/proguanil or doxycycline for antimalarial chemoprophylaxis.
Effectiveness of real-time continuous glucose monitoring to improve glycaemic control and pregnancy outcome in patients with gestational diabetes mellitus: a study protocol for a randomised controlled trial
Authors: Huhn Evelyn Annegret , Linder Tina , Eppel Daniel , Weißhaupt Karen , Klapp Christine , Schellong Karen , Henrich Wolfgang , Yerlikaya-Schatten Gülen , Rosicky Ingo , Husslein Peter , Chalubinski Kinga , Mittlböck Martina , Rust Petra , Hoesli Irene , Winzeler Bettina , Jendle Johan , Fehm T , Icks Andrea , Vomhof Markus , Greiner Gregory Gordon , Szendrödi Julia , Roden Michael , Tura Andrea , Göbl Christian S
Published: November 2020

Introduction

Real-time continuous glucose monitoring (rt-CGM) informs users about current interstitial glucose levels and allows early detection of glycaemic excursions and timely adaptation by behavioural change or pharmacological intervention. Randomised controlled studies adequately powered to evaluate the impact of long-term application of rt-CGM systems on the reduction of adverse obstetric outcomes in women with gestational diabetes (GDM) are missing. We aim to assess differences in the proportion of large for gestational age newborns in women using rt-CGM as compared with women with self-monitored blood glucose (primary outcome). Rates of neonatal hypoglycaemia, caesarean section and shoulder dystocia are secondary outcomes. A comparison of glucose metabolism and quality of life during and after pregnancy completes the scope of this study.

Methods and analysis

Open-label multicentre randomised controlled trial with two parallel groups including 372 female patients with a recent diagnosis of GDM (between 24+0 until 31+6 weeks of gestation): 186 with rt-CGM (Dexcom G6) and 186 with self-monitored blood glucose (SMBG). Women with GDM will be consecutively recruited and randomised to rt-CGM or control (SMBG) group after a run-in period of 6–8 days. The third visit will be scheduled 8–10 days later and then every 2 weeks. At every visit, glucose measurements will be evaluated and all patients will be treated according to the standard care. The control group will receive a blinded CGM for 10 days between the second and third visit and between week 36+0 and 38+6. Cord blood will be sampled immediately after delivery. 48 hours after delivery neonatal biometry and maternal glycosylated haemoglobin A1c (HbA1c) will be assessed, and between weeks 8 and 16 after delivery all patients receive a re-examination of glucose metabolism including blinded CGM for 8–10 days.

Ethics and dissemination

This study received ethical approval from the main ethic committee in Vienna. Data will be presented at international conferences and published in peer-reviewed journals.

Trial registration number

NCT03981328; Pre-results.
Frostbite: an ancient affliction – have we made progress? A case series and review of best practice.
Authors: Thomas R J , Heil K , Johnson K , Wood A M
Published: November 2020

Frostbite represents a spectrum of injuries that can have long term, permanent sequelae, resulting in lifelong disability of otherwise young, fit, economically active individuals. Furthermore, it is generally preventable. Military personnel are put at risk of this condition by the nature of their occupation. With preventative measures, early recognition, appropriate evacuation and repatriation to a medical facility, the impact of this condition can be minimised.

This article describes a case series of Royal Marines who were medically evacuated due to frostbite during an exercise, and a review of current evidence supporting the management of frostbite in the field environment through to definitive care.
The management of rectal bleeding in the military population
Authors: Swain C , Khan M
Published: November 2020

Rectal bleeding continues to be a common ailment, with the clear majority associated with benign conditions.  The deployed environment provides both a diagnostic and in some cases, therapeutic challenge.  This paper aims to highlight the key differences between benign and sinister pathologies, and their management in the Role 1 environment.
The management of drowning: a review of current evidence and guidelines
Authors: McConnell D , Horne S
Published: November 2020

Drowning is responsible for 500,000 deaths each year and is estimated to be 200 times more frequent as a cause of death than road traffic collisions (per man hour at risk). The United Nations estimates that 5000 people drowned trying to cross the Mediterranean in 2016, the highest recorded annual total.

The primary respiratory issues which are the clinical hallmark of drowning are often complicated by additional physiological consequences of the immersion, representing a considerable challenge for the deployed medical team. This article aims to examine recent evidence to provide guidance regarding resuscitation of the drowned casualty.
Medical training for contingency operations – on exercise with the Commando Forward Surgical Group
Authors: Bourn S , Howes J , Rylah O , Ritson J
Published: November 2020

This article describes the involvement of trainees from anaesthetics, emergency medicine and pre-hospital emergency medicine during an exercise with the Command Forward Surgical Group. The exercise allowed for hands-on experience that cannot be gained in a civilian environment and is directly applicable to future deployments as military consultants. Exercising in the field with experienced consultants and the deployable medical modules encouraged the sharing of important speciality specific and multidisciplinary corporate knowledge.
Role 1 Enhanced: a new paradigm in humanitarian operations
Authors: Henning D C W , Bennett A
Published: November 2020

Operation BUCKTAIL is the UK contribution to migrant surveillance and reconnaissance in the Aegean Sea. This paper describes two different and novel medical configurations which deployed in early 2016 to this Area of Operations (AO). Casualties in this situation would be treated under the Convention of Safety Of Life At Sea, a humanitarian role which may be less familiar to some of the Defence Medical Services. Casualty management is discussed and the composition of medical teams examined.
Humidifier fever on a Type 42 destroyer
Authors: Edmondstone M
Published: November 2020

In 1981, the description of symptoms widespread among his messmates by a Leading Seaman admitted to hospital with pneumonia led to an epidemiological and clinical investigation on board HMS SHEFFIELD, a Type 42 destroyer. It was concluded that all the members of one mess deck were affected by humidifier fever. Simple advice which was given to CINCFLEET staff to keep air conditioning systems running during refits and prolonged maintenance periods is believed to have prevented a recurrence on other ships.
The Falklands War: the journals of the fleet’s Medical Officers
Authors: Penn-Barwell JG
Published: November 2020

In response to the Argentine invasion of the Falkland Islands in 1982, a large Naval task force was rapidly despatched to the South Atlantic to retake the islands. These ships carried Medical Officers, typically junior doctors who were providing care to their ship’s company whilst they shared their danger and emotions as the conflict evolved. On return they submitted their journals, providing a unique insight into the hasty assembly of the task force, the fight against enemy aircraft, the provision of Naval Gunfire Support (NGS) to the land forces and the repatriation and care of the casualties of war.
The conversion, role and service of Her Majesty’s Hospital Ship UGANDA during the Falklands War: April-August 1982
Authors: Pugh N
Published: November 2020

In 1982, after Argentinian forces invaded the Falkland Islands, a Royal Navy (RN) Task Force sailed to the South Atlantic. One of the early key decisions made by the Ministry of Defence was to requisition a hospital ship and position her within the war zone. This article describes this deployment and the conversion from Steam Ship (SS) to Her Majesty's Hospital Ship (HMHS) UGANDA in Gibraltar, and the contribution made by those on board to the war-fighting phase of the Falklands War and beyond.
Non-compressible torso haemorrhage: the new holy grail for further improvement in trauma survival
Authors: Barnard E B G , Smith J E
Published: November 2020

Non-compressible torso haemorrhage is the cause of a significant number of trauma deaths and could potentially be the target for the next series of developments in trauma resuscitation. This review describes the epidemiology and outlines potential management options for this condition. To improve survival in this group of patients, further research is required to identify options that are feasible in the pre-hospital as well as hospital environments.
Peptic ulcer disease in the military setting
Authors: McKnight G , Powell C
Published: November 2020

Peptic ulcer disease (PUD) is decreasing in incidence but is still prevalent within the military population. This article describes the epidemiology, pathophysiology and key clinical manifestations as well as outlining the diagnosis, treatment and complications of this disease.
Operation TRENTON 4
Authors: Smith J E , Davies J
Published: November 2020

The Royal Naval Medical Service (RNMS) is currently engaged on Operation TRENTON, as part of the UK military contribution to the United Nations Mission in South Sudan (UNMISS). This article gives some background to the operation, describes the setting, and the facility that is operating in this austere environment.
Reactive Arthritis in the military population
Authors: Bahadur S , Bennett A
Published: November 2020

Military personnel are at increased risk of suffering Reactive Arthritis (ReA), with enteric or genitourinary organisms usually providing the triggering immunogenic precipitant. Presentation is difficult to discern from other causes of joint pain, and clinicians should always identify possible preceding infection and extra-articular symptoms and signs. This clinical review describes ReA and how this debilitating condition affects military personnel in terms of prevalence, pathological origins, presentation and treatment.

It will review the risk factors, organisms involved and operational threats that permit ReA to occur and flourish. Diagnosis and management are described, along with current pharmacological therapies in this little-researched condition, and a therapeutic regime is discussed. Prevention of infectious outbreaks can limit this incapacitating condition in military personnel.
Back-pack palsy in Royal Marine recruits at the Commando Training Centre Royal Marines
Authors: Webster R , Hales R , Hemingway R
Published: November 2020

Introduction

Peripheral nerve injury secondary to load carrying is a rare condition most often described in military personnel secondary to heavy load carrying for prolonged periods. A series of patients is described presenting with compression neuropathy secondary to load carrying, and their disease characteristics are compared to those described in the literature.

Methods

Our rehabilitation database was searched for all cases of shoulder neuropraxia reported between 2008-2016 during initial military training of 8790 Royal Marine (RM) recruits. Incidence, median rehabilitation period required to return to mainstream training, affected nerve distribution, and investigations performed were identified. Also described was the long-term outcome in terms of recovery from neuropathy and onward fitness for RM service.

Results

The incidence of shoulder neuropraxia in RM recruits during training was 330 per 100,000. Of the 29 patients identified, 66% made a full recovery over a median period of 20 weeks. Median follow-up time was 2.3 years. The most common nerve affected was the axillary nerve.

Conclusion

Shoulder neuropraxia is more common in the RM recruit population than in other previously studied groups. This could be explained by the arduous nature of the loaded marches during RM recruit training, the load including heavy packs, irregular terrain and long distances. Emphasis should be placed on prevention, by providing good recruit education on appropriate kit adjustment during load carries and early identification of symptoms.
Combat casualty care: advances in torso trauma and lessons learned from two decades of conflict
Authors: Khan M
Published: November 2020

The last two decades have resulted in rapid developments in the management of torso trauma in injured military personnel. Through international collaboration and targeted research strategies, the UK Defence Medical Services have been at the fore-front of these developments. This review explores the key partnerships and areas of research that have enabled these successful developments to occur.
Medium term outcome of a military population following ankle ligament repair using the modified Broström-Gould procedure
Authors: Myatt R W , Capella S , Ward N J , Gougoulias N , Hinsley D E
Published: November 2020

Aims

Lateral ankle ligament instability is a common and often debilitating condition affecting service personnel. This study aimed to assess the outcome of surgical repair utilising a modified Broström-Gould technique for patients in whom conservative therapies had failed.

Methods

Military patients who underwent ankle surgery at Frimley Park Hospital between 2011-2016 were identified. Patients were contacted and asked to complete a retrospective Visual Analogue Score and Manchester Oxford Foot Questionnaire (MOxFQ). DMICP data were reviewed to identify return to fitness.

Results

109 military patients underwent surgery during this period, of whom 46 were contactable and completed the questionnaires. The median satisfaction score was 9/10, with 89% acknowledging that they would have the same procedure again. The mean increase in stability was 3 to 8 (out of 10), p<0.005. 66% of respondents were still serving in the armed forces, but poor residual ankle function contributed to 23% leaving the military. Of those remaining in service, 50% had returned to a medically fully deployable status at an average of 9.9 months from the date of surgery.

Conclusions

This study has defined outcomes from ankle ligament repair that should help clinicians to manage the expectations of patients referred for this type of surgery.
A systematic review and analysis of learning from major incidents and mass casualty events over the last five years
Authors: Phailly A , King D , Khan M
Published: November 2020

The dawn of the 21stcentury has seen a dramatic increase of mass casualty events internationally, with a number of aetiologies. The key with any healthcare evolution is to identify whether lessons learned are being implemented to help to mitigate future events. This article will explore the lessons learned from mass casualty events over the last five years.
Initial Naval Training for Medical Officers: successes and opportunities
Authors: Heil K M , Thornback A
Published: November 2020

In 2012, the Initial Officer Training (INT(O)) pipeline for Royal Navy Medical and Dental Officers (RN MODOs) was reorganised to ensure the same key training objectives were met by all Officers in the RN. This modernisation programme was initiated by the Institute of Naval Medicine (INM) and Britannia Royal Naval College (BRNC), to guarantee that MOs possess the leadership and military skills required for service in the Royal Navy.

This article describes the course and how it has developed over the seven years since its introduction. It aims to give an understanding of what initial MO training involves, some areas of opportunity, and intends to inform potential RN Medical Service applicants about what they can expect during initial training.
Pacific Partnership 18
Authors: Middleton M
Published: November 2020

In March 2018, a team of five UK Defence Medical Service (DMS) personnel deployed to Hawaii in order to take part in the US Navy-led PACIFIC PARTNERSHIP (PP18) mission. This was the third deployment of UK DMS personnel to this annual humanitarian and disaster relief preparedness mission and further supported a shift in focus into the Indo-Asia-Pacific Region.
A structured review of literature on body composition profiles in Navy personnel: current practices and considerations for the future
Authors: Havenetidis K , Bissas A
Published: November 2020

Introduction

There is need of a better understanding of body composition profiles in multi-national Navy personnel and their relationship with health and fitness. The aim of this review was to produce a critical assessment of original research addressing body composition in this military branch.

Methods

Electronic databases PubMed and SPORTDiscus were searched to identify surveys and randomised clinical trials from journal articles and technical reports investigating body composition profiles on Navy populations.

Results

Twenty-two studies were selected on the basis of stated inclusion criteria for military surveys and randomised clinical trials. Excepting Navy personnel in special operation force units, data indicated that body composition profiles, as determined by Body Mass Index (BMI) and body fat percentage for Navy personnel, were lower compared to respective Army profiles. BMI values increase from shore to ship deployment, with body composition profiles showing less healthy trends for personnel serving on vessels with limited space, whilst special operation forces do not conform to this pattern, constituting a mission-oriented body composition profile.

Conclusions

Body composition profiles in multi-national Navy personnel vary in relation to other military branches, geographical locations, specialty and deployment status. There is a need to validate new body composition techniques so recruitment is based on more representative profiles. Finally, the development of fitness interventions for personnel serving on vessels is deemed absolutely necessary in order to counterbalance health and fitness negative adaptations.
3 Commando Brigade - United States Marine Corps medical interoperability
Authors: Andrews S
Published: November 2020

This article describes a study investigating the medical interoperability of 3 Commando Brigade (3 Cdo Bde) with the US Marine Corps (USMC), predominately in the Role 2 and overarching Command and Control domain. This was conducted over two main exercise periods in 2017. The information was gathered through coalition casualty serials, face to face interviews, attendance at US training courses and visits to US facilities.

The operational patient care pathways are broadly interoperable. There is no critical factor that would prevent medical interoperability between 3 Cdo Bde and the USMC if medical treatment facilities were required to deploy on imminent operations.
Surgeons in surge — the versatility of the acute care surgeon: outcomes of COVID-19 ICU patients in a community hospital where all ICU patients are managed by surgical intensivists
Authors: Choron Rachel Leah , Butts Christopher A , Bargoud Christopher , Krumrei Nicole , Teichman Amanda L , Schroeder Mary , Bover Manderski Michelle T , To Jennifer , Moffa Salvatore M , Rodricks Michael B , Lissauer Matthew , Gupta Rajan
Published: November 2020

Background

Reported characteristics and outcomes of critically ill patients with COVID-19 admitted to the intensive care unit (ICU) are widely disparate with varying mortality rates. No literature describes outcomes in ICU patients with COVID-19 managed by an acute care surgery (ACS) division. Our ACS division manages all ICU patients at a community hospital in New Jersey. When that hospital was overwhelmed and in crisis secondary to COVID-19, we sought to describe outcomes for all patients with COVID-19 admitted to our closed ICU managed by the ACS division.

Methods

This was a prospective case series of the first 120 consecutive patients with COVID-19 admitted on March 14 to May 10, 2020. Final follow-up was May 27, 2020. Patients discharged from the ICU or who died were included. Patients still admitted to the ICU at final follow-up were excluded.

Results

One hundred and twenty patients were included (median age 64 years (range 25–89), 66.7% men). The most common comorbidities were hypertension (75; 62.5%), obesity (61; 50.8%), and diabetes (50; 41.7%). One hundred and thirteen (94%) developed acute respiratory distress syndrome, 89 (74.2%) had shock, and 76 (63.3%) experienced acute kidney injury. One hundred (83.3%) required invasive mechanical ventilation (IMV). Median ICU length of stay (LOS) was 8.5 days (IQR 9), hospital LOS was 14.5 days (IQR 13). Mortality for all ICU patients with COVID-19 was 53.3% and 62% for IMV patients.

Conclusions

This is the first report of patients with COVID-19 admitted to a community hospital ICU managed by an ACS division who also provided all surge care. Mortality of critically ill patients with COVID-19 admitted to an overwhelmed hospital in crisis may not be as high as initially thought based on prior reports. While COVID-19 is a non-surgical disease, ACS divisions have the capability of successfully caring for both surgical and medical critically ill patients, thus providing versatility in times of crisis.

Level of evidence

Level V.