bluuebunny/crossref_metadata_2025 huggingface dataset:
A Novel Approach to Negative Pressure Wound Therapy: Use of High Suction Capillary Device to Improve Wound Healing
Authors: Chatterjee Ranjit , Riddle Tara M , Poskarbiewicz Melisa K , Babcock George F
Published: January 2021

Introduction

Negative Pressure Wound Therapy (NPWT) is a procedure used for nonhealing wounds. In NPWT, a special sealed dressing of large cell foam (>400 µm) or gauze is connected to a pump. Most commonly, negative pressures between −10 and −125 millimeters of mercury (mm Hg) are used. The mechanism of healing is unknown but maybe attributable to removal of the exudate and bacteria, and the stimulation of tissue repair through microdeformation. Reticulated foams with micron-size open cells, Capillary Suction Devices (CSD; 100 to 5 µm) exert capillary suction between 10 and 70 mm of Hg with a multilayered foam dressing.

Materials and Methods

Yorkshire pigs received 5 surgical excision wounds, 3 cm2, on each side of the back. The wounds were covered with a NPWT dressing (110 mm Hg negative pressure by a pump), CSD with capillary suctions of 30 mm Hg (CSD-30) and 70 mm Hg (CSD-70), and a conventional gauze dressing. The wounds were measured on day 2, and then every 4-5 days thereafter; the total fluid collected by the various dressing over time.

Results

By post-wound day 20, the wounds treated with CSD-70 and NPWT were 100% closed while the wounds treated with CSD-30 and gauze were 65% and 45%, respectively. This indicated comparable wound closure efficacies for CSD-70 and NPWT. The average total fluid uptake measured in grams dry weight were similar for CSD-70 and NPWT, 36 and 38 g, respectively, while the values were 24 g for CSD-30 and 12 g for gauze. However, the maximum fluid uptake observed at day 2 indicated that CSD-70 and CSD 30, 24 and 14 g, respectively, were superior to NPWT and gauze 12 and 7 g, respectively.

Conclusion

This data indicate comparable wound closure efficacies for CSD-70 and NPWT. It is felt that CSD is an effective, safe, and lower cost alternative to vacuum-assisted NPWT.
Pelvic Injury Risk Curves for the Military Populations From Lateral Impact
Authors: Yoganandan Narayan , Rooks Tyler F , Chancey Valeta Carol , Pintar Frank A , Banerjee Anjishnu
Published: January 2021

Introduction

Current methods for transporting military troops include nonstandard seating orientations, which may result in novel injuries because of different types/directions of loading impact. The objective of this study is to develop pelvic injury risk curves (IRCs) under lateral impacts from human cadaver tests using survival analysis for application to military populations.

Methods

Published data from lateral impacts applied to whole-body cadaver specimens were analyzed. Forces were treated as response variables. Demographics and body mass index (BMI) were covariates. Injury risk curves were developed for forces without covariates, for males, females, 83 kg body mass, and 25 kg/m2 BMI. Mean and ± 95% confidence interval IRCs, normalized confidence interval sizes at discrete risk levels, and quality indices were obtained for each metric-covariate combination curve.

Results

Mean age, stature, total body mass, and BMI were 70.1 ± 8.6 years, 1.67 ± 0.1 m, 67.0 ± 14.4 kg, and 23.9 ± 3.97 kg/m2, respectively. For a total body mass of 83 kg, peak forces at 10%, 25%, and 50% probability levels were 5.7 kN, 7.4 kN, and 9.6 kN, respectively. For males, peak forces at the 10%, 25%, and 50% probability levels were 4.8 kN, 6.4 kN, and 8.4 kN, respectively. For females, peak forces at the 10%, 25%, and 50% probability levels were 3.0 kN, 4.0 kN, and 5.2 kN, respectively. Other data and risk curves are given.

Conclusions

The IRCs developed in this study can be used as injury criteria for the crashworthiness of future generation military vehicles. The introduction of BMI, sex, and total body mass as covariates quantified their contributions. These IRCs can be used with finite element models to assess and predict injury in impact environments to advance Soldier safety. Manikins specific to relevant military anthropometry may be designed and/or evaluated with the present IRCs to assess and mitigate musculoskeletal injuries associated with this posture and impact direction.
Soldiers’ Perception of a Behavioral Intervention for Positive Airway Pressure Therapy Adherence in a Military Treatment Facility
Authors: Ee Juliana S , Pham Christopher K , Shaha David P , Rogers Mary C , Cacace Gregory S , Mounts Charles W
Published: January 2021

Introduction

The incidence of obstructive sleep apnea in military personnel has increased over 500% since the early 2000s. Adherence to continuous positive airway pressure (PAP), an efficacious treatment, has been suboptimal. This article presents a behavioral intervention model for enhancing PAP therapy adherence and describes how the model was received by military personnel.

Materials and Methods

The study population comprised 254 out of 280 military personnel (93% men, mean age 39 years) who attended a 90-minute behavioral intervention class within the first 8 weeks of PAP use. They were coached on the Knowledge, Skills, Attitudes (KSA) model of PAP therapy success: Knowledge about obstructive sleep apnea and PAP treatment; Skills to develop a habitual loop for nightly PAP use; and Attitudes that address readiness, barriers, and solutions for sustaining PAP use. Participants completed a voluntary, anonymous postclass survey that inquired of their perception of various elements of the class. Data were analyzed using descriptive statistics and a paired sample t-test.

Results

In participants’ self-rating of how much they know about PAP treatment before and after the class, their ratings indicated that they experienced a significant increase in knowledge (P < 0.0001). On the postclass survey, 77% of the participants (N = 195/254) “agree a lot” or “strongly agree” that the class gave them tools to have a successful treatment and 78% (N = 198/254) noted that it was a valuable educational experience. The Knowledge portion was rated by 79% (N = 201/254) of the participants as “quite a lot” or “extremely” beneficial. The Skills segment was rated as “quite a lot” or “extremely” beneficial by 72% (N = 183/254) of the participants. The Attitudes discussion was perceived as “quite a lot” or “extremely” beneficial by 70% (N = 178/254) of the participants. Participants’ free-text responses to “what was most helpful” were generally positive.

Conclusions

A KSA model of behavioral intervention for enhancing PAP therapy adherence was well received by participants. Future research will assess the impact of this intervention on adherence as measured by objective indicators.
The Application of a Computerized Cognitive Screening Tool in Naval Aviators
Authors: Chee Shawnna M , Bigornia Veronica E , Logsdon Daniel L
Published: January 2021

Introduction

The CogScreen-Aeromedical Edition (CogScreen-AE) is a computerized neurocognitive assessment screening tool developed for the Federal Aviation Administration as a rapid, reliable means of measuring neurocognitive deficiency in civilian airline pilots. This has potential use and assessment of military aviators flying high performance aircraft under extreme conditions; however, no data exist on how the dynamic flight environment affects CogScreen-AE scores. The objectives of this study were to determine what changes in performance on CogScreen-AE scores are seen post-flight in Naval Aviators flying high performance aircraft and to determine the potential for use of CogScreen-AE as a screening tool to evaluate degree of impairment, recovery from neurological illness, and return to duty status of a military aviator.

Materials and Methods

Repeated measures, within-subjects experimental design with three CogScreen-AE administrations—introduction session, preflight session, and postflight session. An experimental study group was exposed to dynamic flight between preflight and postflight sessions, while a control group flew a desktop computer flight simulator between sessions. Data were analyzed by mixed model ANOVA using Statistical Package for the Social Sciences to compare CogScreen-AE pre- and postflight performance on 5 composite scores of variables that account for 45% of the variance in predicting flight performance.

Results

Preflight versus postflight scores demonstrated no significant differences in performance attributable to flight in high performance aircraft.

Conclusions

The CogScreen-AE performance is shown to be consistent preflight to post-flight. These data show that CogScreen-AE may be a reliable clinical instrument for assessing aviators’ cognitive function with regard to return to flight duty decision-making. We anticipate future work in determining how CogScreen-AE can be utilized in the operational environment and documenting recovery from neurologic illness.
Female Military Officers Report a Desire for Menstrual Suppression During Military Training
Authors: Ricker Emily A , Goforth Carl W , Barrett Amelia S , Deuster Patricia A , de la Motte Sarah J
Published: January 2021

Introduction

Service women face female-specific challenges that present physiological and logistical burdens and may impact readiness. The stress of training can change menstrual patterns and symptoms, and limited access to hygienic, private facilities can hinder menstrual management. Therefore, suppressing menses with continuous hormonal contraception may be of interest.

Materials and Methods

The 9-item “Military Women’s Attitudes Toward Menstrual Suppression.” questionnaire was administered to female officers upon entry (baseline) and graduation (post) from a 6-month secondary training course. Respondents rated their attitudes about menstruation and the stress of training, the desire for menstrual suppression, and the logistical burden of menstruation on a 1 (strongly agree) through 5 (strongly disagree) scale. Wilcoxon Signed Rank Tests determined changes in the distribution of responses from baseline to post.

Results

Female officers (n = 108) completed baseline and post questionnaires (age 25.2 ± 0.3 years). At baseline, the majority disagreed/strongly disagreed that the stress of training “makes periods worse than usual” (n = 77, 71%), “increases menstrual symptoms and bleeding” (n = 77, 71%), or “magnifies premenstrual syndrome” (PMS; n = 69, 64%). Although 50% (n = 54) agreed/strongly agreed that “stopping periods while women are training is a good idea,” 37% (n = 40) disagreed/strongly disagreed. The majority agreed/strongly agreed that menstrual suppression would prevent “the worry about menstrual supplies” (n = 75, 70%) and “the inconvenience of having a period during training” (n = 69, 64%). Many agreed/strongly agreed that it is difficult to deal with periods during training because “there is no privacy” (n = 52, 48%), “the inability to find adequate facilities” (n = 70, 65%), and “the lack of opportunity to use adequate facilities” (n = 52, 48%). Opinions remained largely consistent from baseline to post.

Conclusions

The desire for menstrual suppression among service women during training is high. Military health care providers should be prepared to counsel service women about strategies to manage menstruation, including the efficacy of continuous hormonal contraception for menstrual suppression. Future studies investigating benefits or risks of continuous hormonal contraception for menstrual suppression in service women should inform the clinical recommendations.
Novel Real-time Digital Pressure Sensor Reveals Wide Variations in Current Nerve Crush Injury Models
Authors: Wandling Grant D , Lee Jung Il , Talukder M A Hassan , Govindappa Prem Kumar , Elfar John C
Published: January 2021

Introduction: Peripheral nerve crush injury (PNCI) models are commonly used to study nerve damage and the potential beneficial effects of novel therapeutic strategies. Current models of PNCI rely on inter-device and operator precision to limit the variation with applied pressure. Although the inability to accurately quantify the PNCI pressure may result in reduced reproducibility between animals and studies, there is very limited information on the standardization and quantification of applied pressure with PNCI. To address this deficit, we constructed a novel device comprised of an Arduino UNO microcontroller board and Force Sensitive Resistor capable of reporting the real-time pressure applied to a nerve.

Methods: Two forceps and two needle drivers were used to perform 30-second PNCIs to the sciatic nerves of mice (n = 5/group). Needle drivers were set to the first notch, and a jig was used to hold the forceps pinch at a reproducible pressure. The Force Sensitive Resistor was interposed in-series between the nerve and instrument during PNCI.

Results: Data collected from these procedures displayed average needle driver pressures an order of multitude greater than forceps pressures. Additionally, needle driver inter- and intra-procedure pressure remained more consistent than forceps pressure, with needle driver coefficient of variation equal to 14.5% vs. a forceps coefficient of variation equal to 45.4%.

Conclusions: This is the first demonstration of real-time pressure measurements in PNCI models and it reveals that the applied pressures are dependent on the types of device used. The large disparity in pressure represents an inability to apply graded accurate and consistent intermediate pressure gradients in PNCI. These findings indicate a need for documentation of pressure severity as a screening for PNCI in animals, and the real-time pressure sensor could be a useful tool in monitoring and applying consistent pressure, reducing the outcome variability within the same experimental model of PNCI.
Should I Stay or Should I Go? Identifying Intrinsic and Extrinsic Factors in the Decision to Return to Duty Following Lower Extremity Injury
Authors: Wilson Jonathan B , Rábago Christopher A , Hoppes Carrie W , Harper Phaidra L , Gao Jin , Russell Esposito Elizabeth
Published: January 2021

Introduction

Rehabilitation research of wounded service members (SMs) commonly focuses on physical ability to return to duty (RTD) as a measure of successful recovery. However, numerous factors or barriers may influence a SM’s ability and/or desire to RTD after lower extremity musculoskeletal trauma. SMs themselves as well as the clinical care team that works with them daily, often for years at a time, both offer unique perspectives on the influential factors that weigh into decisions to RTD. The purpose of this study was to identify the intrinsic and extrinsic factors patients and clinicians recognized as influencing the decision to RTD after severe lower extremity trauma.

Materials and Methods

Thirty-two SMs with severe lower extremity trauma (amputation and lower limb salvage) and 30 providers with at least 2 years’ experience caring for SMs with similar injuries participated separately in either a SM or provider/clinician focus group. Open-ended questions on factors influencing RTD and other rehabilitation success were discussed. Data analysis consisted of qualitative transcription and participatory active sorting, followed by thematic coding and grouping of qualitative data.

Results

Individual (health condition, personal traits, and career consideration), interpersonal (clinician’s impact, family influence, and peer influence), health care system (systems of care, transdisciplinary rehabilitation, and innovation availability), and institutional (policy, benefits, and unit/commander) themes emerged amongst SM patients and clinicians. Expected frequently occurring themes common to both groups were the influence of the team and family unit, as well as career trajectory options after a severe injury. An unexpected theme was acknowledgment of and dissatisfaction with the recent dismantling of institutional systems that support wounded SMs. Patients placed less emphasis on severity of injury and greater emphasis on system and policy barriers than did clinicians.

Conclusions

Characterization and classification of these clinician and SM-identified factors that influence the decision to RTD after severe lower extremity trauma is expected to improve the efficacy of future rehabilitation efforts and clinical practice guidelines by providing the clinical team the knowledge necessary to recognize modifiable barriers to patient success. A better understanding of factors influencing RTD decision-making may support policies for mitigating RTD barriers, better monitoring of the changing landscape of RTD after lower extremity trauma, improving systems of health care, and/or reducing turnover and facilitating force readiness.
Developing and Testing a Web-Based Provider Training for Cognitive Behavioral Therapy of Insomnia
Authors: Taylor Daniel J , Dietch Jessica R , Pruiksma Kristi , Calhoun Casey D , Milanak Melissa E , Wardle-Pinkston Sophie , Rheingold Alyssa A , Ruggiero Kenneth J , Bunnell Brian E , Wilkerson Allison K
Published: January 2021

Introduction

Chronic insomnia is a common and debilitating disease that increases risk for significant morbidity and workplace difficulties. Cognitive behavioral therapy for insomnia (CBT-I) is the first-line treatment, but there is a critical lack of behavioral health providers trained in CBT-I because, in part, of a bottleneck in training availability and costs. The current project developed and evaluated a web-based provider training course for CBT-I: CBTIweb.org.

Materials and Methods

Subject matter experts developed the content for CBTIweb.org. Then, trainees completed alpha testing (n = 24) and focus groups, and the site was improved. Next, licensed behavioral health providers and trainees completed beta testing (n = 41) and the site underwent another round of modifications. Finally, to compare CBTIweb.org to an in-person workshop, licensed behavioral health providers were randomly assigned to CBTIweb.org (n = 21) or an in-person workshop (n = 23). All participants were CBT-I naïve and completed the following assessments: Computer System Usability Questionnaire, Website Usability Satisfaction Questionnaire, Website Content Satisfaction Questionnaire, and Continuing Education knowledge acquisition questionnaires.

Results

Alpha and beta testers of CBTIweb.org reported high levels of usability and satisfaction with the site and showed significant within-group knowledge acquisition. In the pilot comparison study, linear fixed-effects modeling on the pre-/postquestionnaires revealed a significant main effect for time, indicating a significant increase in knowledge acquisition from 69% correct at baseline to 92% correct at posttraining collapsed across in-person and CBTIweb.org groups. The interaction effect of Time by Condition was nonsignificant, indicating equivalence in knowledge gains across both groups.

Conclusion

CBTIweb.org appears to be an engaging, interactive, and concise provider training that can be easily navigated by its users and produce significant knowledge gains that are equivalent to traditional in-person workshops. CBTIweb.org will allow for worldwide dissemination of CBT-I to any English-speaking behavioral health providers. Future research will work on translating this training to other languages and extending this web-based platform to the treatment of other sleep disorders (e.g., nightmares) and populations (e.g., pediatric populations with insomnia).
A Synthetic Biology Approach Using Engineered Bacteria to Detect Perfluoroalkyl Substance (PFAS) Contamination in Water
Authors: Young Nathaniel A , Lambert Ryan L , Buch Angela M , Dahl Christen L , Harris Jackson D , Barnhart Michael D , Sitko John C , Jordan Steel James
Published: January 2021

Introduction

Per- and polyfluoroalkyl substances (PFAS) are a class of synthetic compounds used industrially for a wide variety of applications. These PFAS compounds are very stable and persist in the environment. The PFAS contamination is a growing health issue as these compounds have been reported to impact human health and have been detected in both domestic and global water sources. Contaminated water found on military bases poses a potentially serious health concern for active duty military, their families, and the surrounding communities. Previous detection methods for PFAS in contaminated water samples require expensive and time-consuming testing protocols that limit the ability to detect this important global pollutant. The main objective of this work was to develop a novel detection system that utilizes a biological reporter and engineered bacteria as a way to rapidly and efficiently detect PFAS contamination.

Materials and Methods

The United States Air Force Academy International Genetically Engineered Machine team is genetically engineering Rhodococcus jostii strain RHA1 to contain novel DNA sequences composed of a propane 2-monooxygenase alpha (prmA) promoter and monomeric red fluorescent protein (mRFP). The prmA promoter is activated in the presence of PFAS and transcribes the mRFP reporter.

Results

The recombinant R. jostii containing the prmA promoter and mRFP reporter respond to exposure of PFAS by activating gene expression of the mRFP. At 100 µM of perfluorooctanoic acid, the mRFP expression was increased 3-fold (qRT-PCR). Rhodococcus jostii without exposure to PFAS compounds had no mRFP expression.

Conclusions

This novel detection system represents a synthetic biology approach to more efficiently detect PFAS in contaminated samples. With further refinement and modifications, a similar system could be readily deployed in the field around the world to detect this critical pollutant.
Clinical Readiness Program: Refocusing the Military Health System
Authors: Holt Danielle B , Hueman Matthew T , Jaffin Jonathan , Sanchez Michael , Hamilton Mark A , Mabry Charles D , Bailey Jeffrey A , Elster Eric A
Published: January 2021

Introduction

The Military Health System serves to globally provide health services and trained medical forces. Military providers possess variable levels of deployment preparedness. The aim of the Clinical Readiness Program is to develop and assess the knowledge, skills, and abilities (KSAs) needed for combat casualty care.

Methods

The Clinical Readiness Program developed a KSA metric for general and orthopedic surgery. The KSA methodology underwent a proof of concept in six medical treatment facilities.

Results

The KSA metric feasibly quantifies the combat relevance of surgical practice. Orthopedic surgeons are more likely than general surgeons to meet the threshold. Medical treatment facilities do not provide enough demand for general surgery services to achieve readiness.

Conclusion

The Clinical Readiness Program identifies imbalances between the health care delivery and readiness missions. To close the readiness gap, the Military Health System needs to recapture high KSA value procedures, expand access to care, and/or partner with civilian institutions.
Use of Mobile Technology Paired with Heart Rate Monitor to Remotely Quantify Behavioral Health Markers among Military Reservists and First Responders
Authors: Davila Maria I , Kizakevich Paul N , Eckhoff Randy , Morgan Jessica , Meleth Sreelatha , Ramirez Derek , Morgan Tim , Strange Laura B , Lane Marion , Weimer Belinda , Lewis Amanda , Lewis Gregory F , Hourani Laurel I
Published: January 2021

Introduction

Heart rate variability (HRV) is a biological marker that reflects an individual’s autonomic nervous system regulation. Psychological resilience is an individual’s ability to recover from an adverse event and return to physiological homeostasis and mental well-being, indicated by higher resting HRV. The Biofeedback Assisted Resilience Training (BART) study evaluates a resilience-building intervention, with or without HRV biofeedback. This article evaluates the feasibility of remote psychophysiological research by validating the HRV data collected.

Materials and Methods

The BART platform consists of a mobile health application (BART app) paired to a wearable heart rate monitor. The BART app is installed on the participant’s personal phone/tablet to track and collect self-report psychological and physiological data. The platform collects raw heart rate data and processes HRV to server as online biofeedback. The raw data is processed offline to derive HRV for statistical analysis. The following HRV parameters are validated: inter-beat interval, respiratory sinus arrhythmia, low-frequency HRV, biofeedback HRV, and heart period. Bland–Altman and scatter plots are used to compare and contrast online and offline HRV measures. Repeated-measures ANOVA are used to compared means across tasks during the stress (rest, stress, and recovery) and training (rest and paced breathing) sessions in order to validate autonomic nervous system changes to physiological challenges.

Results

The analyses included 245 participants. Bland–Altman plots showed excellent agreement and minimal bias between online and offline unedited inter-beat interval data during the stress session. RMANOVA during the training session indicated a significant strong effect on biofeedback HRV, F(11,390) = 967.96, P < .01. During the stress session, RMANOVA showed significant strong effect on respiratory sinus arrhythmia and low-frequency HRV, and a significant but weak effect on heart period.

Conclusions

The BART digital health platform supports remote behavioral and physiological data collection, intervention delivery, and online HRV biofeedback.
Measurements of Infrasound Signatures From Grenade Blast During Training
Authors: Medda Alessio , Funk Rob , Ahuja Krish , Kamimori Gary
Published: January 2021

Introduction

Military personnel during training and military operations are exposed to a large number of repeated exposures to low-level blast overpressure from a variety of sources. These exposures rarely produce a concussion, but anecdotal evidence from soldiers indicates that it can still cause transient neurological effects. Impulsive acoustic sources, such as the ones encountered during military training, are characterized by a broadband energy distribution with resulting pressure measurements that exhibit frequency components well within the infrasound range. This infrasound can couple directly with the human body and in this way alter or influence physiological processes up to inducing concussion-like symptoms.

Materials and Methods

This study explores the presence of infrasound energy in measured acoustic signals collected during grenade training at Ft. Benning, GA. Acoustic data from traditional microphones and specialized infrasound microphones were collected during one training session and time and time–frequency analysis was performed to highlight the frequency content of the signals.

Results

The analysis of the collected measurements indicates peak SPLs between 140 and 160 dB during explosions corresponding to the shockwave. Also, high-intensity infrasound was observed during grenade explosions with significant energy in the infrasound range and in particular below 3 Hz. This energy appears in the form of three distinct tones at frequencies of 1.987, 2.296, and 2.528 Hz that are present only for the duration of the blast wave.

Conclusions

The results presented in this article suggest that reported symptoms from military personnel exposed to repeated low-level blast may also be because of acoustic loading. Therefore, to take into account these findings, future studies aimed at characterizing the effects of repeated low-level blast exposure should consider including acoustic measurements in their investigations.
Inertial-based Fluidic Platform for Rapid Isolation of Blood-borne Pathogens
Authors: Batcho Erin C , Miller Sinead , Cover Timothy L , McClain Mark S , Marasco Christina , Bell Charleson S , Giorgio Todd D
Published: January 2021

Introduction

Bacterial sepsis is a life-threatening disease and a significant clinical problem caused by host responses to a microbial infection. Sepsis is a leading cause of death worldwide and, importantly, a significant cause of morbidity and mortality in combat settings, placing a considerable burden on military personnel and military health budgets. The current method of treating sepsis is restricted to pathogen identification, which can be prolonged, and antibiotic administration, which is, initially, often suboptimal. The clinical trials that have been performed to evaluate bacterial separation as a sepsis therapy have been unsuccessful, and new approaches are needed to address this unmet clinical need.

Materials and Methods

An inertial-based, scalable spiral microfluidic device has been created to overcome these previous deficiencies through successful separation of infection-causing pathogens from the bloodstream, serving as a proof of principle for future adaptations. Fluorescent imaging of fluorescent microspheres mimicking the sizes of bacteria cells and blood cells as well as fluorescently stained Acinetobacter baumannii were used to visualize flow within the spiral. The particles were imaged when flowing at a constant volumetric rate of 0.2 mL min−1 through the device. The same device was functionalized with colistin and exposed to flowing A. baumannii at 0.2 mL h−1.

Results

Fluorescent imaging within the channel under a constant volumetric flow rate demonstrated that smaller, bacteria-sized microspheres accumulated along the inner wall of the channel, whereas larger blood cell–sized microspheres accumulated within the center of the channel. Additionally, fluorescently stained A. baumannii displayed accumulation along the channel walls in agreement with calculated performance. Nearly 106 colony-forming units of A. baumannii were extracted with 100% capture efficiency from flowing phosphate-buffered saline at 0.2 mL h−1 in this device; this is at least one order of magnitude more bacteria than present in the blood of a human at the onset of sepsis.

Conclusions

This type of bacterial separation device potentially provides an ideal approach for treating soldiers in combat settings. It eliminates the need for immediate pathogen identification and determination of antimicrobial susceptibility, making it suitable for rapid use within low-resource environments. The overall simplicity and durability of this design also supports its broad translational potential to improve military mortality rates and overall patient outcomes.
A Novel Stress Fracture Rehabilitation Program: A Pilot Study
Authors: Brown William J , Lewis Paul C , Neugebauer-Sperlein Jennifer , Zarow Gregory J , Rivas Elizabeth
Published: January 2021

Introduction

Stress fractures (SFx) of the tibia are common and limit military readiness, but there is presently no scientifically validated program that objectively fosters tibia SFx rehabilitation. Therefore, this pilot study evaluated the feasibility of a Graduated Exercise Program (GEP) based on the theory that programmed rest between exercise bouts improves the osteogenic response, which may enhance rehabilitation and military readiness.

Methods

Participants were randomly assigned to the GEP or standard-of-care exercise program. Both programs use a walk-jog-run progression, but the GEP splits daily exercise into morning and evening episodes and provides 5 days of programmed rest after each stage is completed. The GEP included autonomy support to foster program adherence. Outcome measures included adherence, subjective and ActiGraph-validated objective assessments of exercise duration and intensity, pain assessments, and autonomy support assessments. Participants offered suggestions for program improvement.

Results

Quantitative findings were mixed, but more importantly, this pilot study showed that the measurement, support, and self-reporting parameters were feasible, with high compliance by participants. Barriers to recruitment and retention were identified, along with solutions to overcome these barriers, starting with obtaining unit support for GEP participation.

Conclusion

This pilot study demonstrated the feasibility of a GEP with autonomy support, along with challenges and their solutions, providing the foundation for a formal large-sample study.
Evaluating the Relationship Between Initial Injury, Referral to A Pain Clinic, and Medical Retirement from the Army: A Retrospective Analysis
Authors: Stewart Justin J , Flynn Diane , Steffen Alana D , Langford Dale , McQuinn Honor , Doorenbos Ardith
Published: January 2021

Introduction

Soldiers are expected to deploy worldwide and must be medically ready in order to accomplish their mission. Soldiers unable to deploy for an extended period of time because of chronic pain or other conditions undergo an evaluation for medical retirement. A retrospective analysis of existing longitudinal data from an Interdisciplinary Pain Management Center (IPMC) was used to evaluate the temporal relationship between the time of initial duty restriction and referral for comprehensive pain care to being evaluated for medical retirement.

Methods

Patients were adults (>18 years old) and were cared for in an IPMC at least once between May 1, 2014 and February 28, 2018. A total of 1,764 patients were included in the final analysis. Logistic regression was used to evaluate the impact of duration between date of first duty restriction documentation and IPMC referral to the outcome variable of establishment of a permanent 3 (P3) profile.

Results

The duration between date of first duty restriction and IPMC referral showed a curvilinear relationship to probability of a P3 profile. According to our model, a longer duration before referral is associated with an increased probability of a subsequent P3 profile with the highest probability peaking at 19 months. The probability of P3 declines gradually for those who were referred later.

Discussion

This is the first time the relationship between time of initial duty restriction, referral to an IPMC, and subsequent P3 or higher profile has been tested. Future research is needed to examine medical conditions listed on the profile to see how they might contribute to the cause of referral to the IPMC.

Conclusion

A longer duration between initial duty restriction and referral to IPMC was associated with higher odds of subsequent P3 status for up to 19 months. Referral to an IPMC for comprehensive pain care early in the course of chronic pain conditions may reduce the likelihood of P3 profile and eventual medical retirement of soldiers.
Sleep Deprivation and Sleep-Onset Insomnia are Associated with Blunted Physiological Reactivity to Stressors
Authors: Hansen Devon A , Satterfield Brieann C , Layton Matthew E , Van Dongen Hans P A
Published: January 2021

Introduction

Military operations often involve intense exposure to stressors combined with acute sleep deprivation, while military personnel also experience high prevalence of chronic sleep deficiency from insomnia and other sleep disorders. However, the impact of acute and chronic sleep deficiency on physiologic stressor responses is poorly understood. In a controlled laboratory study with normal sleepers and individuals with chronic sleep-onset insomnia, we measured responses to an acute stressor administered in a sleep deprivation condition or a control condition.

Methods

Twenty-two adults (aged 22-40 years; 16 females)—11 healthy normal sleepers and 11 individuals with sleep-onset insomnia—completed a 5-day (4-night) in-laboratory study. After an adaptation day and a baseline day, subjects were assigned to a 38-hour total sleep deprivation (TSD) condition or a control condition; the study ended with a recovery day. At 8:00 PM after 36 hours awake in the sleep deprivation condition or 12 hours awake in the control condition, subjects underwent a Maastricht Acute Stress Test (MAST). Salivary cortisol was measured immediately before the MAST at 8:00 PM, every 15 minutes after the MAST from 8:15 PM until 9:15 PM, and 30 minutes later at 9:45 PM. Baseline salivary cortisol was collected in the evening of the baseline day. Additionally, before and immediately upon completion of the MAST, self-report ratings of affect and pain were collected.

Results

The MAST elicited a stressor response in both normal sleepers and individuals with sleep-onset insomnia, regardless of the condition, as evidenced by increases in negative affect and pain ratings. Relative to baseline, cortisol levels increased immediately following the MAST, peaked 30 minutes later, and then gradually returned to pre-MAST levels. At the cortisol peak, there was a significant difference across groups and conditions, reflecting a pronounced blunting of the cortisol response in the normal sleepers in the TSD condition and the sleep-onset insomnia group in both the TSD and control conditions.

Conclusions

Blunted stressor reactivity as a result of sleep deficiency, whether acute or chronic, may reflect reduced resiliency attributable to allostatic load and may put warfighters at increased risk in high-stakes, rapid response scenarios.
Inexperienced but Confident: A Survey of Advanced Life Support Providers and Life-saving Interventions in the Israel Defense Forces
Authors: Haddad Nadav , Tsur Avishai M , Nadler Roy , Glassberg Elon , Benov Avi , Chen Jacob
Published: January 2021

Objective

The objective of this study was to assess the current experience of Israel Defense Forces’ (IDF) advanced life support (ALS) providers in performing life-saving interventions (LSIs), the rate of doctors and paramedics achieving the Trauma and Combat Medicine Branch benchmarks, and the rate of providers feeling confident in performing the interventions although not achieving the benchmarks.

Methods

This study was based on an online survey delivered to IDF ALS providers. The survey investigated demographics; experience in performing endotracheal intubation, cricothyroidotomy, tube thoracostomy, and intraosseous access on human patients; and confidence in performing these LSIs. All benchmarks chosen referred to the number of times performed in the previous year. The benchmarks were 20 for intubation, 3 for cricothyroidotomy, 4 for tube thoracostomy, and 3 for intraosseous access.

Results

During the survey period, 175 IDF ALS providers started the survey, but only 138 (79%) completed it, 93 (67%) of them were paramedics. Doctors had higher rates than paramedics of failing to achieve the benchmarks for intubation (96 vs. 57%, P < .001) and intraosseous access (100 vs. 66%, P < .001). All respondents failed to achieve the benchmark for cricothyroidotomy, and all but one paramedic failed to achieve the tube thoracostomy benchmark. Doctors had lower rates of high confidence when failing to achieve the benchmark for intubation (35 vs. 64%, P = .008) and intraosseous access (7 vs. 31%, P = .005) compared to paramedics.

Conclusion

IDF ALS providers have alarmingly limited experience in performing LSIs. Many of them are confident in their ability despite not achieving evidence-based benchmarks. Additional training is required, maybe as a part of an annual medical fitness test.
Development of Predictive Informatics Tool Using Electronic Health Records to Inform Personalized Evidence-Based Pressure Injury Management for Veterans with Spinal Cord Injury
Authors: Bogie Kath M , Roggenkamp Steven K , Zeng Ningzhou , Seton Jacinta M , Schwartz Katelyn R , Henzel M Kristi , Richmond Mary Ann , Sun Jiayang , Zhang Guo-Qiang
Published: January 2021

Background

Pressure injuries (PrI) are serious complications for many with spinal cord injury (SCI), significantly burdening health care systems, in particular the Veterans Health Administration. Clinical practice guidelines (CPG) provide recommendations. However, many risk factors span multiple domains. Effective prioritization of CPG recommendations has been identified as a need. Bioinformatics facilitates clinical decision support for complex challenges. The Veteran’s Administration Informatics and Computing Infrastructure provides access to electronic health record (EHR) data for all Veterans Health Administration health care encounters. The overall study objective was to expand our prototype structural model of environmental, social, and clinical factors and develop the foundation for resource which will provide weighted systemic insight into PrI risk in veterans with SCI.

Methods

The SCI PrI Resource (SCI-PIR) includes three integrated modules: (1) the SCIPUDSphere multidomain database of veterans’ EHR data extracted from October 2010 to September 2015 for ICD-9-CM coding consistency together with tissue health profiles, (2) the Spinal Cord Injury Pressure Ulcer and Deep Tissue Injury Ontology (SCIPUDO) developed from the cohort’s free text clinical note (Text Integration Utility) notes, and (3) the clinical user interface for direct SCI-PIR query.

Results

The SCI-PIR contains relevant EHR data for a study cohort of 36,626 veterans with SCI, representing 10% to 14% of the U.S. population with SCI. Extracted datasets include SCI diagnostics, demographics, comorbidities, rurality, medications, and laboratory tests. Many terminology variations for non-coded input data were found. SCIPUDO facilitates robust information extraction from over six million Text Integration Utility notes annually for the study cohort. Visual widgets in the clinical user interface can be directly populated with SCIPUDO terms, allowing patient-specific query construction.

Conclusion

The SCI-PIR contains valuable clinical data based on CPG-identified risk factors, providing a basis for personalized PrI risk management following SCI. Understanding the relative impact of risk factors supports PrI management for veterans with SCI. Personalized interactive programs can enhance best practices by decreasing both initial PrI formation and readmission rates due to PrI recurrence for veterans with SCI.
Dynamical evolution of multiple-population globular clusters
Authors: Vesperini Enrico , Hong Jongsuk , Giersz Mirek , Hypki Arkadiusz
Published: January 2021

We have carried out a set of Monte Carlo simulations to study a number of fundamental aspects of the dynamical evolution of multiple stellar populations in globular clusters with different initial masses, fractions of second generation (2G) stars, and structural properties. Our simulations explore and elucidate: (1) the role of early and long-term dynamical processes and stellar escape in the evolution of the fraction of 2G stars and the link between the evolution of the fraction of 2G stars and various dynamical parameters; (2) the link between the fraction of 2G stars inside the cluster and in the population of escaping stars during a cluster’s dynamical evolution; (3) the dynamics of the spatial mixing of the first-generation (1G) and 2G stars and the details of the structural properties of the two populations as they evolve toward mixing; (4) the implications of the initial differences between the spatial distribution of 1G and 2G stars for the evolution of the anisotropy in the velocity distribution and the expected radial profile of the 1G and 2G anisotropy for clusters at different stages of their dynamical history; and (5) the variation of the degree of energy equipartition of the 1G and the 2G populations as a function of the distance from the cluster’s centre and the cluster’s evolutionary phase.
Death in the Archives: Witnessing War in Ireland, 1919–1921
Authors: Dolan Anne
Published: January 2021

In a relatively brief, not very lethal, but meticulously documented guerrilla war in Ireland there is an opportunity to reflect on who historians choose to listen to when writing about violence. Across 1920–21 thousands of inquests captured the voices of the men, women and sometimes children who were the first to describe and define the act of killing in this conflict, but who very quickly fell out of the historical record after that point. This article considers the contribution these bystanders can make to a history of violence, and some of the challenges their evidence presents. By witnessing death were they an integral part of how killing was meant to be understood? Are they fundamental to an understanding of how terror worked, and did they, by their presence, by the way they spoke of what they saw, contribute to why so few deaths were needed for the message to be understood in the Irish context? Ultimately, these witnesses also raise questions about the reactions they prompted then as well as now. Is it easier to hear of killing from a combatant than from a child, and are there consequences for the history of violence in the making of that choice?
Test–Retest Reliability of the Mini-BESTest in People With Mild to Moderate Multiple Sclerosis
Authors: Wallin Andreas , Kierkegaard Marie , Franzén Erika , Johansson Sverker
Published: January 2021

Objective

The mini-Balance Evaluation Systems Test (BESTest) is a balance measure for assessment of the underlying physiological systems for balance control in adults. Evaluations of test–retest reliability of the mini-BESTest in larger samples of people with multiple sclerosis (MS) are lacking. The purpose of this study was to investigate test–retest reliability of the mini-BESTest total and section sum scores and individual items in people with mild to moderate overall MS disability.

Methods

This study used a test–retest design in a movement laboratory setting. Fifty-four people with mild to moderate overall MS disability according to the Expanded Disability Status Scale (EDSS) were included, with 28 in the mild subgroup (EDSS 2.0–3.5) and 26 in the moderate subgroup (EDSS 4.0–5.5). Test–retest reliability of the mini-BESTest was evaluated by repeated measurements taken 1 week apart. Reliability and measurement error were analyzed.

Results

Test–retest reliability for the total scores was considered good to excellent, with intraclass correlation coefficients of .88 for the whole sample, .83 for the mild MS subgroup, and .80 for the moderate MS subgroup. Measurement errors were small, with standard error of measurement and minimal detectable change of 1.3 and 3.5, respectively, in mild MS, and 1.7 and 4.7, respectively, in moderate MS. The limits of agreement were −3.4 and 4.6. Test–retest reliability for the section scores were fair to good or excellent; weighted kappa values ranged from .62 to .83. All items but 1 showed fair to good or excellent test–retest reliability, and percentage agreement ranged from 61% to 100%.

Conclusion

The mini-BESTest demonstrated good to excellent test–retest reliability and small measurement errors and is recommended for use in people with mild to moderate MS.

Impact

Knowledge of limits of agreement and minimal detectable change contribute to the interpretability of the mini-BESTest total score. The findings of this study enhance the clinical usefulness of the test for evaluation of balance control and for designing individually customized balance training with high precision and accuracy in people with MS.
Childhood socioeconomic status and adulthood mental health: results from the survey on employees of Tehran University of Medical Sciences
Authors: Mehri Ahmad , Baigi Vali , Rahimi Danial , Nedjat Saharnaz
Published: January 2021

Background

Socioeconomic status, especially during childhood, is known as one of the key factors affecting health. This study’s objective was to investigate the association between childhood socioeconomic and mental health status in adulthood.

Methods

This cross-sectional study was conducted on 2062 employees of Tehran University of Medical Sciences. Depression, stress and anxiety were measured using the validated DASS-42 questionnaire. A self-rated question was used to assess childhood socioeconomic status. Other variables including age, sex, marital status, and also wealth index, were measured. Linear regression models were used to analyze the data.

Results

24.6% of men and 33.8% of women had degrees of depression (mild, moderate, severe or very severe). 32.9% of men and 29.4% of women had mild, moderate, severe or very severe anxiety. 36.3% of men and 45.2% of women also exhibited mild, moderate, severe or very severe stress. Results showed after adjusting for the current socioeconomic status, childhood socioeconomic status has a relationship with the mental health of individuals.

Conclusion

People with a suboptimal childhood socioeconomic status seem to be a high-risk group for depression, stress and anxiety in adulthood. Strategies need to put into practice to improve the mental health of these people.