bluuebunny/crossref_metadata_2025 huggingface dataset:
Foreign language anxiety in relation to affective variables
Authors: Jee Min Jung
Published: March 2019

This study investigated Korean-as-a-foreign-language (KFL) students’ foreign language anxiety (FLA) in relation to
five affective variables (i.e., unwillingness to communicate, classroom risk-taking, classroom sociability, motivation, and
self-efficacy) as well as to self-rated Korean proficiency. One hundred and fifty-two KFL students who were enrolled in Korean
classes in a large public university in Australia completed survey items for the study. Overall, KFL students in Australia showed
moderate levels of anxiety (M = 2.79) and unwillingness to communicate (M = 2.58). Additionally,
their levels of motivation (M = 3.92) and self-efficacy (M = 3.41) were high. Five affective
variables were proven to be significantly related with FLA: a positive correlation between FLA and unwillingness to communicate;
and negative correlations between FLA and classroom risk-taking, classroom sociability, motivation and self-efficacy. Among the
variables, self-efficacy and self-rated overall Korean proficiency were found to be the best predictors of FLA.
Classroom learners of Chinese in senior secondary school
Authors: Keynton Janice
Published: March 2019

This study looks at the Chinese-learning experiences of six classroom learners who continued to the end of
secondary school in Victoria, Australia, through in-depth interviews. Various systemic deterrents to continued Chinese language
study are identified by the participants, including: (1) the schooling journey, including transition between primary and high
school and disruption from uninterested students in compulsory classes; (2) the curriculum and the learning demands dictated by
the form of assessment; (3) the risk of poor assessment results prejudicing post-school study options, in particular because the
cohort includes large numbers of home speaker learners. In Victoria, Australia, a large part of what schools provide is dictated
by the metasystem of education and the assessments at which it aims. Thus the structural deterrents to Chinese classroom learner
continuation identified are within the power of government agencies to change, in order to enable more of these students to
continue.
A Yolŋu ‘Bothways’ approach to English and Warramiri literacy at Gäwa
Authors: Gelderen Ben van , Guthadjaka Kathy
Published: March 2019

In the famous Djuranydjura story from North-East Arnhem Land, when the visiting ‘Macassan’ offers the Yolŋu ancestral dog rice, shoes and blankets, he rejects them all, in favour of his own land and resources. At Gäwa homeland on Elcho Island, this powerful story is reinterpreted to include the arrival ofbalanda(white) teachers, and their focus on English literacy. However, it is not that English literacy is devalued, but that it must maintain its proper place; negotiated to sit alongside the foundational literacy of the land, and Warramiri language itself. An approach of applying such a ‘Bothways’ pedagogy through utilising the ‘Accelerated Literacy’ methodology forbothlanguages and cultures is outlined to demonstrate that strengthened identity is attainable when the community moves together.
Caught in the middle
Authors: Heath Jeffrey
Published: March 2019

The relationship between the Songhay and Mande language families has fascinated West Africanists. The typological similarities run deep, but the respective lexicons are noncognate. I focus here on a typological rarity, a bidirectional case marker (BCM), namely Proto-Songhay *nà and its descendants, and argue that it was most likely borrowed from Mande as part of the adoption by Songhay of the equally typologically rare Mande-type S(‑infl)‑O‑V‑X syntax, which reduces to S‑O‑V‑X when there is no post-subject inflectional morpheme (predicative marker). Apparently Songhay had little choice but to borrow the morpheme on the grounds that it did not previously possess the S(‑infl)‑O‑V‑X construction of which it is a key component, especially since a buffer between S and O prevents real-time mis-parsing of two adjacent NPs as possessor-possessum. The medial (‘caught in the middle’) position of the morpheme in the S‑BCM‑O sequence favored the borrowing, in spite of its abstract relational function which in some theoretical models should block borrowing.
Task repetition and the public performance of speaking tasks in EFL classes at a Vietnamese high school
Authors: Newton Jonathan , Nguyen Bao Trang Thi
Published: March 2019

This study investigated the occurrence of language-related episodes (LREs) in interactive tasks performed by pairs of Vietnamese English Foreign Language (EFL) learners and the extent to which linguistic knowledge targeted in these LREs was transferred to subsequent public performance (PP) of the same tasks in front of the class. Task performance data was collected from 24 pairs of learners from six intact grade 11 EFL classes at a Vietnamese high school as they carried out two interactive speaking tasks in consecutive weeks, first privately in pairs and then, within the same lesson, publically in front of the class. Teachers and learners were also interviewed. Results showed LREs to be frequent in task rehearsals. The majority of LREs were resolved correctly by the learners and led to more accurate use of the targeted linguistic items in subsequent public performance. The results and supporting interview data shows how, in this school, the practice of asking learners to repeat the performance of tasks in front of the class positively affected learner engagement and enriched the language learning opportunities available through interactive oral tasks.
Inhale, exhale: Probing the inside-out mechanism of nicotine addiction using novel fluorescent sensors
Authors: McManus Owen B. , Werley Christopher A. , Dempsey Graham T.
Published: March 2019

McManus, Werley, and Dempsey highlight new work showing that nicotine rapidly equilibrates in the ER after extracellular application.
Ultradense protium p(0) and deuterium D(0) and their relation to ordinary Rydberg matter: a review
Authors: Holmlid Leif , Zeiner-Gundersen Sindre
Published: March 2019

The extremely large density of ultra-dense hydrogen H(0) has been proved in numerous experiments by three laser-induced methods, namely Coulomb explosions observed by particle time-of-flight (TOF) and TOF mass spectrometry, rotational emission spectroscopy in the visible, and annihilation-like meson ejecting nuclear reaction processes. The density of H(0) at the quite common spin level s = 2 is of the order of 100 kg cm−3. The theory of ultra-dense hydrogen H(0) is described briefly, especially the ‘mixed’ spin quantum number s and its relation to the internuclear distances. The orbital angular momentum of the bonding electrons in H(0) is l = 0, which gives the H(0) designation. At s = 2 with electron total angular momentum L = ħ, the internuclear distance is 2.24 pm, and at s = 1 thus L = ħ/2, it is as small as 0.56 pm. The internuclear distances are measured by optical rotational spectroscopy with a precision as good as 10−3, thus with femtometer resolution. The dimensional factor (ratio of internuclear distance to the electron orbit radius) was determined to be 2.9 by electrostatic stability calculations for ordinary Rydberg matter. This value is found to be valid with high precision also for H(0) clusters with different shapes. Superfluidity and a Meissner effect at room temperature are only found for the long chain clusters H2N
(0), while the small H3(0) and H4(0) clusters do not have any super properties. Instead, they are the clusters in which most of the nuclear reaction processes take place. These processes give meson showers (most types of kaons and pions) and, after meson decay, large fluxes of muons and other leptons. Published applications of these results already exist in the field of nuclear reactions, energy production (patented fusion reactor), space physics (the solar wind), and in astrophysics (dark matter and the interstellar medium).
Characterizing precipitation events leading to surface water flood damage over large regions of complex terrain
Authors: Bernet Daniel Benjamin , Trefalt Simona , Martius Olivia , Weingartner Rolf , Mosimann Markus , Röthlisberger Veronika , Zischg Andreas Paul
Published: March 2019

Surface water floods (SWFs) that lead to household losses are mainly localized phenomena. Research on describing the associated precipitation characteristics has previously been based on case studies and on the derivation of local rainfall thresholds, but no approaches have yet been presented on the national scale. Here, we propose a new way to overcome this scaling problem. We linked a gridded precipitation dataset based on both rainfall gauges and radar data with geolocated insurance claims for all of Switzerland. We show that the absolute thresholds vary markedly over complex terrain, and we thus propose basing early warning systems for predicting damage-relevant SWF events on local quantiles of maximum intensity and the total sum of event precipitation. A threshold model based on these two parameters is able to classify rainfall events potentially leading to damage-relevant SWF events over large areas of complex terrain, including high mountains and lowland areas, and a variety of geological conditions. Our approach is an important step towards the development of impact-based early warning systems. Weather warning agencies or insurance companies can build upon these findings to find workarounds for issuing user-targeted warnings at national scale or for nowcasting purposes.
The American Society for Clinical Pathology’s 2018 Vacancy Survey of Medical Laboratories in the United States
Authors: Garcia Edna , Kundu Iman , Kelly Melissa , Soles Ryan
Published: March 2019

Objectives

To determine the extent and distribution of workforce shortages within the nation’s medical laboratories.

Methods

The survey was conducted through collaboration between the American Society for Clinical Pathology’s Institute of Science, Technology, and Policy in Washington, DC, and the Evaluation, Measurement, and Assessment Department and Board of Certification in Chicago, IL. Data were collected via an internet survey distributed to individuals who were able to report on staffing and certifications for their laboratories.

Results

Results show increased vacancy rates for laboratory positions across all departments surveyed. The overall retirement rates are at its lowest, suggesting that the field has already experienced loss of personnel with a vast amount of experience.

Conclusions

Focus on retention of qualified and certified laboratory professionals would be crucial factors in addressing the needs of the laboratory workforce. The field also needs to intensify its efforts on recruiting the next generation of laboratory personnel.
Oral Language Performance of Deaf and Hard-of-Hearing Students in Mainstream Schools
Authors: Lau Tammy H M , Lee Kathy Y S , Lam Emily Y C , Lam Joffee H S , Yiu Chris K M , Tang Gladys W L
Published: March 2019

In Hong Kong, students are expected to speak fluent Cantonese, Putonghua, and English. However, the curriculum does not include Cantonese studies, as children are expected to have already acquired Cantonese by the age of school entry. This study examined the language outcomes of Cantonese-speaking deaf or hard-of-hearing children who attend primary schools within the Hong Kong educational system and considered whether the system currently meets the needs of these children. The Hong Kong Cantonese Oral Language Assessment Scale, which comprises six subtests, was used to assess 98 children with mild to profound hearing loss. A regression analysis was used to examine the influences of various variables on oral language performance in these children. Notably, 41% of the participants had achieved age-appropriate oral language skills, while 18% and 41% exhibited mild-to-moderate or severe oral language impairment, respectively. The degree of hearing loss and the use of speech therapy were identified as significant negative predictors of oral language performance. The issues of a relatively late diagnosis and device fitting, as well as the very poor oral language outcomes, strongly emphasize the need for policy makers to reconsider the existing educational approaches and support for deaf or hard-of-hearing children.
Evolutionary origins of polycystic ovary syndrome: An environmental mismatch disorder
Authors: Charifson Mia A , Trumble Benjamin C
Published: March 2019

Polycystic ovary syndrome (PCOS) is the most common female endocrine disorder and has important evolutionary implications for female reproduction and health. PCOS presents an interesting paradox, as it results in significant anovulation and potential sub-fecundity in industrialized populations, yet it has a surprisingly high prevalence and has a high heritability. In this review, we discuss an overview of PCOS, current diagnostic criteria, associated hormonal pathways and a review of proposed evolutionary hypotheses for the disorder. With a multifactorial etiology that includes ovarian function, metabolism, insulin signaling and multiple genetic risk alleles, PCOS is a complex disorder. We propose that PCOS is a mismatch between previously neutral genetic variants that evolved in physically active subsistence settings that have the potential to become harmful in sedentary industrialized environments. Sedentary obesogenic environments did not exist in ancestral times and exacerbate many of these pathways, resulting in the high prevalence and severity of PCOS today. Overall, the negative impacts of PCOS on reproductive success would likely have been minimal during most of human evolution and unlikely to generate strong selection. Future research and preventative measures should focus on these gene-environment interactions as a form of evolutionary mismatch, particularly in populations that are disproportionately affected by obesity and metabolic disorders.

Lay Summary

The most severe form of polycystic ovary syndrome (PCOS) is likely a result of interactions between genetic predispositions for PCOS and modern obesogenic environments. PCOS would likely have been less severe ancestrally and the fitness reducing effects of PCOS seen today are likely a novel product of sedentary, urban environments.
Making Settlers Muslim: Religion, Resistance and Everday Life in Nineteenth-Century French Algeria
Authors: Sessions Jennifer
Published: March 2019

On 26 April 1901, members of the Righa tribe overran the French colonial village of Margueritte in central Algiers province. They seized the settlement’s male colonists and demanded they ‘make [them]selves Muslims’ by reciting the shehada and donning North African clothing. Several Europeans who could not or would not comply were killed. This article explores the meanings of this forced conversion of European settlers, which made the Margueritte revolt unique in the history of Algerian resistance to French colonialism. For French colonial officials, the religious ritual indicated the causal role of ‘Islamic fanaticism’ in fomenting the revolt. Administrators and magistrates focused their investigations on the religious habits of the revolt’s leaders, possible ties to Sufi brotherhoods and pan-Islamist conspiracies. But in doing so, they largely overlooked the more quotidian meanings of the conversion ritual for the inhabitants of Margueritte itself. By resituating the symbolic transformation of body and soul within the cultural logics of everyday life in the settler village, the article attempts to map out the more mundane social practices by which ethno-religious colonial hierarchies were enacted and embodied in French Algeria.
Study risk assessment of Japan Clinical Oncology Group (JCOG) clinical trials using the European Organisation for Research and Treatment of Cancer (EORTC) study risk calculator
Authors: Miyamoto Kenichi , Nakamura Kenichi , Mizusawa Junki , de Balincourt Christine , Fukuda Haruhiko
Published: March 2019

Background

New Japanese ethical guidelines for medical researches and the Clinical Trials Act have come into effect and monitoring is mandated for intervention studies. Methods of monitoring can be modified according to a study risk, but there is no established method in Japan regarding how to assess a study risk. EORTC assesses a study risk using their own study risk calculator and classifies their trials into three categories. For each category, different levels of monitoring are applied. This project is aimed to assess the study risks of JCOG trials using the EORTC calculator.

Methods

We selected clinical trials open to patient recruitment in JCOG as of Nov 2014. Each trial was scored based on the EORTC study risk calculator and classified into three risk categories; low, medium and high.

Results

A total of 40 studies were included in the assessment. Twenty-seven studies (67.5%) were classified into low risk group, 12 (30%) in medium risk group, and only 1 (2.5%) in high risk group. Clinical trials evaluating multimodality therapy and/or using unapproved drugs tended to be scored higher and most of them were classified into medium or high risk group.

Conclusions

JCOG conducts central monitoring and site visit audit with sampling source data verification for every trial, which are almost compatible with the way in EORTC for the medium risk group. Because most of the JCOG studies were classified into low or medium risk group, the intensity of monitoring and audit in JCOG was considered as reasonable even from the EORTC perspective.
Two new species of shrew-rats (Rhynchomys: Muridae: Rodentia) from Luzon Island, Philippines
Authors: Rickart Eric A , Balete Danilo S , Timm Robert M , Alviola Phillip A , Esselstyn Jacob A , Heaney Lawrence R
Published: March 2019

The murine genus Rhynchomys includes the large-bodied Philippine “shrew-rats,” highly specialized members of the vermivorous clade of Philippine murids. Four species are recognized, all of which are endemic to Luzon Island: R. soricoides from mountains within the Central Cordillera, R. isarogensis from Mt. Isarog on the Bicol Peninsula, R. banahao from Mt. Banahaw in south-central Luzon, and R. tapulao from Mt. Tapulao in the Zambales Mountains. Field surveys in 2006 and 2008 revealed two additional populations of Rhynchomys, one from Mt. Labo (1,544 m), a dormant stratovolcano at the base of the Bicol Peninsula, the other from Mt. Mingan (1,901 m), the highest peak in the central Sierra Madre of east-central Luzon. Assessment of external and craniodental features of available specimens from throughout Luzon support our description of the populations on Mt. Labo and Mt. Mingan as new species. All species of Rhynchomys are restricted to high-elevation, montane, and mossy forest habitats, separated by intervening lowlands. These discoveries highlight the importance of isolated highland areas in the historical diversification of Southeast Asian murines, and as current centers of endemism.
Mechanism and therapeutic window of a genistein nanosuspension to protect against hematopoietic-acute radiation syndrome
Authors: Landauer Michael R , Harvey Adam J , Kaytor Michael D , Day Regina M
Published: March 2019

There are no FDA-approved drugs that can be administered prior to ionizing radiation exposure to prevent hematopoietic–acute radiation syndrome (H-ARS). A suspension of synthetic genistein nanoparticles was previously shown to be an effective radioprotectant against H-ARS when administered prior to exposure to a lethal dose of total body radiation. Here we aimed to determine the time to protection and the duration of protection when the genistein nanosuspension was administered by intramuscular injection, and we also investigated the drug’s mechanism of action. A single intramuscular injection of the genistein nanosuspension was an effective radioprotectant when given prophylactically 48 h to 12 h before irradiation, with maximum effectiveness occurring when administered 24 h before. No survival advantage was observed in animals administered only a single dose of drug after irradiation. The dose reduction factor of the genistein nanosuspension was determined by comparing the survival of treated and untreated animals following different doses of total body irradiation. As genistein is a selective estrogen receptor beta agonist, we also explored whether this was a central component of its radioprotective mechanism of action. Mice that received an intramuscular injection of an estrogen receptor antagonist (ICI 182,780) prior to administration of the genistein nanosuspension had significantly lower survival following total body irradiation compared with animals only receiving the nanosuspension (P < 0.01). These data define the time to and duration of radioprotection following a single intramuscular injection of the genistein nanosuspension and identify its likely mechanism of action.
Development of a Methodology for Simulating Complex Head Impacts With the Advanced Combat Helmet
Authors: Begonia Mark , Rooks Tyler , Pintar Frank A , Yoganandan Narayan
Published: March 2019

Blunt impact assessment of the Advanced Combat Helmet (ACH) is currently based on the linear head response. The current study presents a methodology for testing the ACH under complex loading that generates linear and rotational head motion. Experiments were performed on a guided, free-fall drop tower using an instrumented National Operating Committee for Standards on Athletic Equipment (NOCSAE) head attached to a Hybrid III (HIII) or EuroSID-2 (ES-2) dummy neck and carriage. Rear and lateral impacts occurred at 3.0 m/s with peak linear accelerations (PLA) and peak rotational accelerations (PRA) measured at the NOCSAE head center-of-gravity. Experimental data served as inputs for the Simulated Injury Monitor (SIMon) computational model to estimate brain strain. Rear ACH impacts had 22% and 7% higher PLA and PRA when using the HIII neck versus the ES-2 neck. Lateral ACH impacts had 33% and 35% lower PLA and PRA when using HIII neck versus the ES-2 neck. Computational results showed that total estimated brain strain increased by 25% and 76% under rear and lateral ACH impacts when using the ES-2 neck. This methodology was developed to simulate complex ACH impacts involving the rotational head motion associated with diffuse brain injuries, including concussion, in military environments.
Using Simulation to Address a Training Gap in Battlefield Ocular Trauma: A Lateral Canthotomy and Cantholysis (LCC) Prototype Training System
Authors: Sotomayor Teresita M , Bailey Margaret P , Dorton Stephen L
Published: March 2019

Over the past 15 years of conflict, eye injuries have ocurred at a steady rate of 5–10% of combat casualties, attributed to the enemy’s use of improvised explosive devices. Many of these injuries result in a compartment syndrome of the orbit, easily decompressed through the use of a simple procedure called a Lateral Canthotomy and Cantholysis (LCC). Current training curricula at the U.S. Army Center for Pre-Hospital Medicine at Fort Sam Houston, Texas incorporates LCC training presented in lectures and taught using cadavers and goats (resources permitting), but lacks a LCC training device for the development of psychomotor skills. Requirements analysis, iterative design and development, and testing were performed for a simulation-based training system that may be used to practice the LCC procedure. Subject matter experts have conducted numerous reviews of the prototype system, where feedback is used to drive subsequent designs. Further work, including formal analysis of training effectiveness, will be performed to validate the training system. This will benefit will benefit military and civilian training programs by training psychomotor skills to enhance competency in the LCC procedure for preserving eyesight.
Characterization of Protection Mechanisms to Blast Overpressure for Personal Hearing Protection Devices – Biomechanical Measurement and Computational Modeling
Authors: Gan Rong Z , Leckness Kegan , Smith Kyle , Ji Xiao D
Published: March 2019

Hearing damage induced by blast exposure is a common injury in military personnel involved in most operation activities. Personal hearing protection devices such as earplugs come as a standard issue for Service members; however, it is not clear how to accurately evaluate the protection mechanisms of different hearing protection devices for blast overpressures (BOP). This paper reports a recent study on characterization of earplugs’ protective function to BOP using human cadaver ears and 3D finite element (FE) model of the human ear. The cadaver ear mounted with pressure sensors near the eardrum (P1) and inside the middle ear (P2) and with an earplug inserted was exposed to BOP in the blast test chamber. P1, P2, and BOP at the ear canal entrance (P0) were simultaneously recorded. The measured P0 waveform was then applied at the ear canal entrance in the FE model and the P1 and P2 pressures were derived from the model. Both experiments and FE modeling resulted in the P1 reduction which represents the effective protection function of the earplug. Different earplugs showed variations in pressure waveforms transmitted to the eardrum, which determine the protection level of earplugs.
Augmented Reality as a Medium for Improved Telementoring
Authors: Rojas-Muñoz Edgar , Andersen Dan , Cabrera Maria Eugenia , Popescu Voicu , Marley Sherri , Zarzaur Ben , Mullis Brian , Wachs Juan P
Published: March 2019

Combat trauma injuries require urgent and specialized care. When patient evacuation is infeasible, critical life-saving care must be given at the point of injury in real-time and under austere conditions associated to forward operating bases. Surgical telementoring allows local generalists to receive remote instruction from specialists thousands of miles away. However, current telementoring systems have limited annotation capabilities and lack of direct visualization of the future result of the surgical actions by the specialist. The System for Telementoring with Augmented Reality (STAR) is a surgical telementoring platform that improves the transfer of medical expertise by integrating a full-size interaction table for mentors to create graphical annotations, with augmented reality (AR) devices to display surgical annotations directly onto the generalist’s field of view. Along with the explanation of the system’s features, this paper provides results of user studies that validate STAR as a comprehensive AR surgical telementoring platform. In addition, potential future applications of STAR are discussed, which are desired features that state-of-the-art AR medical telementoring platforms should have when combat trauma scenarios are in the spotlight of such technologies.
Fast Fourier Transformation of Peripheral Venous Pressure Changes More Than Vital Signs with Hemorrhage
Authors: Bonasso Patrick C , Dassinger Melvin S , McLaughlin Brady , Burford Jeffrey M , Sexton Kevin W
Published: March 2019

Vital signs are included in the determination of shock secondary to hemorrhage; however, more granular predictors are needed. We hypothesized that fast Fourier transformation (FFT) would have a greater percent change after hemorrhage than heart rate (HR) or systolic blood pressure (SBP). Using a porcine model, nine 17 kg pigs were hemorrhaged 10% of their calculated blood volume. Peripheral venous pressure waveforms, HR and SBP were collected at baseline and after 10% blood loss. FFT was performed on the peripheral venous pressure waveforms and the peak between 1 and 3 hertz (f1) corresponded to HR. To normalize values for comparison, percent change was calculated for f1, SBP, and HR. The mean percent change for f1 was an 18.8% decrease; SBP was a 3.31% decrease; and HR was a 0.95% increase. Using analysis of variance, FFT at f1 demonstrates a statistically significant greater change than HR or SBP after loss of 10% of circulating blood volume (p = 0.0023). Further work is needed to determine if this could be used in field triage to guide resuscitation.
Relationships and Evidence-Based Theoretical Perspectives on Persisting Symptoms and Functional Impairment Among Mild Traumatic Brain Injury and Behavioral Health Conditions
Authors: Herrold Amy A , Smith Bridget , Aaronson Alexandra L , Coleman John , Pape Theresa L -B
Published: March 2019

The purpose of this study is to characterize and describe the relationships between symptoms and functional impairment following mild traumatic brain injury (mTBI) and behavioral health conditions (BHCs) in order to inform evidence-based theories on why symptoms and functional impairments persist in some individuals but not others. This is a retrospective, multi-site, cross-sectional study utilizing data collected from a total of 289 Operation Iraqi Freedom/Operation Enduring Freedom Veterans who were classified into diagnostic groups using the symptom attribution and classification algorithm and the VA clinical reminder and comprehensive traumatic brain injury evaluation. The Neurobehavioral Symptom Inventory was used to assess mTBI symptom number and severity. The World Health Organization Disability Assessment Schedule 2.0 was used to assess functional impairment. Symptom profiles differed between diagnostic groups irrespective of symptom attribution method used. Veterans with both mTBI and BHCs and those with BHCs alone had consistently greater number of symptoms and more severe symptoms relative to no symptom and symptoms resolved groups. Symptom number and severity were significantly associated with functional impairment. Both symptom number and functional impairment were significantly associated with the number of mTBI exposures. Together, these results informed evidence-based theories on understanding why symptoms and functional impairment persist among some OEF/OIF Veterans.
The Joint Pathology Center/Vision Center of Excellence Approach to Analyzing Intra-Ocular “Foreign Bodies”
Authors: Lewin-Smith Michael R , Strausborger Stacy L , Jenkins H Marie , Merezhinskaya Natalya , Latkany Paul A , Mazzoli Robert A , Colyer Marcus H , Mines Michael J
Published: March 2019

Background

The Military Health System recognizes the importance of analyzing “foreign bodies” removed from US service members through several policy documents. This activity focuses on detecting potentially toxic metals. Intra-ocular “foreign bodies” (IOFBs) represent a small, clinically important subset. The development of ocular metallosis with iron and copper fragments is a specific local reaction to IOFBs. The results of the compositional analysis of removed IOFBs can influence clinical management decisions aimed at optimizing the preservation of sight.

Method

The Joint Pathology Center (JPC) and Vision Center of Excellence (VCE) have established a pathway for the analysis of IOFBs removed from Department of Defense and Veterans Health Administration patients. The analysis of IOFBs uses analytical methods to provide information about the fragments’ surface elemental and molecular composition.

Results

Metallic specimens analyzed included iron and copper-containing fragments. Non-metallic IOFBs analyzed include glass, plastic (polyurethane), and nitro-cellulose fragments.

Conclusion

The JPC/VCE approach to analyzing IOFBs promotes uniform handling and shipping of specimens to minimize contamination. The analytical approach allows for the characterization of IOFBs with a wide variety of compositions. The results support clinical management decisions aimed at optimal treatment for the preservation of patients’ visual acuity.
Autoimmunity-Associated Gut Commensals Modulate Gut Permeability and Immunity in Humanized Mice
Authors: Balakrishnan Baskar , Luckey David , Taneja Veena
Published: March 2019

Objective

Although the etiology of rheumatoid arthritis (RA) is unknown, recent studies have led to the concept that gut dysbiosis may be involved in onset. In this study, we aimed to determine if human gut commensals modulate the immune response and gut epithelial integrity in DQ8 mice.

Methods

DQ8 mice were orally gavaged with RA-associated (Eggerthella lenta or Collinsella aerofaciens) and non-associated (Prevotella histicola or Bifidobacterium sp.) on alternate days for 1 week in naïve mice. Some mice were immunized with type II collagen and oral gavage continued for 6 weeks and followed for arthritis. Epithelial integrity was done by FITC-Dextran assay. In addition, cytokines were measured in sera by ELISA and various immune cells were quantified using flow cytometry.

Results

Gut permeability was increased by the RA-associated bacteria and was sex and age-dependent. In vivo and in vitro observations showed that the RA-non-associated bacteria outgrow the RA-associated bacteria when gavaged or cultured together. Mice gavaged with the RA-non-associated bacteria produced lower levels of pro-inflammatory MCP-1 and MCP-3 and had lower numbers of Inflammatory monocytes CD11c+Ly6c+, when compared to controls. E. lenta treated naïve mice produce Th17 cytokines.

Conclusions

Our studies suggest that gut commensals influence immune response in and away from the gut by changing the gut permeability and immunity. Dysbiosis helps the growth of RA-associated bacteria and reduces the beneficial bacteria.
Development of a Mobile Motion Capture (MO2CA) System for Future Military Application
Authors: Parks Melissa , Chien Jung Hung , Siu Ka-Chun
Published: March 2019

State-of-the-art three-dimensional motion analysis systems, which are utilized to predict, diagnose, and treat many musculoskeletal and neurological disorders, are expensive and space consuming. These systems have only been widely used in large research facilities because of their lack of this transportability. Since device portability is a critically important in the military, most small military hospitals are therefore deprived of these systems. The purpose of this study was to develop a mobile motion capture system, MO2CA, to automatically detect the movement of the human body. Twenty healthy young adults participated in this study. Colored tape was attached on the heel, and subjects walked on the treadmill at three different speeds: preferred, fast, and slow. Two motion capture systems were used concurrently: Qualisys (100 Hz) and MO2CA (60 Hz). Four dependent variables were: stride length, stride time, stride length variability, and stride time variability. Paired t-tests, Pearson correlation, and Bland–Altman plots were used to investigate the statistical differences between two systems. No significant differences were found for all dependent variables. Regression and Bland–Altman plots showed strong agreements between the two systems. Our MO2CA shows a potential for real-time tracking of biomechanical changes in gait, which is extremely important for military use.
Correlates of Depression in U.S. Military Service Members With a History of Mild Traumatic Brain Injury
Authors: Kennedy Jan E , Lu Lisa H , Reid Matthew W , Leal Felix O , Cooper Douglas B
Published: March 2019

Objectives

Post-traumatic stress disorder (PTSD) and traumatic brain injury (TBI) are identified as signature injuries of the Wars in Iraq and Afghanistan. Statistics have confirmed a high incidence of PTSD among military personnel with mild TBI (mTBI) who served in these conflicts. Although receiving less attention, individuals with a history of mTBI are also at increased risk for depressive disorders. This study examines the incidence and correlates of depression in service members with a history of mTBI received an average of 4–1/2 years prior to evaluation.

Methods

Retrospective analysis of 184 service members with a history of mTBI extracted from a data repository maintained at a military medical center.

Results

One-third of the sample (34.2%) was clinically diagnosed with a depressive disorder in the month preceding evaluation. Of those with depression, 81% (51 of 63) were also diagnosed with PTSD. Proportionately more women than men had depression. Depression was more common among those who were undergoing a Military Evaluation Board and those who served in more than three combat deployments.

Conclusions

Results confirm chronically elevated the rates of depressive disorders and PTSD comorbidity among service members with a history of mTBI. Depression screening and treatment within the Military Health System should remain a priority for service members reporting a remote history of mTBI. Individuals with chronic PTSD, women, service members undergoing MEB and those who served in greater than three combat deployments are at particular risk.
Impact of Tinnitus on Military Service Members
Authors: Henry James A , Griest Susan E , Blankenship Cody , Thielman Emily J , Theodoroff Sarah M , Hammill Tanisha , Carlson Kathleen F
Published: March 2019

Objectives

The Noise Outcomes in Servicemembers Epidemiology (NOISE) Study is obtaining longitudinal data to evaluate the effects of noise and other exposures on auditory function in military personnel. A gap in the literature is the lack of studies concerning how active-duty Service members might be impacted by having tinnitus. The present study reports NOISE Study data that address this gap.

Methods

Data are reported from current Service members and recently-separated (within 2.5 years) Veterans, enabling a direct comparison of results between active and post-military samples. Data were collected from two sites: VA Portland Health Care System, Portland, OR and Department of Defense Hearing Center of Excellence, San Antonio, TX. Participants completed comprehensive audiometric testing and numerous questionnaires.

Results

Results are presented from n = 428 participants across the two sites, including 246 Veterans and 182 Service members. The data reveal that, for both Service members and Veterans, the presence of tinnitus has effects on job performance, concentration, anxiety, depression, and sleep.

Conclusions

This study has revealed that, for these samples of study participants, tinnitus has an impact on military Service members that is comparable to how it affects Veterans who have completed their military service within the previous 2.5 years.
Low-Level Primary Blast Induces Neuroinflammation and Neurodegeneration in Rats
Authors: Li Yansong , Yang Zhangsheng , Liu Bin , Valdez Celina , Chavko Mikulas , Cancio Leopoldo C
Published: March 2019

Objective

Mild blast traumatic brain injury is commonly prevalent in modern combat casualty care and has been associated with the development of neurodegenerative conditions. However, whether primary lower level blast overpressure (LBOP) causes neurodegeneration and neuroinflammation remains largely unknown. The aim of our present study was to determine whether LBOP can cause neuroinflammation and neurodegeneration.

Methods

Anesthetized rats were randomly assigned to LBOP group (70 kPa, n = 5) or sham group (without blast, n = 5). Histopathological and cytokine changes in brain tissue at 5 days post-injury were evaluated by hematoxylin-eosin staining and Bioplex assay, respectively.

Results

Histopathological assessment revealed neuronal degeneration and increased density of inflammatory cells in frontal and parietal cortex, hippocampus and thalamus in rats exposed to LBOP. LBOP exposure significantly elevated levels of pro-inflammatory cytokines (EPO, IL-1β, IL-6, IL-12, IL-18, and TNF-α) and chemokines (GRO and RANTES) as well as of an anti-inflammatory cytokine (IL-13) in the frontal cortex.

Conclusions

This study reveals a role of neuroinflammation in neurodegeneration after mild blast traumatic brain injury. Therapies that target this process might in warfighters might function either by attenuating the development of post-traumatic stress disorder, chronic traumatic encephalopathy and Alzheimer’s disease, or by slowing their progression.
The Impact of Affective States on Postconcussive Symptoms in a TBI Population
Authors: Garcia Katelyn , Moore Brian , Kim Grace , Dsurney John , Chan Leighton
Published: March 2019

The occurrence of persistent postconcussive symptoms (PCS) associated with traumatic brain injury (TBI) is an increasing cause of disability and lost productivity. The reasons for these persistent symptoms in a percentage of even mild TBI are poorly understood. The existence of comorbid conditions such as post-traumatic stress disorder or other traumatic injuries may be factors that impact the presence of PCS. We expect that greater levels of affective symptoms will be associated with increases in PCS assessed on the Neurobehavioral Symptom Inventory (NSI). TBI subjects (N = 69) who were seen 1 year post-injury were recruited from a larger cohort study of TBI. Subjects were administered the NSI, Brief Symptom Inventory-18 (BSI-18) and the Post Traumatic Stress Disorder Checklist (PCL). Data were analyzed using Spearman’s rho correlations and analysis of variances. We found significant correlations between the four NSI factors and the three BSI factors and the PCL total score. Mild TBI subjects were found to have the highest correlations between affective and somatic symptoms. These findings support our hypothesis that affective states are associated with higher PCS reporting and that early identification and treatment may decrease PCS.
A Mobile Device Dual-Task Paradigm for the Assessment of mTBI
Authors: Linder Susan M , Koop Mandy Miller , Ozinga Sarah , Goldfarb Zachary , Alberts Jay L
Published: March 2019

Research Objective

Dual-task performance, in which individuals complete two or more activities simultaneously, is impaired following mild traumatic brain injury. The aim of this project was to develop a dual-task paradigm that may be conducive to military utilization in evaluating cognitive-motor function in a standardized and scalable manner by leveraging mobile device technology.

Methods

Fifty healthy young adult civilians (18–24 years) completed four balance stances and a number discrimination task under single- and dual-task conditions. Postural stability was quantified using data gathered from iPad’s native accelerometer and gyroscope. Cognitive task difficulty was manipulated by presenting stimuli at 30, 60, or 90 per minute. Performance of cognitive and balance tasks was compared between single- and dual-task trials.

Results

Cognitive performance from single- to dual-task paradigms showed no significant main effect of balance condition or the interaction of condition by frequency. From single- to dual-task conditions, a significant difference in postural control was revealed in only one stance: tandem with eyes closed, in which a slight improvement in postural stability was observed under dual-task conditions.

Conclusion

The optimal dual-task paradigm to evaluate cognitive-motor performance with minimal floor and ceiling effects consists of tandem stance with eyes closed while stimuli are presented at a rate of one per second.
Combat-Related Extremity Wounds: Injury Factors Predicting Early Onset Infections
Authors: Stewart Laveta , Shaikh Faraz , Bradley William , Lu Dan , Blyth Dana M , Petfield Joseph L , Whitman Timothy J , Krauss Margot , Greenberg Lauren , Tribble David R
Published: March 2019

We examined risk factors for combat-related extremity wound infections (CEWI) among U.S. military patients injured in Iraq and Afghanistan (2009–2012). Patients with ≥1 combat-related, open extremity wound admitted to a participating U.S. hospital (≤7 days postinjury) were retrospectively assessed. The population was classified based upon most severe injury (amputation, open fracture without amputation, or open soft-tissue injury defined as non-fracture/non-amputation wounds). Among 1271 eligible patients, 395 (31%) patients had ≥1 amputation, 457 (36%) had open fractures, and 419 (33%) had open soft-tissue wounds as their most severe injury, respectively. Among patients with traumatic amputations, 100 (47%) developed a CEWI compared to 66 (14%) and 12 (3%) patients with open fractures and open soft-tissue wounds, respectively. In a Cox proportional hazard analysis restricted to CEWIs ≤30 days postinjury among the traumatic amputation and open fracture groups, sustaining an amputation (hazard ratio: 1.79; 95% confidence interval: 1.25–2.56), blood transfusion ≤24 hours postinjury, improvised explosive device blast, first documented shock index ≥0.80, and >4 injury sites were independently associated with CEWI risk. The presence of a non-extremity infection at least 4 days prior to a CEWI diagnosis was associated with lower CEWI risk, suggesting impact of recent exposure to directed antimicrobial therapy. Further assessment of early clinical management will help to elucidate risk factor contribution. The wound classification system provides a comprehensive approach in assessment of injury and clinical factors for the risk and outcomes of an extremity wound infection.
Implementing the Knowledge Assessment of CPT Critical Skills (KACCS) Scale
Authors: Atuel Hazel R , Ursich Luci , Schuyler Ashley , Berg Dax , Kintzle Sara , Castro Carl
Published: March 2019

Cognitive processing therapy (CPT) has been endorsed as an evidence-based therapy for PTSD. It is currently being implemented within the Veterans Health Administration (VA) as a manualized, trauma-focused psychotherapy in line with recommendations from the most recent VA/DOD Clinical Practice Guideline for the management of PTSD. While research on CPT implementation has focused on individual factors that facilitate or hinder adoption, little is known on whether trainees retain core concepts of CPT. The present research addresses this gap in the literature by conducting a validation study of the Knowledge Assessment of CPT Critical Skills (KACCS) Scale among known user groups of CPT (no experience, immediate user, expert user) and, subsequently, an implementation study of the KACCS Scale among clinician trainees participating in an online CPT training. The validation study found that the KACCS Scale can discriminate among various CPT user groups (no experience, intermediate, expert), while the implementation study found that the KACCS Scale provides specific information on core concepts that have been learned at the end of training. The KACCS Scale could benefit from further validation studies and, subsequently, be added to the current CPT instrumentation to monitor learning and retention of core concepts at various training periods (initial workshop, consultation, booster workshop).
Modeling Framework Used to Analyze and Describe Junctional Tourniquet Skills
Authors: Bauchwitz Benjamin R , Curley Taylor , Kwan Calvin , Niehaus James M , Pugh Carla M , Weyhrauch Peter W
Published: March 2019

Medical educators have acknowledged the importance of simulation training in developing procedural skills. While simulation training in other disciplines has benefitted from evaluations of users’ skill acquisition, the majority of medical training simulators continue to be developed from overly simplified descriptions of procedures, such as techniques prescribed by existing instructional material. Our objective was to use a modeling framework to characterize the skill of various users in applying junctional tourniquets in order to design an effective training simulator. We recorded 46 medical first responders performing training exercises applying a junctional tourniquet and used coded video and sensor data to identify the hierarchy of actions they performed in the process. The model provides several insights into trainee performance, such as the way in which advanced users perform more tasks in parallel, or areas where advanced users employ situational awareness to identify ways they can deviate from recommended protocol to improve outcomes. The model successfully identifies variations in tourniquet application technique that correlates with improvement on clinically relevant metrics including application speed, pressure applied, and tourniquet placement stability. This methodology can improve medical training simulations by indicating changes during the course of learning a new task, such as helpful deviations from instructional protocol.