bluuebunny/crossref_metadata_2025_split huggingface dataset:
Predicting and Planning for Musculoskeletal Service-Connected Disabilities in VA Using Disability for Active Duty OEF/OIF Military Service Members
Authors: Gundlapalli Adi V , Redd Andrew M , Suo Ying , Pettey Warren B P , Brignone Emily , Chin David L , Walker Lauren E , Poltavskiy Eduard A , Janak Jud C , Howard Jeffrey T , Sosnov Lt Col Jonathan A , Stewart Lt Col Ian J 
Published: February 2020

ABSTRACT

Introduction
Musculoskeletal (MSK) conditions are commonly seen among military service members (SM) and Veterans. We explored correlates of award of MSK-related service-connected disability benefits (SCDB) among SM seeking care in Veterans Affairs (VA) hospitals.

Materials and Methods
Department of Defense data on SM who separated from October 1, 2001 to May 2017 were linked to VA administrative data. Using adjusted logistic regression models, we determined the odds of receiving MSK SCDB.

Results
A total of 1,558,449 (79% of separating SM) had at least one encounter in VA during the study period (7.8% disability separations). Overall, 51% of this cohort had at least one MSK SCDB (88% among disability separations, 48% among normal). Those with disability separations (as compared to normal separations) were significantly more likely to receive MSK SCDB (odds ratio 2.37) as were females (compared to males, odds ratio 1.15).

Conclusions
Although active duty SM with disability separations were more likely to receive MSK-related service-connected disability ratings in the VA, those with normal separations also received such awards. Identifying those at highest risk for MSK-related disability could lead to improved surveillance and prevention strategies in the Department of Defense and VA health care systems to prevent further damage and disability.
Materials Characterization of Cranial Simulants for Blast-Induced Traumatic Brain Injury
Authors: Wermer Anna , Kerwin Joseph , Welsh Kelsea , Mejia-Alvarez Ricardo , Tartis Michaelann , Willis Adam 
Published: February 2020

ABSTRACT

Introduction
The mechanical response of brain tissue to high-speed forces in the blast and blunt traumatic brain injury is poorly understood. Object-to-object variation and interspecies differences are current limitations in animal and cadaver studies conducted to study damage mechanisms. Biofidelic and transparent tissue simulants allow the use of high-speed optical diagnostics during a blast event, making it possible to observe deformations and damage patterns for comparison to observed injuries seen post-mortem in traumatic brain injury victims.

Methods
Material properties of several tissue simulants were quantified using standard mechanical characterization techniques, that is, shear rheometric, tensile, and compressive testing.

Results
Polyacrylamide simulants exhibited the best optical and mechanical property matching with the fewest trade-offs in the design of a cranial test object. Polyacrylamide gels yielded densities of ~1.04 g/cc and shear moduli ranging 1.3–14.55 kPa, allowing gray and white matter simulant tuning to a 30–35% difference in shear for biofidelity.

Conclusions
These materials are intended for use as layered cranial phantoms in a shock tube and open field blasts, with focus on observing phenomena occurring at the interfaces of adjacent tissue simulant types or material-fluid boundaries. Mechanistic findings from these studies may be used to inform the design of protective gear to mitigate blast injuries.
Histopathological Evidence of Multiple Organ Damage After Simulated Aeromedical Evacuation in a Swine Acute Lung Injury Model
Authors: Scultetus Anke H , Jefferson Michelle A , Haque Ashraful , Hubbell Jordan N , Arnaud Francoise G , Moon-Massat Paula , McCarron Richard M , Malone Debra L 
Published: February 2020

ABSTRACTIntroductionRapid aeromedical evacuation (AE) is standard of care in current conflicts. However, not much is known about possible effects of hypobaric conditions. We investigated possible effects of hypobaria on organ damage in a swine model of acute lung injury.MethodsLung injury was induced in anesthetized swine via intravenous oleic acid infusion. After a stabilization phase, animals were subjected to a 4 hour simulated AE at 8000 feet (HYPO). Control animals were kept at normobaria. After euthanasia and necropsy, organ damage was assessed by combined scores for hemorrhage, inflammation, edema, necrosis, and microatelectasis.ResultsHemodynamic, neurological, or hematologic measurements were similar prior to transport. Hemodynamic instability became apparent during the last 2 hours of transport in the HYPO group. Histological injury scores in the HYPO group were higher for all organs (lung, kidney, liver, pancreas, and adrenal glands) except the brain, with the largest difference in the lungs (P &lt; 0.001).ConclusionsSwine with mild acute lung injury subjected to a 4 hour simulated AE showed more injury to most organs and, in particular, to the lungs compared with ground transport. This may exacerbate otherwise subclinical pathology and, eventually, manifest as abnormalities in gas exchange or possibly end-organ function.
The ABCs of Ocular Trauma: Adapting a Familiar Mnemonic for Rapid Eye Exam in the Pre-Ophthalmic Zone of Care
Authors: Kroesen Christiaan F , Snider Matthew , Bailey James , Buchanan Adam , Karesh James W , La Piana Frank , Seefeldt Erin , Egan Jo Ann , Mazzoli Robert A 
Published: February 2020

Abstract
Evaluation and management of eye trauma is daunting to many practitioners. For general medical emergencies, the familiar ABCs mnemonic serves to both recompose the provider as well as provide a logical order for evaluation and action. We recently adapted an ABCs mnemonic to provide non-ophthalmologists with a familiar method for systematically evaluating and managing eye trauma. A = ACUITY. Visual acuity is the most importance piece of information in eye trauma. B = BEST exam of BOTH eyes. Starting with acuity, examination proceeds from the front to the rear of the eye. Examine the uninjured eye first. C = CONTIGUOUS STRUCTURES and CONTACT LENSES. Examine structures contiguous to the apparent injury. Inspect for contact lens wear. D = DRUGS, DIAGNOSTIC IMAGING, and the DON’TS. Start antibiotics, antiemetics, and analgesics. Administer tetanus. Obtain computerized tomography if available. Do not attempt ocular ultrasound or magnetic resonance imaging. Do not apply pressure to the eye. Do not patch the eye or apply any medication. E = EYE SHIELD and EVACUATE. Shield and ship to ophthalmology. The mnemonic was adapted to reflect current Joint Trauma Services and Tactical Combat Casualty Care practice guidelines. We believe this familiar mnemonic will serve as a useful tool in allowing non-ophthalmologists to comfortably and safely evaluate an eye for trauma.
Simulation of Cumulative Exposure Statistics for Blast Pressure Transmission Into the Brain
Authors: Tan X Gary , Matic Peter 
Published: February 2020

Abstract

Introduction
This study develops and demonstrates an analysis approach to understand the statistics of cumulative pressure exposure of the brain to repetitive blasts events.

Materials and Methods
A finite element model of blast loading on the head was used for brain model biomechanical responses. The cumulative pressure exposure fraction (CPEF), ranging from 0.0 to 1.0, was used to characterize the extent and repetition of high pressures. Monte Carlo simulations were performed to generate repetitive blast cumulative exposures.

Results
The blast orientation effect is as influential as the blast overpressure magnitudes. A 75° (from the side) blast orientation can produce CPEF values exceeding traumatic brain injury pressure thresholds &gt;0.95 while, for the same blast overpressure, a 0° (front) blast orientation results in a CPEF &lt;0.25. Monte Carlo results for different sequences reflecting notional operational and training environments show that both mean values and standard deviations of CPEF reach the statistically equilibrium state at a finite value of n exposures for each sequence.

Conclusions
Statistical convergence of the brain pressure response metrics versus number of blasts for different exposures characterizes the transitions from “low” to “high” number of blasts and quantitatively highlights the differences between operational and training exposures.
Measuring Blunt Force Head Impacts in Athletes
Authors: Bartsch Adam , Dama Rajiv , Alberts Jay , Samorezov Sergey , Benzel Edward , Miele Vincent , Shah Alok , Humm John , McCrea Michael , Stemper Brian 
Published: February 2020

Abstract

Introduction
Although concussion continues to be a major source of acute and chronic injuries, concussion injury mechanisms and risk functions are ill-defined. This lack of definition has hindered efforts to develop standardized concussion monitoring, safety testing, and protective countermeasures. To overcome this knowledge gap, we have developed, tested, and deployed a head impact monitoring mouthguard (IMM) system.

Materials and Methods
The IMM system was first calibrated in 731 laboratory tests. Versus reference, Laboratory IMM data fit a linear model, with results close to the ideal linear model of form y = x + 0, R2 = 1. Next, during on-field play involving n = 54 amateur American athletes in football and boxing, there were tens of thousands of events collected by the IMM. A total of 890 true-positive head impacts were confirmed using a combination of signal processing and National Institute of Neurological Disorders and Stroke/National Institutes of Health Common Data Elements methods.

Results
The median and 99th percentile of peak scalar linear acceleration and peak angular acceleration were 20 and 50 g and 1,700 and 4,600 rad/s2, respectively. No athletes were diagnosed with concussion.

Conclusions
While these data are useful for preliminary human tolerance limits, a larger population must be used to quantify real-world dose response as a function of impact magnitude, direction, location, and accumulation. This work is ongoing.
Thalamocortical Anatomical Connectivity in Schizophrenia and Psychotic Bipolar Disorder
Authors: Sheffield Julia M , Huang Anna S , Rogers Baxter P , Giraldo-Chica Monica , Landman Bennett A , Blackford Jennifer Urbano , Heckers Stephan , Woodward Neil D 
Published: February 2020

Abstract

Background
Anatomical connectivity between the thalamus and cortex, including the prefrontal cortex (PFC), is abnormal in schizophrenia. Overlapping phenotypes, including deficits in executive cognitive abilities dependent on PFC-thalamic circuitry, suggest dysrupted thalamocortical anatomical connectivity may extend to psychotic bipolar disorder. We tested this hypothesis and examined the impact of illness stage to inform when in the illness course thalamocortical dysconnectivity emerges.

Methods
Diffusion-weighted imaging data were collected on 70 healthy individuals and 124 people with a psychotic disorder (schizophrenia spectrum = 75; psychotic bipolar disorder = 49), including 62 individuals in the early stage of psychosis. Anatomical connectivity between major divisions of the cortex and thalamus was quantified using probabilistic tractography and compared between groups. Associations between PFC-thalamic anatomical connectivity and executive cognitive abilities were examined using regression analysis.

Results
Psychosis was associated with lower PFC-thalamic and elevated somatosensory-thalamic anatomical connectivity. Follow-up analyses established that lower PFC-thalamic and elevated somatosensory-thalamic anatomical connectivity were present in both schizophrenia and psychotic bipolar disorder. Lower PFC-thalamic anatomical connectivity was also present in early-stage and chronic psychosis. Contrary to expectations, lower PFC-thalamic anatomical connectivity was not associated with impaired executive cognitive abilities.

Conclusions
Altered thalamocortical anatomical connectivity, especially reduced PFC-thalamic connectivity, is a transdiagnostic feature of psychosis detectable in the early stage of illness. Further work is required to elucidate the functional consequences of the full spectrum of thalamocortical connectivity abnormalities in psychosis.
“We’d Rather Be Relevant than Theoretically Accurate”: The Translation and Commodification of Social Scientific Knowledge for Clinical Practice
Authors: Olsen Lauren D 
Published: February 2020

AbstractAt the turn of the 21st century, one of the ways in which the U.S. medical profession attempted to address the rampant health and healthcare disparities facing their patient populations was to pay more attention to a patient’s culture. Proving to be easier said than done, the operationalization of the social scientific concept of culture for clinical practice has been fraught with implementation difficulties—from clinician buy-in to stereotyping. I draw upon ethnographic data to detail how an interdisciplinary group of social scientists and clinicians work to translate a theoretically-complex, reflexive, and social-justice-oriented conceptualization of culture into a clinical intervention tool. As opposed to previous accounts of interdisciplinary collaboration that describe social science being ignored, marginalized, or non-commodifiable, I show how this group makes the anthropological concept of culture both clinically and commercially relevant and the importance of clinicians-as-consumers in the translational process.
Genetics and epigenetics of allergy
Authors: Agache Ioana , Cojanu Catalina , Laculiceanu Alexandru , Rogozea Liliana 
Published: February 2020

Purpose of review
Allergic diseases are prototypic examples for gene × environment-wide interactions. This review considers the current evidence for genetic and epigenetic mechanisms in allergic diseases and highlights barriers and facilitators for the implementation of these novel tools both for research and clinical practice.

Recent findings
The value of whole-genome sequencing studies and the use of polygenic risk score analysis in homogeneous well characterized populations are currently being tested. Epigenetic mechanisms are known to play a crucial role in the pathogenesis of allergic disorders, especially through mediating the effects of the environmental factors, well recognized risk modifiers. There is emerging evidence for the immune-modulatory role of probiotics through epigenetic changes. Direct or indirect targeting of epigenetic mechanisms affect expression of the genes favouring the development of allergic diseases and can improve tissue biology. The ability to specifically edit the epigenome, especially using the Clustered Regularly Interspaced Short Palindromic Repeats (CRISPR)/Cas9 technology, holds the promise of enhancing understanding of how epigenetic modifications function and enabling manipulation of cell phenotype for research or therapeutic purposes.

Summary
Additional research in the role of genetic and epigenetic mechanisms in relation to allergic diseases’ endotypes is needed. An international project characterizing the human epigenome in relation to allergic diseases is warranted.
Clinically significant differences in patient-reported outcomes evaluations in chronic spontaneous urticaria
Authors: Baiardini Ilaria , Canonica Giorgio W. , La Grutta Stefania , Braido Fulvio 
Published: February 2020

Purpose of reviewThe aim of this review is to highlight the conceptual and practical knowledge for interpreting score changes in patient-reported outcomes (PROs) that have been validated for chronic spontaneous urticaria (CSU).Recent findingsThe urticaria guidelines recommends to assess PROs as Health-Related Quality of Life, disease activity and disease control, to detect the CSU impact and the overall treatment effect. To this aim it is crucial to determine the minimal important difference (MID) to assess if changes in questionnaire scores represent either perceived improvement or deterioration for patients. Methods for establishing the MID are well defined and are clustered into two broad categories: distribution-based and anchor-based.SummaryFor the majority of the available questionnaires for CSU, an MID has been defined, according to the results of various approaches. In most of the studies in our review, anchor-based methods, either alone or in combination with distribution ones, were used. The available information regarding MIDs across validated tools for CSU patients helps to interpret measurement scores and allows the implementation of PROs in routine practices.
Scurvy as a Sequela of Avoidant-Restrictive Food Intake Disorder in Autism: A Systematic Review
Authors: Sharp William G. , Berry Rashelle C. , Burrell Lindsey , Scahill Lawrence , McElhanon Barbara O. 
Published: February 2020

ABSTRACT:

Objective:
To document the clinical presentation of scurvy in children with autism spectrum disorder (ASD) and summarize the contemporary approaches to assessment and management in this population. Scurvy is a disease caused by vitamin C deficiency most often detected in populations at high risk for nutrition insufficiency (e.g., extreme poverty). Children with ASD and severe food selectivity consistent with avoidant-restrictive food intake disorder may also be at risk for scurvy.

Method:
We searched MEDLINE, CINAHL, and PsycINFO databases (1990–2018) in peer-reviewed journals for studies of children with ASD and scurvy. Inclusion criteria required confirmed diagnosis of ASD and scurvy in children (birth to 18 years) with a clear description of restrictive dietary patterns. Cases of scurvy due to other causes were excluded. We used a standardized protocol to independently code information; agreement between coders was high.

Results:
The systematic search identified 20 case reports involving 24 children (mean age = 9 ± 3.5; 22 boys/2 girls). The eventual diagnosis of scurvy followed a wide range of negative diagnostic testing; treatment with ascorbic acid and/or a multivitamin resulted in rapid improvement.

Conclusions:
Symptoms of scurvy mimic other pediatric conditions (e.g., cancer). The range of diagnostic testing increased costs and healthcare risks (radiation, sedation) and delayed the diagnosis of scurvy. In children with ASD and severe food selectivity, a nutrition evaluation and laboratory testing are warranted before a more elaborate testing.
Video-assisted cardiopulmonary resuscitation via smartphone improves quality of resuscitation
Authors: Ecker Hannes , Lindacher Falko , Adams Niels , Hamacher Stefanie , Wingen Sabine , Schier Robert , Böttiger Bernd W. , Wetsch Wolfgang A. 
Published: February 2020

BACKGROUND
Despite intensive research, cardiac arrest remains a leading cause of death. It is of paramount importance to undertake every possible effort to increase the overall quality of cardiopulmonary resuscitation (CPR) and improve patient outcome. CPR initiated by a bystander is one of the key factors in survival of such an incident. Telephone-assisted CPR (T-CPR) has proved to be an effective measure in improving layperson resuscitation.

OBJECTIVE
We hypothesised that adding video-telephony to the emergency call (video-CPR, V-CPR) enhances the quality of layperson resuscitation.

DESIGN
This randomised controlled simulation trial was performed from July to August 2018. Laypersons were randomly assigned to video-assisted (V-CPR), telephone-assisted (T-CPR) or control (unassisted CPR) groups. Participants were instructed to perform first aid on a mannequin during a simulated cardiac arrest.

SETTING
This study was conducted in the Skills Lab of the University Hospital of Cologne.

PARTICIPANTS
One hundred and fifty healthy adult volunteers.

INTERVENTION
The participants received a smartphone to call emergency services, with Emergency Eye video-call in V-CPR group, and normal telephone functionality in the other groups. T-CPR and V-CPR groups received standardised CPR assistance via phone.

MAIN OUTCOME MEASURES
Our primary endpoint was resuscitation quality, quantified by compression frequency and depth, and correct hand position.

RESULTS
Mean compression frequency of V-CPR group was 106.4 ± 11.7 min, T-CPR group 98.9 ± 12.3 min (NS), unassisted group 71.6 ± 32.3 min (P < 0.001). Mean compression depth was 55.4 ± 12.3 mm in V-CPR, 52.1 ± 13.3 mm in T-CPR (P < 0.001) and 52.9 ± 15.5 mm in unassisted (P < 0.001). Total percentage of correct chest compressions was significantly higher (P < 0.001) in V-CPR (82.6%), than T-CPR (75.4%) and unassisted (77.3%) groups.

CONCLUSION
V-CPR was shown to be superior to unassisted CPR, and was comparable to T-CPR. However, V-CPR leads to a significantly better hand position compared with the other study groups. V-CPR assistance resulted in volunteers performing chest compressions with more accurate compression depth. Despite reaching statistical significance, this may be of little clinical relevance.

TRIAL REGISTRATION
ClinicalTrials.gov (Identifier: NCT03527771)
Recent advances in genome editing for cardiovascular disease
Authors: Doerfler Alexandria M. , Walkey Christopher J. , Lagor William R. 
Published: February 2020

Purpose of review
This review highlights recent progress in applying genome editing to the study and treatment of cardiovascular disease (CVD).

Recent findings
Recent work has shown that genome editing can be used to determine the pathogenicity of variants of unknown significance in patient-derived induced pluripotent stem cells. These cells can also be used to test therapeutic genome editing approaches in a personalized manner. Somatic genome editing holds great promise for the treatment of CVD, and important proof of concept experiments have already been performed in animal models. Here we briefly review recent progress in patient-derived cells, as well as the development of somatic genome-editing therapies for CVD, with a particular focus on liver and heart.

Summary
Translating this technology into the clinic will require precise editing enzymes, efficient delivery systems, and mitigation of off-target events and immune responses. Further development of these technologies will improve diagnostics and enable permanent correction of some of the most severe forms of CVD.
Bowman Layer Onlay Transplantation to Manage Herpes Corneal Scar
Authors: Dapena Isabel , Musayeva Aytan , Dragnea Diana C. , Groeneveld-van Beek Esther A. , Ní Dhubhghaill Sorcha , Parker Jack S. , van Dijk Korine , Melles Gerrit R. J. 
Published: February 2020

Purpose:
To introduce the concept of using a Bowman layer (BL) onlay graft to manage superficial herpetic corneal scarring and to describe the clinical outcomes of the first 2 cases undergoing this procedure.

Methods:
Two patients with a quiescent superficial corneal scar after herpes (varicella zoster virus [n = 1] and herpes simplex virus [n = 1]) keratitis underwent BL onlay transplantation. After the removal of the host epithelium and limited superficial keratectomy, an isolated BL graft was placed onto the host corneal surface. The cornea was then covered with an amniotic membrane and a bandage contact lens. Best spectacle-corrected visual acuity (VA) and/or best contact lens-corrected VA (BCLVA), biomicroscopy, corneal tomography, and anterior segment optical coherence tomography were recorded at 1 week, 1 month, and 3, 6, 9, 12, and 18 months postoperatively.

Results:
In both cases, the surgical and postoperative courses were uneventful. An improvement of the corneal clarity was observed at biomicroscopy, and no varicella zoster virus/herpes simplex virus reactivation occurred throughout the follow-up period. Biomicroscopy, Scheimpflug imaging, and anterior segment optical coherence tomography showed a completely epithelialized and well-integrated graft postoperatively. In case 1, BCLVA with a scleral lens improved from 20/100 (0.1) preoperatively to 20/32 (0.6) postoperatively. For case 2, no preoperative BCLVA was available, but a BCLVA of 20/36 (0.55) was achieved after the procedure.

Conclusions:
A BL onlay graft may be a feasible surgical procedure, which may have the potential to reduce superficial corneal scarring and/or anterior corneal irregularities without resorting to deeper keratoplasty in these complex cases.