bluuebunny/crossref_metadata_2025 huggingface dataset:
Why put a museum in a book? Ferrante Imperato and the image of natural history in sixteenth-century Naples
Authors: Findlen Paula
Published: January 2021

The first image of a natural history museum appeared in Ferrante Imperato’s ‘Natural History’ (1599), a book that is, nonetheless, not a catalogue of the contents of his museum. This article explores contemporary accounts of the Neapolitan apothecary’s collection, and offers a close reading of its portrayal in this woodcut, in relation to the contents of the ‘Natural History’. How did Imperato’s museum reflect his relations with other naturalists, in Naples and beyond, and the politics of knowledge in Spanish Naples? What kind of civic monument was Imperato’s museum?
Phytohormones and their crosstalk in regulating stomatal development and patterning
Authors: Wei Hongbin , Jing Yifeng , Zhang Lei , Kong Dexin
Published: January 2021

Phytohormones play important roles in regulating various aspects of plant growth and development as well as in biotic and abiotic stress responses. Stomata are openings on the surface of land plants that control gas exchange with the environment. Accumulating evidence shows that various phytohormones, including abscisic acid, jasmonic acid, brassinosteroids, auxin, cytokinin, ethylene, and gibberellic acid, play many roles in the regulation of stomatal development and patterning, and that the cotyledons/leaves and hypocotyls/stems of Arabidopsis exhibit differential responsiveness to phytohormones. In this review, we first discuss the shared regulatory mechanisms controlling stomatal development and patterning in Arabidopsis cotyledons and hypocotyls and those that are distinct. We then summarize current knowledge of how distinct hormonal signaling circuits are integrated into the core stomatal development pathways and how different phytohormones crosstalk to tailor stomatal density and spacing patterns. Knowledge obtained from Arabidopsis may pave the way for future research to elucidate the effects of phytohormones in regulating stomatal development and patterning in cereal grasses for the purpose of increasing crop adaptive responses.
The Feasibility of a Novel Index From a Wireless Doppler Ultrasound Patch to Detect Decreasing Cardiac Output in Healthy Volunteers
Authors: Kenny Jon-Émile S , Eibl Andrew M , Parrotta Matthew , Long Bradley F , Eibl Joseph K
Published: January 2021

Introduction

Early hemorrhage is often missed by traditional vital signs because of physiological reserve, especially in the young and healthy. We have developed a novel, wearable, wireless Doppler ultrasound patch that tracks real-time blood velocity in the common carotid artery.

Materials and Methods

We studied eight healthy volunteers who decreased their cardiac output using a standardized Valsalva maneuver. In all eight, we simultaneously monitored the velocity time integral (VTI) of the common carotid artery (using the ultrasound patch) as well as the descending aorta (using a traditional pulsed wave duplex imaging system); the descending aortic VTI was used as a surrogate for left ventricular stroke volume (SV). Additionally, in a subset of four, we simultaneously measured SV using a noninvasive pulse contour analysis device.

Results

From baseline to peak effect of Valsalva, there was a statistically significant fall in descending aortic and common carotid VTI of 37% (P = 0.0005) and 23% (P < 0.0001), respectively. Both values returned to baseline on recovery. Additionally, a novel index from the carotid ultrasound patch (i.e., the heart rate divided by the carotid artery VTI) detected a 10% fall in aortic VTI with high sensitivity and specificity (100% and 100%, respectively); this novel index also accurately detected a 10% decrease in SV as measured by the noninvasive SV monitor. The mean arterial pressure, measured by the noninvasive pulse contour device, did not correctly detect the fall in SV.

Conclusion

In summary, a novel index from a wireless Doppler ultrasound patch may be more sensitive and specific for detecting decreased cardiac output than standard vital signs in healthy volunteers.
From the Dexterous Surgical Skill to the Battlefield—A Robotics Exploratory Study
Authors: Gonzalez Glebys T , Kaur Upinder , Rahman Masudur , Venkatesh Vishnunandan , Sanchez Natalia , Hager Gregory , Xue Yexiang , Voyles Richard , Wachs Juan
Published: January 2021

Introduction

Short response time is critical for future military medical operations in austere settings or remote areas. Such effective patient care at the point of injury can greatly benefit from the integration of semi-autonomous robotic systems. To achieve autonomy, robots would require massive libraries of maneuvers collected with the goal of training machine learning algorithms. Although this is attainable in controlled settings, obtaining surgical data in austere settings can be difficult. Hence, in this article, we present the Dexterous Surgical Skill (DESK) database for knowledge transfer between robots. The peg transfer task was selected as it is one of the six main tasks of laparoscopic training. In addition, we provide a machine learning framework to evaluate novel transfer learning methodologies on this database.

Methods

A set of surgical gestures was collected for a peg transfer task, composed of seven atomic maneuvers referred to as surgemes. The collected Dexterous Surgical Skill dataset comprises a set of surgical robotic skills using the four robotic platforms: Taurus II, simulated Taurus II, YuMi, and the da Vinci Research Kit. Then, we explored two different learning scenarios: no-transfer and domain-transfer. In the no-transfer scenario, the training and testing data were obtained from the same domain; whereas in the domain-transfer scenario, the training data are a blend of simulated and real robot data, which are tested on a real robot.

Results

Using simulation data to train the learning algorithms enhances the performance on the real robot where limited or no real data are available. The transfer model showed an accuracy of 81% for the YuMi robot when the ratio of real-tosimulated data were 22% to 78%. For the Taurus II and the da Vinci, the model showed an accuracy of 97.5% and 93%, respectively, training only with simulation data.

Conclusions

The results indicate that simulation can be used to augment training data to enhance the performance of learned models in real scenarios. This shows potential for the future use of surgical data from the operating room in deployable surgical robots in remote areas.
Hypocalcemia in Military Casualties From Point of Injury to Surgical Teams in Afghanistan
Authors: Conner Jeffrey R , Benavides Linda C , Shackelford Stacy A , Gurney Jennifer M , Burke Edward F , Remley Michael A , Ditzel Ricky M , Cap Andrew P
Published: January 2021

Introduction

Hypocalcemia is a known sequela of citrated blood product transfusion. Civilian data suggest hypocalcemia on hospital admission is associated with worse outcomes. Initial calcium levels in military casualties have not previously been analyzed. The objective of this retrospective review aimed to assess the initial calcium levels in military trauma casualties at different Forward Surgical Teams (FST) locations in Afghanistan and describe the effects of prehospital blood product administration on arrival calcium levels.

Materials and Methods

This is a retrospective cohort analysis of military casualties arriving from point of injury to one of two FSTs in Afghanistan from August 2018 to February 2019 split into four locations. The primary outcome was incidence of hypocalcemia (ionized calcium < 1.20 mmol/L).

Results

There were 101 patients included; 55 (54.5%) experienced hypocalcemia on arrival to the FST with a mean calcium of 1.16 mmol/L (95% confidence interval [CI], 1.14 to 1.18). The predominant mechanism of injury consisted of blast patterns, 46 (45.5%), which conferred an increased risk of hypocalcemia compared to all other patterns of injury (odds ratio = 2.42, P = .042). Thirty-eight (37.6%) patients required blood product transfusion. Thirty-three (86.8%) of the patients requiring blood product transfusion were hypocalcemic on arrival. Mean initial calcium of patients receiving blood product was 1.13 mmol/L (95% CI, 1.08 to 1.18), which was significantly lower than those who did not require transfusion (P = .01). Eight (7.9%) of the patients received blood products before arrival, with 6/8 (75%) presenting with hypocalcemia.

Conclusions

Hypocalcemia develops rapidly in military casualties and is prevalent on admission even before transfusion of citrated blood products. Blast injuries may confer an increased risk of developing hypocalcemia. This data support earlier use of calcium supplementation during resuscitation.
Tele-TB: Using TeleMedicine to Increase Access to Directly Observed Therapy for Latent Tuberculosis Infection
Authors: Donahue Megan L , Eberly Matthew D , Rajnik Michael
Published: January 2021

Introduction

Treatment of latent tuberculosis infection (LTBI) decreases risk of progression to active tuberculosis. Traditional treatment regimens required either daily isoniazid for 9 months, with historically poor compliance, or 12-week directly observed therapy (DOT) with isoniazid and rifapentine, with improved compliance but additional challenges of coordinating weekly clinic visits, further complicated if patients must travel a great distance for care.

Materials and Methods

Our referral area is complicated by congested traffic often resulting in one-way commutes, which can exceed 2 hours. These travel times would be prohibitive for conducting weekly in-clinic DOT. In an effort to improve access to DOT, we implemented TeleMedicine LTBI DOT (vDOT) within a military pediatric infectious diseases clinic. Patients aged 24 months or older diagnosed with LTBI were referred for possible enrollment into our vDOT clinic. All patients without contraindications for receiving isoniazid and/or rifapentine were offered LTBI treatment via weekly vDOT or daily treatment with isoniazid or rifampin. The first visit for vDOT patients was performed in person to discuss treatment options, demonstrate use of TeleMedicine software, and ensure the patient was able to take the medications. Baseline information about patients and travel time to our facility was determined.

Results

To date, 16 patients have completed LTBI therapy using vDOT. Average one-way travel time to our facility for patients was 51 minutes. Actual time spent in most vDOT encounters was less than 10 minutes. Appointments were arranged to take place outside usual school and work hours so patients could complete vDOT with minimal interruptions to daily life, resulting in 100% treatment compliance and completion.

Discussion

Conducting LTBI DOT using TeleMedicine is a viable and time-saving measure that still allows for high levels of patient compliance and treatment completion while minimizing interruptions to academic and work schedules.
Longitudinal Relationship of Combat Exposure With Mental Health Diagnoses in the Military Health System
Authors: Campbell Marjorie S , O’Gallagher Kevin , Smolenski Derek J , Stewart Lindsay , Otto Jean , Belsher Bradley E , Evatt Daniel P
Published: January 2021

Introduction

Combat deployment is associated with mental and physical health disorders and functional impairment. Mental health (MH) diagnoses such as adjustment and anxiety disorders have received little research attention but may reflect important postdeployment sequelae. The purpose of this study was to investigate the association of combat exposure with the acquisition of a wide range of mental health diagnoses over 2 years.

Materials and Methods

This retrospective longitudinal study utilized multiple administrative Military Health System datasets compiled for all individuals who entered active duty in the U.S. Army from FY2005 to FY2011. A total eligible cohort of 289,922 Service members was stratified into three mutually exclusive groups according to their deployment status after 2 years in service: Deployed, Combat-Exposed; Deployed, Not-Combat-Exposed; and Not Deployed. Outcomes of interest were new mental health diagnoses grouped into six categories—posttraumatic stress disorder, anxiety, adjustment, mood, substance use disorders, and any MH diagnosis. Survival analyses over 2 years were conducted and adjusted hazard ratios were calculated.

Results

Combat exposure in the first 2 years of military service was associated with significantly higher rates of a wide range of mental health diagnoses over a two-year follow-up period, compared with deployment with no combat exposure and no deployment. Adjusted cumulative failure proportions demonstrated that approximately a third of the Combat-Exposed group, a quarter of the Not-Combat-Exposed, and a fifth of the Not Deployed groups received a MH diagnosis over 2 years. For all groups, cumulative failure proportions and incidence rates were highest for adjustment disorder and lowest for posttraumatic stress disorder diagnoses.

Conclusions

Researchers and providers should be alerted to the impact of combat exposure and the wide range of MH conditions and diagnoses that may represent important postdeployment sequelae.
Modeling Zika Vaccination Combined With Vector Interventions in DoD Populations
Authors: Burgess Colleen , Nelis Lis , Huang Cassie
Published: January 2021

Introduction

Zika virus (ZIKV) is a mild febrile illness generally transmitted via the bite of infected Aedes species mosquitoes, including Aedes aegypti, with the potential to cause neurological complications. Nearly 200 U.S. military installations are located within areas where Aedes mosquitos are found, putting thousands of personnel at risk for infection with ZIKV. This analysis aims to quantify the benefits of interventions, including vaccination, to decrease the risk of ZIKV on U.S. military installations.

Methods

The authors developed a dynamic transmission model to test the “effectiveness” of vaccination, personal protective measures (PPM), and mosquito control at reducing morbidity within U.S. military populations. ZIKV transmission was modeled as a compartmental susceptible-exposed-infected-recovered model tracking interactions between humans and mosquitos and incorporating seasonality of mosquito populations and the potential for herd immunity. The model included two-dose vaccination as well as symptomatic and asymptomatic infection. The model was calibrated against 2016 public health data in Puerto Rico; sensitivity analyses were performed on model parameters and interventions.

Results

The greatest reduction in total modeled ZIKV cases resulted from vaccination combined with mosquito control and PPM. All three interventions at their highest estimated level of efficiency reduced ZIKV cases by 99.9% over the baseline case of low-level adherence to PPM. The addition of vaccination had limited additional benefit over effective vector control and PPM since the significant lag to vaccine-induced protection limited effectiveness of vaccination.

Conclusions

Given the current vaccine, the model predicted that up to 92.8% of Zika cases occurring in deployment settings over a 10-year period could be prevented by adding vaccination to current low-level PPM. Combining vaccination with other interventions can reduce cases further. A location-specific cost-benefit analysis would be a valuable contribution to outbreak control policy as it could evaluate the economic impact of the interventions versus the reduced level of illness and downtime in this setting.
Retention of Coagulation Factors and Storage of Freeze-Dried Plasma
Authors: Flaumenhaft Elissa J , Khat Terry , Marschner Susanne
Published: January 2021

Introduction

Terumo BCT is developing a system to produce a freeze-dried plasma product, Terumo’s freeze-dried plasma (TFDP), that is stored in a rugged, light-weight plastic package suitable for field use, which retains a stable level of specific coagulation factors and proteins within clinical range, when stored for up to 2 years at room temperature and 4°C.

Materials and Methods

Plasma frozen within 24 hours of phlebotomy (PF24) were thawed, sampled, and individually lyophilized to produce a corresponding TFDP unit. Fresh frozen plasma (FFP) units were thawed, sampled, pooled in groups of 10 units (also sampled) and lyophilized to produce 2 lots of TFDP. Each TFDP unit was reconstituted with water for injection (WFI) and tested for pH, prothrombin time, activated partial thromboplastin time, factors V and VIII, fibrinogen, protein C, and protein S. Results were compared with PF24/FFP. Additional FFP units were thawed, sampled, pooled, divided to generate 2 TFDP units for each time point (1, 2, 3, 6, 12, 18, and 24 months, one each stored at 4°C and 25°C) and lyophilized. Postlyophilization, TFDP units were stored at 4°C or 25°C, reconstituted with WFI, and tested for the factors listed above. Residual moisture content of the lyophilized plasma was also tested.

Results

Coagulation factor activity of TFDP was ±20% of PF24/FFP. Pooling standardized variation in TFDP coagulation factor activities, which were within clinical ranges postlyophilization. The pH of TFDP and PF24/FFP were within required range. Residual moisture content of TFDP was <2%.

Conclusions

The TFDP process had no negative impact on coagulation factor activity. Input plasma and anticoagulant type did not affect TFDP quality. Pooling FFP normalized factor variability in TFDP and did not negatively impact product quality. The TFDP is stable for up to 24 months at room and refrigerated temperatures. Terumo’s freeze-dried plasma is comparable to PF24/FFP. It does not require complex logistics or time-consuming thawing. Terumo’s freeze-dried plasma may be suitable for rapid treatment of coagulopathies with logistical advantages over PF24/FFP.
Development and Validation of a Mobile Application to Detect Visual Dysfunction Following Mild Traumatic Brain Injury
Authors: Linder Susan M , Koop Mandy Miller , Tucker Diane , Guzi Karen , Gray Daniel C , Alberts Jay L
Published: January 2021

Introduction

Following mild traumatic brain injury, visual dysfunction is a common occurrence, yet the condition often goes undiagnosed. A mobile application was developed to measure aspects of visual acuity and oculomotor function. The aim of this project was to validate the newly developed suite of outcomes conducive for use in the field to detect visual dysfunction.

Materials and Methods

A custom mobile application was developed on an Apple iPad using iOS operating system software version 11.0 in Objective C to measure near point of convergence (NPC), distance visual acuity, reading fluency, and self-rated convergence insufficiency (CI). To determine construct validity, 50 healthy young adults were administered NPC and distance visual acuity assessments using the iPad and standard clinical approaches. A ruler measurement was obtained simultaneous to the iPad NPC measurement to determine measurement accuracy. All testing was administered by a licensed optometrist and the order of testing (iPad versus clinical) was randomized.

Results

The correlation coefficient between the iPad and clinical measurements of NPC was 0.893, while iPad and ruler measurement was 0.947. Modest accordance was found between iPad and wall chart measures assessing distance visual acuity. A ceiling effect was evident with use of a wall chart to determine distance visual acuity. Healthy young adults scored a mean (SD) of 13.0 (7.4) on the Convergence Insufficiency Symptom Survey. Reading fluency was highly variable with a mean (SD) of 291 (119) words per minute.

Conclusions

iPad measures of NPC were highly correlated with clinical measures, while visual acuity measured with the iPad showed modest correlation. Nonetheless, the suite of visual assessments provide value as screening tools, and when used in combination with reading fluency assessment and self-reported CI may be effective in identifying visual dysfunction following mild traumatic brain injury.
PV[O]H: Noninvasive Enabling Technology, New Physiological Monitoring, and Big Data
Authors: Rice David , Bebernes Jeff , Cormier Jonathan , Fayos John , Fillioe Seth , Peterson Charles M , Houk Michael , Ammenheuser Howard , Chaiken Joseph
Published: January 2021

Introduction

Measures of normal and abnormal physiology are interrelated and vary continuously. Our ability to detect and predict changes in physiology in real time has been limited in part by the requirement for blood sampling and the lack of a continuous data stream of various “signals”, i.e., measurements of vital signs. It is important to determine which signals are most revealing for detection and treatment of, e.g., internal bleeding, managing fluid balance for mission/combat readiness, and hydration. Although our current algorithm for PV[O]H reflects changes in hematocrit and blood and plasma volumes, additional algorithms utilizing the whole raw PV[O]H data stream, along with other variables, can be constructed. We present a working prototype demonstrating that acceptable size, power, and complexity footprints for military needs can be achieved. Results of previous studies involving humans have demonstrated that PV[O]H can provide simultaneous, noninvasive, in vivo continuous monitoring of hematocrit, vascular volume, hemoglobin oxygen saturation, pulse rate, and breathing rate using a single light source with a reporting frequency of every 3 seconds.

Materials and Methods

We have engineered an instrument implementing the PV[O]H algorithm in which (1) single channel photodetectors replace multichannel detection; (2) optical filters replace gratings; (3) battery power is used; and (4) sufficient computation with input/output capability moderated by application specific graphical user interfaces, and compatible with all cloud, wireless environment, and local protocols is implemented.

Results

We have engineered a complete version of a two-probe PV[O]H system meeting military needs and have fabricated a first version. Testing of subsystems, calibration, and optical characterization of the optical probes are underway.

Conclusions

Simultaneous noninvasive continuous monitoring of peripheral vessels using a previous PV[O]H system demonstrates large, physiology revealing data sets. The technologies enable the methodical search for relevant physiological signals allowing the use of discriminant analysis, Bayesian approaches, and artificial intelligence to create predictive algorithms enabling timely interventions in medical care and troop training.
Comparative Finite Element Modeling Study of Anterior Cervical Arthrodesis Versus Cervical Arthroplasty With Bryan Disc or Prodisc C
Authors: Choi Hoon , Purushothaman Yuvaraj , Baisden Jamie L , Rajasekaran Deepak , Jebaseelan Davidson , Yoganandan Narayan
Published: January 2021

Introduction

Cervical disc arthroplasty (CDA), a motion-preserving alternative to anterior cervical discectomy and fusion (ACDF), is used in military patients for the treatment of disorders such as spondylosis. Since 2007, the FDA has approved eight artificial discs. The objective of this study is to compare the biomechanics after ACDF and CDA with two FDA-approved devices of differing designs under head and head supported mass loadings.

Materials and Methods

A previously validated osteoligamentous C2-T1 finite element model was used to simulate ACDF and two types of CDA (Bryan and Prodisc C) at the C5-C6 level. The hybrid loading protocol associated with in vivo head and head supported mass was used to apply flexion and extension loading. First, intact spine was subjected to 2 Nm of flexion extension and the range of motion (ROM) was measured. Next, for each surgical option, flexion-extension moments duplicating the same ROM as the intact spine were determined. Under these surgery-specific moments, ROM and facet force were obtained at the index level, and ROM, facet force, and intradiscal pressure at the rostral and caudal adjacent levels.

Results

ACDF led to increased motion, force and pressures at the adjacent levels. Prodisc C led to increased motion and facet force at the index level, and decreased motion, facet force, and intradiscal pressure at both adjacent levels. Bryan produced less dramatic biomechanical alterations compared with ACDF and Prodisc C. Numerical results are given in the article.

Conclusions

Recognizing that ROM is a clinical measure of spine stability/performance, CDA demonstrates a more physiological biomechanical response than ACDF, although the exact pattern depends on the implant design. Anterior and posterior column load-sharing patterns were different between the two implants and may affect implant selection based on the anatomical and pathological state at the index and adjacent levels.
Perceptions of Gender and Race Equality in Leadership and Advancement Among Military Family Physicians
Authors: Massaquoi Mariama A , Reese Tyler R , Barrett John , Nguyen Dana
Published: January 2021

Introduction

There is increasing interest in assessing gender and race-based disparities in academic medicine and healthcare leadership in civilian medicine and the U.S. Military Health System. Approximately 15% of U.S. active duty service members are women, and racial minorities are 30% of the total active duty force. This study evaluates the following factors among uniformed services family physicians: gender and race representation in attaining early career leadership positions during training and 2 years postresidency; perceptions regarding leadership opportunities and career advancement.

Methods

Registered attendees (n = 300) of the 2016 Uniformed Services Academy of Family Physicians Annual Meeting were given a voluntary and anonymous online questionnaire. The main outcomes measured were early leadership assignments and perceptions about command/leadership support, gender roles in leadership assignment, confidence to achieve leadership goals, and being passed over for leadership positions.

Results

Sixty-eight percent of registered attendees completed the study questionnaire. Statistically significant results, adjusting for service, grade, race, and gender, were that non-Caucasian family physicians were less likely to be chief residents (odds ratio 0.23, 95% CI 0.01-1.00) and less likely to have leadership positions within 2 years postresidency (odds ratio 0.30, 95% CI 0.10-0.91). Female family physicians were more likely to agree that gender has a role in assigning leadership positions (odds ratio 2.33, 95% CI 1.01-5.39). There were no differences in perceptions of command support for leadership; confidence in achieving desired leadership level; or in being passed over for leadership positions.

Conclusions

This study provides important information about perceived gender and race equality among uniformed services family physicians. Key findings included that non-Caucasian military family physicians were less likely to attain junior leadership positions or be assigned to academic settings; and female respondents were more likely to agree that gender has a role in assignment of leadership positions. Evaluating composite personnel records of services’ family physicians would provide invaluable information to complement this study.
An Observation of Application of Structural Brain Injury Devices for Traumatic Brain Injury Evaluation in Austere Military Prehospital Settings
Authors: Koreerat Nicholas R , Giese Russell
Published: January 2021

Introduction

Military units lack the ability to quickly, objectively, and accurately assess individuals that have suffered a closed head injury for structural brain injury and functional brain impairments in forward settings, where neurological assessment equipment and expertise may be lacking. With acute traumatic brain injury patients, detached medical providers are often faced with a decision to wait and observe or medically evacuate, both of which have cascading consequences. Structural brain injury assessment devices, when employed in forward environments, have the potential to reduce the risk of undiagnosed and/or mismanaged traumatic brain injuries given their high negative predictive value and suggested increased specificity compared to common subjective clinical decision rules. These handheld devices are portable and have an ease of use, from combat medic to physician, allowing for use in austere environments, safely keeping soldiers with their teams when able and suggesting further evaluation via computed tomography (CT) scan when warranted.

Methods

Data collected on 13 encounters at 5 locations were retrospectively analyzed using descriptive statistics.

Results

A total number of 13 examinations were performed using the BrainScope One device during the 9-month deployment. The Structural Injury Classification was negative for 11 of the patients. Two of the 11 patients underwent head CT scans, which confirmed the absence of intracranial hemorrhage. Of the two positive Structural Injury Classification exams, one was CT negative and no CT was performed for the other based on clinical judgment.

Conclusion

The data from this study suggest that structural brain injury devices may provide value by ruling out serious brain injury pathology while limiting excessive medical evacuations from austere settings, where neurological assessment equipment and expertise may be lacking, reducing unnecessary head CT scans.
Results of the Behavioral Health Readiness Evaluation and Decision-Making Instrument Study
Authors: Curley Justin M , Nugent Katie L , Clarke-Walper Kristina M , Penix Elizabeth A , Macdonald James B , McDonald Jennifer L , Wilk Joshua E
Published: January 2021

Introduction

Recent reports have demonstrated behavioral health (BH) system and individual provider challenges to BH readiness success. These pose a risk to winning on the battlefield and present a significant safety issue for the Army. One of the most promising areas for achieving better BH readiness results lies in improving readiness decision-making support for BH providers. The Walter Reed Army Institute of Research (WRAIR) has taken the lead in addressing this challenge by developing and empirically testing such tools. The results of the Behavioral Health Readiness Evaluation and Decision-Making Instrument (B-REDI) field study are herein described.

Methods

The B-REDI study received WRAIR Institutional Review Board approval, and BH providers across five U.S. Army Forces Command installations completed surveys from September 2018 to March 2019. The B-REDI tools/training were disseminated to 307 providers through random clinic assignments. Of these, 250 (81%) providers consented to participate and 149 (60%) completed both initial and 3-month follow-up surveys. Survey items included a wide range of satisfaction, utilization, and proficiency-level outcome measures. Analyses included examinations of descriptive statistics, McNemar’s tests pre-/post-B-REDI exposure, Z-tests with subgroup populations, and chi-square tests with demographic comparisons.

Results

The B-REDI resulted in broad, statistically significant improvements across the measured range of provider proficiency-level outcomes. Net gains in each domain ranged from 16.5% to 22.9% for knowledge/awareness (P = .000), from 11.1% to 15.8% for personal confidence (P = .001-.000), and from 6.2% to 15.1% for decision-making/documentation (P = .035-.002) 3 months following B-REDI initiation, and only one (knowledge) failed to maintain a statistically significant improvement in all of its subcategories. The B-REDI also received high favorability ratings (79%-97% positive) across a wide array of end-user satisfaction measures.

Conclusions

The B-REDI directly addresses several critical Army BH readiness challenges by providing tangible decision-making support solutions for BH providers. Providers reported high degrees of end-user B-REDI satisfaction and significant improvements in all measured provider proficiency-level domains. By effectively addressing the readiness decision-making challenges Army BH providers encounter, B-REDI provides the Army BH health care system with a successful blueprint to set the conditions necessary for providers to make more accurate and timely readiness determinations. This may ultimately reduce safety and mission failure risks enterprise-wide, and policymakers should consider formalizing and integrating the B-REDI model into current Army BH practice.
Immersive Rehearsal in a Simulated Environment
Authors: Clouse Cassandra , Ewer Matthew W , French DeAnne , Gallimore Jennie , Ganapathy Subhashini
Published: January 2021

Introduction

Recent advancements in virtual environment (VE) technology and the increasing use of VEs for treatment are opening up possibilities for rehearsal in safe and rich environments. Research has shown that VEs can be used to treat individuals with posttraumatic stress disorder (PTSD), but little research has been done to suggest guidelines for creating an effective environment. The aim of this study was to determine the design of systems that would allow military veterans to rehearse potentially stressful events in a VE before having to step into the actual environment. This research evaluated the responses to six stimuli: startle sound, direct eye contact, horizontal movement across the visual field, social conflict, an abandoned item, and a crowded auditorium. Measures used included change in heart rate (ΔHR), change in subjective unit of discomfort scores, and participant behavior.

Materials and Methods

Thirty-eight participants, both with and without PTSD, experienced two VEs in first person using an Oculus Rift device. The first VE consisted of a tranquil garden, which allowed the participants to practice in the system, whereas baseline data were collected. The second VE was the experimental condition where the participant completed tasks within the VE and encountered stimuli designed to evoke responses from those with PTSD.

Results

There was a significant difference in ΔHR between the PTSD and non-PTSD groups (P = .008), and the PTSD group had a higher mean ΔHR for all stimuli. The stimulus type was also significant for all participants (P < .001). Crowded auditorium and startle sound had the largest impact on the participants’ ΔHR. Change in subjective unit of discomfort showed a significant interaction between the group factor (PTSD, non-PTSD) and stimulus (P = .043). Individuals with PTSD also presented more avoidance behavior than those without PTSD.

Conclusions

Findings imply that VEs other than virtual combat zones can elicit behavioral, emotional, and physiological responses in individuals with PTSD, and these types of environments should be further studied for use with veterans suffering from PTSD. In future studies, systems should include initial stimuli that can be configured to allow focus on specific past traumatic experiences. Stimuli should also include both a crowded room and a startle noise scenario.
Repeated Occupational Exposure to Low-level Blast in the Canadian Armed Forces: Effects on Hearing, Balance, and Ataxia
Authors: Nakashima Ann , Vartanian Oshin , Rhind Shawn G , King Kristen , Tenn Catherine , Jetly Col Rakesh
Published: January 2021

Introduction

Recently, there has been increasing concern about the adverse health effects of long-term occupational exposure to low-level blast in military personnel. Occupational blast exposure occurs routinely in garrison through use of armaments and controlled blast detonations. In the current study, we focused on a population of breaching instructors and range staff. Breaching is a tactical technique that is used to gain entry into closed spaces, often through the use of explosives.

Materials and Methods

Initial measurements of blast overpressure collected during breaching courses found that up to 10% of the blasts for range staff and up to 32% of the blasts for instructors exceeded the recommended 3 psi exposure limit. Using a cross-sectional design, we used tests of balance, ataxia, and hearing to compare a sample of breachers (n = 19) to age-and sex-matched military controls (n = 19).

Results

There were no significant differences between the two groups on the balance and ataxia tests, although the average scores of both groups were lower than would be expected in a normative population. The prevalence of hearing loss was low in the breacher group (4 of 19), and hearing thresholds were not significantly different from the controls. However, the prevalence of self-reported tinnitus was significantly higher in the breacher group (12 of 19) compared with the controls (4 of 19), and all breachers who were identified as having hearing loss also reported tinnitus.

Conclusions

Our results suggest that basic tests of balance, ataxia, and hearing on their own were not sensitive to the effects of long-term occupational exposure to low-level blast. Some of the blast exposure levels exceeded limits, and there was a significant association of exposure with tinnitus. Future studies should supplement with additional information including exposure history and functional hearing assessments. These findings should be considered in the design of future acute and longitudinal studies of low-level blast exposure.
Antifungal effects ofStreptococcus mutansextract onCandidastrains susceptible and resistant to fluconazole: Anin vivostudy
Authors: Alves Mariana de Sá , Fugisaki Luciana Ruano de Oliveira , dos Santos Jéssica Diane , Scorzoni Liliana , Medina Rebeca Previate , Silva Dulce Helena Siqueira , Junqueira Juliana Campos
Published: January 2021

Previous studies showed that the crude extract obtained from Streptococcus mutans inhibited the growth of Candida albicans reference strains. In this study, we evaluated whether the antifungal effects of S. mutans extract can be extended to clinical Candida isolates, including C. albicans and non-abicans strains with different susceptibilities to fluconazole. We verified that S. mutans extract increased the survival of Galleria mellonella larvae infected with C. albicans and C. glabrata and inhibited the fungal cells in hemolymph. These antifungal effects occurred for both fluconazole-susceptible and fluconazole-resistant strains. However, larvae infected by C. krusei were not affected by S. mutans extract.

Lay Summary

Streptococcus mutans crude extract shows antifungal effects on clinical Candida strains susceptible and resistant to fluconazole in Galleria mellonella model.
Mildly relativistic magnetized shocks in electron–ion plasmas – II. Particle acceleration and heating
Authors: Ligorini Arianna , Niemiec Jacek , Kobzar Oleh , Iwamoto Masanori , Bohdan Artem , Pohl Martin , Matsumoto Yosuke , Amano Takanobu , Matsukiyo Shuichi , Hoshino Masahiro
Published: January 2021

Particle acceleration and heating at mildly relativistic magnetized shocks in electron–ion plasma are investigated with unprecedentedly high-resolution 2D particle-in-cell simulations that include ion-scale shock rippling. Electrons are super-adiabatically heated at the shock, and most of the energy transfer from protons to electrons takes place at or downstream of the shock. We are the first to demonstrate that shock rippling is crucial for the energization of electrons at the shock. They remain well below equipartition with the protons. The downstream electron spectra are approximately thermal with a limited supra-thermal power-law component. Our results are discussed in the context of wakefield acceleration and the modelling of electromagnetic radiation from blazar cores.
Characteristic time variability of gravitational-wave and neutrino signals from three-dimensional simulations of non-rotating and rapidly rotating stellar core collapse
Authors: Shibagaki Shota , Kuroda Takami , Kotake Kei , Takiwaki Tomoya
Published: January 2021

We present results from full general relativistic 3D hydrodynamics simulations of stellar core collapse of a 70 M⊙ star with spectral neutrino transport. To investigate the impact of rotation on non-axisymmetric instabilities, we compute three models by parametrically changing the initial strength of rotation. The most rapidly rotating model exhibits a transient development of the low-T/|W| instability with one-armed spiral flow at the early post-bounce phase. Subsequently, the two-armed spiral flow appears, which persists during the simulation time. The moderately rotating model also shows the growth of the low-T/|W| instability, but only with the two-armed spiral flow. In the non-rotating model, a vigorous activity of the standing accretion-shock instability (SASI) is only observed. The SASI is first dominated by the sloshing mode, which is followed by the spiral SASI until the black hole (BH) formation. We present a spectrogram analysis of the gravitational waves (GWs) and neutrinos, focusing on the time correlation. Our results show that characteristic time modulations in the GW and neutrino signals can be linked to the growth of the non-axisymmetric instabilities. We find that the degree of the protoneutron star (PNS) deformation, depending upon which modes of the non-axisymmetric instabilities develop, predominantly affects the characteristic frequencies of the correlated GW and neutrino signals. We point out that these signals would be simultaneously detectable by the current-generation detectors up to ∼10 kpc. Our findings suggest that the joint observation of GWs and neutrinos is indispensable for extracting information on the PNS evolution preceding the BH formation.
The Umov effect in cosmic dust analogue fluffy aggregates
Authors: Mazarbhuiya A M , Das H S , Halder P
Published: January 2021

We investigate the effect of porosity in the Umov effect for the first time using the aggregate dust model. The Umov effect is an inverse correlation between the reflectivity (or geometric albedo) of an object and the degree of linear polarization of light scattered by it. Three different types of fractal aggregates: ballistic agglomeration (BA), ballistic agglomeration with one migration (BAM1), and ballistic agglomeration with two migrations (BAM2) having porosities 0.87, 0.74, and 0.64, respectively (which have the same characteristic radius ∼1 μm), are considered in our simulations. Using the multisphere T-matrix (mstm) code, maximum positive polarization (Pmax) and geometric albedo (A) are calculated for three different fractal aggregated structures considering amorphous silicate composition. Then Pmax and A are plotted against each other in logarithmic scale that shows a linear inverse correlation and a strong porosity dependence. This study shows that the porosity of the aggregates plays a crucial role in the Umov-law diagram. Further, we explore the effect of aggregate size parameter and the effect of composition in the Umov diagram for particles larger than the wavelength of incident radiation. A systematic study is presented in this paper.
Evidence for galaxy assembly bias in BOSS CMASS redshift-space galaxy correlation function
Authors: Yuan Sihan , Hadzhiyska Boryana , Bose Sownak , Eisenstein Daniel J , Guo Hong
Published: January 2021

Building accurate and flexible galaxy–halo connection models is crucial in modelling galaxy clustering on non-linear scales. Recent studies have found that halo concentration by itself cannot capture the full galaxy assembly bias effect and that the local environment of the halo can be an excellent indicator of galaxy assembly bias. In this paper, we propose an extended halo occupation distribution (HOD) model that includes both a concentration-based assembly bias term and an environment-based assembly bias term. We use this model to achieve a good fit (χ2/degrees of freedom = 1.35) on the 2D redshift-space two-point correlation function (2PCF) of the Baryon Oscillation Spectroscopic Survey (BOSS) CMASS galaxy sample. We find that the inclusion of both assembly bias terms is strongly favoured by the data and the standard five-parameter HOD model is strongly rejected. More interestingly, the redshift-space 2PCF drives the assembly bias parameters in a way that preferentially assigns galaxies to lower mass haloes. This results in galaxy–galaxy lensing predictions that are within 1σ agreement with the observation, alleviating the perceived tension between galaxy clustering and lensing. We also showcase a consistent 3σ–5σ preference for a positive environment-based assembly bias that persists over variations in the fit. We speculate that the environmental dependence might be driven by underlying processes such as mergers and feedback, but might also be indicative of a larger halo boundaries such as the splashback radius. Regardless, this work highlights the importance of building flexible galaxy–halo connection models and demonstrates the extra constraining power of the redshift-space 2PCF.
Single cell epigenetic visualization assay
Authors: Kint Sam , Van Criekinge Wim , Vandekerckhove Linos , De Vos Winnok H , Bomsztyk Karol , Krause Diane S , Denisenko Oleg
Published: January 2021

Characterization of the epigenetic status of individual cells remains a challenge. Current sequencing approaches have limited coverage, and it is difficult to assign an epigenetic status to the transcription state of individual gene alleles in the same cell. To address these limitations, a targeted microscopy-based epigenetic visualization assay (EVA) was developed for detection and quantification of epigenetic marks at genes of interest in single cells. The assay is based on an in situ biochemical reaction between an antibody-conjugated alkaline phosphatase bound to the epigenetic mark of interest, and a 5′-phosphorylated fluorophore-labeled DNA oligo tethered to a target gene by gene-specific oligonucleotides. When the epigenetic mark is present at the gene, phosphate group removal by the phosphatase protects the oligo from λ-exonuclease activity providing a quantitative fluorescent readout. We applied EVA to measure 5-methylcytosine (5mC) and H3K9Ac levels at different genes and the HIV-1 provirus in human cell lines. To link epigenetic marks to gene transcription, EVA was combined with RNA-FISH. Higher 5mC levels at the silenced compared to transcribed XIST gene alleles in female somatic cells validated this approach and demonstrated that EVA can be used to relate epigenetic marks to the transcription status of individual gene alleles.
HuB and HuD repress telomerase activity by dissociating HuR from TERC
Authors: Cheng Xiaolei , Gu Xiaoping , Xia Tianjiao , Ma Zhengliang , Yang Zhongzhou , Feng Helen Lechen , Zhao Yong , Ma Wenbin , Ju Zhenyu , Gorospe Myriam , Yi Xia , Tang Hao , Wang Wengong
Published: January 2021

The ubiquitous RNA-binding protein HuR (ELAVL1) promotes telomerase activity by associating with the telomerase noncoding RNA TERC. However, the role of the neural-specific members HuB, HuC, and HuD (ELAVL2–4) in telomerase activity is unknown. Here, we report that HuB and HuD, but not HuC, repress telomerase activity in human neuroblastoma cells. By associating with AU-rich sequences in TERC, HuB and HuD repressed the assembly of the TERT–TERC core complex. Furthermore, HuB and HuD competed with HuR for binding to TERC and antagonized the function of HuR that was previously shown to enhance telomerase activity to promote cell growth. Our findings reveal a novel mechanism controlling telomerase activity in human neuroblastoma cells that involves a competition between HuR and the related, neural-specific proteins HuB and HuD.
Strategies to lower fibroblast growth factor 23 bioactivity
Authors: Verbueken Devin , Moe Orson W
Published: January 2021

Fibroblast growth factor 23 (FGF23) is a circulating hormone derived from the bone whose release is controlled by many factors and exerts a multitude of systemic actions. There are congenital and acquired disorders of increased and decreased FGF23 levels. In chronic kidney disease (CKD), elevations of FGF23 levels can be 1000-fold above the upper physiological limit. It is still debated whether this high FGF23 in CKD is a biomarker or causally related to morbidity and mortality. Data from human association studies support pathogenicity, while experimental data are less robust. Knowledge of the biology and pathobiology of FGF23 has generated a plethora of means to reduce FGF23 bioactivity at many levels that will be useful for therapeutic translations. This article summarizes these approaches and addresses several critical questions that still need to be answered.