bluuebunny/crossref_metadata_2025_split huggingface dataset:
Sore eyes as the most significant ocular symptom experienced by people with COVID-19: a comparison between pre-COVID-19 and during COVID-19 states
Authors: Pardhan Shahina , Vaughan Megan , Zhang Jufen , Smith Lee , Chichger Havovi 
Published: November 2020

ObjectiveConjunctivitis has been reported in people suffering from COVID-19. However, many ocular symptoms are associated with the term ‘conjunctivitis’ which may be misleading. It is also unknown whether ocular symptoms were different in chronic sufferers of anterior eye diseases, when they were experienced or how long they lasted for compared with other COVID-19 symptoms.MethodsAn online structured questionnaire obtained self-report data from people who had a confirmed diagnosis of COVID-19. Data for the type, frequency and duration of different COVID-19 symptoms were ascertained. Anterior eye symptoms experienced by participants in the pre-COVID-19 state were compared with during the COVID-19 state.ResultsData from 83 participants showed that the most reported COVID-19 symptoms were dry cough (66%), fever (76%), fatigue (90%) and loss of smell/taste (70%). The three most common ocular symptoms experienced by participants were photophobia (18%), sore eyes (16%) and itchy eyes (17%). The frequency of sore eyes was significantly higher (p=0.002) during COVID-19 state (16%) compared with pre-COVID-19 state (5%). There were no differences between males and females (p>0.05). 81% of participants reported to have experienced ocular symptoms within 2 weeks of other COVID-19 symptoms, and 80% reported they lasted for less than 2 weeks.ConclusionThe most significant ocular symptom experienced by people suffering from COVID-19 was sore eyes. Other symptoms associated with other types of conjunctivitis, such as mucous discharge and gritty eyes linked to bacterial infection, did not reach significance. The term ‘conjunctivitis’ is too broad and should be used with caution.
Establishing and maintaining a robust Role 2 Afloat organisation within the Royal Naval Medical Services
Authors: Matthews J J , Mercer S J , Khan M A , Hillman C M , Robin J , Scott T E 
Published: November 2020

AbstractIn 2009, the Royal Navy (RN) reconfigured the Role 2 maritime medical treatment capability, the Role 2 Afloat (R2A). This capability is now firmly established on a number of platforms in the fleet and was recently externally validated on RFA MOUNTS BAY prior to completion of an operational deployment supporting contingency operations in the Mediterranean. This article outlines the future challenges for R2A and offers suggestions on how to maintain a robust R2A organisation within the Royal Naval Medical Service (RNMS).
Peripheral venous disease and its implications for military practice
Authors: Swain C , Khan M 
Published: November 2020

AbstractPeripheral venous disease includes a spectrum of conditions which can be considered in two categories, corresponding to venous anatomy: superficial, and deep. Superficial diseases, including varicose veins and superficial thrombophlebitis, are relatively common conditions which present in the primary care setting and require appropriate management. Deep vein thrombosis (DVT) can significantly impact on operational capability and future deployability and employability.This review discusses venous anatomy and physiology, and the clinical picture of venous disease, including classification and management within the military setting.
The Role 2 Afloat custodian
Authors: Hudson J , Mercer S 
Published: November 2020

AbstractThe Role 2 Afloat (R2A) capability is now firmly established on several maritime platforms using the 370 Module (afloat) equipment. This year has seen the appointment on board ships that support R2A of a new full-time role, the Medical Module Manager (MMM), who is responsible for the equipment on board. This article outlines the new role.
Using simple exercise tests in the field to assess susceptibility to Acute Mountain Sickness; the Chester Step Test may be a useful predictor
Authors: Thornton HE , Williams T Harcourt 
Published: November 2020

AbstractIntroductionWe undertook an observational study with eight volunteer participants which aimed to identify whether simple cardio-respiratory measurements, before and after different forms of exercise testing, could offer a reliable means of predicting Acute Mountain Sickness (AMS). Three tests were used, all of which were easily performed in the mountain environment.MethodsDuring an expedition to Mt Elbrus (5642m), in the Caucasus region of Russia, daily cardiorespiratory observations were made on eight subjects after exercise testing, and compared with Lake Louise Self-Assessment Questionnaire (LLSAQ) scores.ResultsAt all altitudes, the Chester Step Test (CST) demonstrated differences in the time taken to reach 80% of the calculated maximum heart rate between participants due to variance in levels of aerobic fitness. At 3800m, there was a significant difference (t = 3.06, p = 0.02) between those who reached 80% of their maximum heart rate rapidly, and those who did not. This difference was associated with symptoms of severe AMS; the group who developed more severe symptoms were able to exercise for longer than the group who demonstrated mild AMS (Mann-Whitney U score: p = 0.004).ConclusionsDespite small numbers, these results suggest that there is a difference between mountaineers who develop severe AMS and those who are less severely affected, upon testing of their aerobic capacity. This may reflect adaptation of the cardiovascular system, and further investigation is warranted.
An evaluation of the mental health of servicewomen in the perinatal period
Authors: Guest R 
Published: November 2020

AbstractBackgroundDepression and anxiety are the most common mental health disorders during the perinatal period. The aims of this study were to observe the potential scale and impact of perinatal low mood in the military population, to ascertain if patients were recognised and treated appropriately during maternity leave and to identify potential barriers to care.MethodsA 10-question survey was designed using an online platform in consultation with military community mental health professionals, and sent out via Royal Naval maternity cells and relevant social media.ResultsOf 249 respondents, 68% had concerns regarding their mood in the perinatal period; 54% were unaware they could access help from Defence mental health during maternity leave and 65% had one or more risk factors for developing perinatal mood disturbance. Using the Edinburgh Postnatal Depression Scale, 54% felt that they had had a problem with perinatal low mood. Of these 71% reported having symptoms on their return to work and 80% felt that these had impacted on family relationships. Free text comments were separated into seven themes, namely: isolation, military implications, information flow between the civilian and military healthcare systems, knowledge of healthcare professionals, stigma, return to work and positive comments.ConclusionsIssues explored in this paper concern: increased risk; information flow; barriers to presentation; isolation; and medical service knowledge gaps. Suggested action points include increased input from medical services into maternity groups, phone contact from sick bays to servicewomen on maternity leave, improvements in information flow, maternity-specific return to work medical, maternity leads within military practices and areas for potential future research.
The management of inflammatory bowel disease in the UK Armed Forces
Authors: Holden A , Booth R , Howes J 
Published: November 2020

AbstractInflammatory bowel disease is the umbrella term for ulcerative colitis and Crohn’s disease. Diagnosis is assisted by thorough history-taking, examination and targeted investigations, but endoscopic analysis is required to confirm the diagnosis. Multiple challenges exist in the deployed environment and, depending on the level of care available, repatriation may be required. In the deployed environment, prior to diagnosis, isolation in case of an infective cause of symptoms is key, along with close monitoring and symptomatic management. Inflammatory bowel disease is a bar to selection to the UK Armed Forces, but service may continue in some cases if diagnosis occurs during a military career. Due to high relapse rates, severity of symptoms and side effects of therapies, continued military service may not be possible in the long term.
Prone position ventilation in the Role 2 Afloat environment
Authors: Hill A , Hillman C , Scott T E 
Published: November 2020

AbstractProne position ventilation is a life-saving technique for the management of hypoxic respiratory failure in ventilated patients. It has particular application in the isolated Role 2 Afloat (R2A) environment where both human and material resources are limited. It can be achieved with minimal training. This article describes the rationale behind prone position ventilation and equips the reader with the knowledge base that will allow the technique to be instigated.
How has military use of medical imaging in austere environments changed? A comparison between deployments of the Victorian era and today
Authors: Lee A J , Gibb I E , Stevenson T 
Published: November 2020

AbstractOver 100 years ago, in the late 19thcentury, the British military first deployed radiological equipment to theatres of war, notably to Afghanistan during the Tirah campaign and to Sudan during the River War. The efforts of early radiological pioneers, and the clear diagnostic utility their equipment offered, quickly saw radiology formally incorporated into military medicine as its own discipline. The two World Wars saw the specialisation advance rapidly in scope and capability. To draw comparison with earlier conflicts, the early 21stcentury saw modern medical imaging equipment utilised in the same geographical regions: first as part of Op HERRICK in Afghanistan from 2003-14; and currently as part of Op TRENTON in South Sudan.In the intervening period throughout the 20thcentury, the capability has developed enormously. Initially the ‘Roentgen Ray’, X-ray was used to identify bone fractures and locate and identify foreign bodies located within wounds, thus reducing the risk of infection and further trauma previously inflicted by surgical exploration, whilst also giving added precision to extraction of bullets and fragmentation. Modern day military radiology further improves diagnostic capability, giving a more comprehensive picture of injuries sustained and providing assistance in treatment. State-of-the-art radiological equipment can now be routinely operated in the most austere military environments. Nonetheless, modern military radiologists face similar challenges to their Victorian counterparts in delivering capability, notably climate, equipment fragility and environmental hazards. Whilst equipment continues to evolve, the need for resourcefulness and adaptability amongst those personnel operating and maintaining it remains undiminished.
Increasing Role 2 Afloat capability on the Bay Class platforms – lessons from Exercise AZRAQ SERPENT 2018
Authors: Matthews J J 
Published: November 2020

AbstractA recent medical proof of concept exercise (Exercise AZRAQ SERPENT 2018) allowed the opportunity for a United States Navy Surgical Team to deploy onto one of the Bay Class platforms (RFA CARDIGAN BAY). This team was utilised in a serial during the exercise to establish a secondary operating position within the medical complex. This showed that the standard Role 2 Afloat team deployed to Bay Class platforms could be supplemented by an additional small surgical team to increase the capability offered and allow a third patient to be treated concurrently. The lessons from this exercise are discussed.
The inception of the Bastion Protocol for trauma CT scanning
Authors: Carter N J , Kirkwood G W , Miles R , Gay D A T 
Published: November 2020

AbstractDuring Operation HERRICK, increasing numbers of battlefield casualties resulted in the need for innovation in the medical management of trauma. The aim of diagnostic radiology was to provide fast and accurate diagnostic information to the trauma team. The Bastion Protocol Computed Tomography (CT) Traumagram played a vital part in achieving this aim in the Joint Force Role 3 Medical Treatment Facility (R3), Camp Bastion.The CT Traumagram comprises a non-contrast CT scan of the head, followed by a biphasic intravenous contrast injection with single-pass acquisition from the Circle of Willis to the ischial tuberosities or as far down the legs as is necessary. Diagnostic CT, once a time-consuming process, became one of the major medical successes of Operation HERRICK. As a result, the Bastion Protocol, in modified forms, has been widely accepted and adopted in civilian trauma practice throughout the United Kingdom (UK). This paper aims to document the inception of the Bastion Protocol.
Of men and moulds
Authors: Watkins P E 
Published: November 2020

AbstractIn 2015, this Journal carried a commentary on a paper relating to probably the most important medical discovery of the 20thcentury.1The original paper appeared in 1945, and reported the Robert Campbell Oration to the Ulster Medical Society, given by Professor Sir Alexander Fleming.2In this he described the discovery and subsequent development of penicillin. It is now 90 years since Fleming made his discovery, which altered the practice of medicine.
The effectiveness of pre-impregnated permethrin in military clothing in the prevention of insect bites
Authors: Biggs D 
Published: November 2020

AbstractIntroductionWhen on operational deployment, or where a vector-borne disease threat has been identified, military personnel wear uniform that has been pre-impregnated with permethrin insecticide to prevent insect bites, as part of an integrated approach to bite avoidance in order to reduce disease non-battle injury. This article reports a study that was carried out to investigate whether the clothing treatments currently in use are effective at preventing insect bites.MethodsA human volunteer study was conducted using two different species of mosquito and clothing subjected to different washing schedules. The number of landing events and probing events, and insect mortality, were recorded.ResultsThere was a marked increase in mosquito activity as the amount of viable permethrin was reduced through washing. There was a statistically significant difference between 50 washes and the negative control, and between 50 and 5 washes. As clothing is increasingly washed, its effectiveness is reduced.ConclusionThe use of pre-impregnated uniform does not provide complete protection against biting insects throughout the life of the garment. No single means of protection will prevent personnel from being bitten, and a suite of personal and communal measures should be employed to reduce the risk of vector-borne disease, including the use of insect repellent, mosquito nets, anti-malarial chemoprophylaxis and re-treatment of clothing against biting insects in order to reduce the risk of disease transmission. Since this study, alternative means of clothing treatment have been sought to reinforce the pre-treated uniforms issued. Advice and direction is available, specific to the environment personnel are deploying to, based upon risk.
Too hot to handle: how quickly do surgical instruments cool sufficiently to use safely following sterilisation using the Medical Device Decontamination Capability (Forward)?
Authors: Roper D , McClean A , Hand C J 
Published: November 2020

AbstractThe Role 2 Basic medical treatment facility deploys with the Medical Device Decontamination Capability (MDDC) (Forward) to sterilise re-usable surgical instruments. After use, the instrument sets are placed in a wire basket, unwrapped and sterilised using MDDC (Forward). The instrument sets are taken out of the steriliser at 69°C but need to cool before reaching a safe handling temperature. If the instruments are needed immediately for surgery, current practice is to pour water over the instruments to speed the cooling process, although it is not known how long instruments take to reach a safe working temperature range. We compared the current standard practice of cooling against four other methods in order to establish the optimum technique.
Physiotherapy support to the Carrier Strike Group
Authors: Rutter T , Matthews J J 
Published: November 2020

AbstractThe recent First of Class Flying Trials for the F-35 Lightning 2 took place on HMS QUEEN ELIZABETH (QNLZ) during the WESTLANT 18 deployment. WESTLANT 18 took place over four months off the eastern seaboard of the United States of America and involved a busy daily flying programme. The deployment was supported by a full Role 2 Afloat (R2A) team. The Role 1 team onboard was augmented during WESTLANT 18 with a physiotherapist. Data collected during WESTLANT 18 suggests that provision of a physiotherapist to support the Carrier Strike Group (CSG) is a force enabler and force protection asset, as they are able to keep patients on board who would otherwise require aeromedical evacuation back to the United Kingdom. The deployed physiotherapist was well employed and, when complemented by plain radiography and supported by an embarked orthopaedic surgeon, saved a significant amount of lost working hours and the associated costs of investigations and treatment in the host nation. This reduces the risk to operational capability due to musculoskeletal injury to the aircrew or to the ship’s company and embarked forces.
Military combat movements and exercises: is there a role for adopting sports nutrition carbohydrate recommendations during exercise?
Authors: King A J , Mellor A , O’Hara J P 
Published: November 2020

AbstractThe daily energy requirements for specialist military troops can reach 5000 kcal during training and wartime deployment. Maintaining energy balance is important for health and physical and mental performance in this population, who can effectively be considered as high-performance endurance athletes. In the sporting world, a balanced diet consisting of 50-60% carbohydrate (CHO), 20-25% protein and 25-30% fat is recommended for these athletes. CHO intake is regarded as a key dietary constituent, as this substrate provides the sole fuel source during high-intensity exercise. However, achieving such high CHO intake rates can be challenging for military personnel, especially in the field. In sports nutrition, athletes commonly use dietary CHO supplements to reduce this deficit. There may be lessons and insight from nutrition and metabolism in sport that could provide Royal Marines, Medical Officers and other embedded medical professionals with strategies to increase CHO intake during intense training or combat situations.This review will highlight the exercise demands of infantry soldiering, will suggest supplementary strategies to increase CHO intake, in addition to dietary intake, and will describe the metabolic effects of CHO ingestion during prolonged activity in the context of military exercise.
Trauma system funding: implications for the surgeon health policy advocate
Authors: Lin Saunders , Johnson Christian , Opelka Frank , Liepert Amy 
Published: November 2020

BackgroundTrauma systems improve mortality for the most severely injured patients; however, these systems are managed by individual states with different funding mechanisms, which can lead to inconsistencies in the quality of care. This study compiles trauma system legislation and regulations of funding sources and creates a trauma funding categorization system. Such data help to inform the systems of trauma care delivery within and between states.MethodsOnline searches of state statutes were performed to establish the presence of legislative code to establish a trauma system, the presence of legislative code that funds these trauma systems, and the amount of funding that was allocated to each state’s trauma system in fiscal year 2016 to 2017. Following this, each state’s trauma system was contacted via email and telephone to further obtain this information.ResultsSpecific state legislation creating a trauma system was identified in 48 states (96%). Data for categorization of trauma system funding were obtained in 30 states (60%). Of these 30 states, 29 have legislation funding their trauma systems. 17 states funded their trauma systems through general appropriations legislation, 10 states used percentages of fines from criminal and misdemeanor offenses, and 7 states used fees and taxes. New York state does not have any specific funding legislation. Individual state financial contributions to state trauma systems ranged from $55 000 to $25 899 450, annually.DiscussionThere is a limited amount of trauma system funding details available, and among these there is wide variation of funding source types and amounts allotted toward trauma systems. It is difficult to obtain and summate legislative information for use for surgical health policy advocacy efforts. Further study and method development to disseminate comprehensive and comparative legislative and regulatory data and information to physicians and other trauma system stakeholders are needed.Level of evidenceIII, economic and valued-based evaluation; analyses based on limited alternatives and costs; poor estimates.
Evidence gaps and research needs in current guidance on feeding children from birth to 24 months
Authors: Atkinson Stephanie A. , Jimenez Elizabeth Yakes , Pérez-Escamilla Rafael 
Published: November 2020

A United States National Academies report summarized recommendations on what and how to feed infants and young children in high-income countries from 43 eligible guideline documents. Consistency existed across many recommendations, but some differences occurred in topic areas, age groupings, and methodological approaches. Future development of guidelines on feeding of infants and young children requires new research and a rigorous evidence-based review process that is harmonized within and across countries and incorporates dissemination and implementation guidance. Novelty: New research and rigorous methods are recommended to develop future harmonized guidance on feeding of infants and young children that incorporates dissemination and implementation methods.
Do Not Cut Wood with an Angle Grinder, or You Might Lose a Finger: A Retrospective Study
Authors: Tsumura Takuya , Matsumoto Taiichi , Matsushita Mutsumi , Kishimoto Katsuma , Shiode Hayao 
Published: November 2020

Background: Angle grinders are a handheld power tool used for grinding and polishing stone, metal, and concrete. Some people, however, use them with a circular saw blade attachment for cutting wood and consequently, suffer injuries. We aimed to investigate the underlying cause and mechanisms of injuries caused by cutting wood with an angle grinder. Methods: We conducted a retrospective study using medical records from our trauma center and identified 15 patients treated for angle grinder injury between 2017 and 2018. Moreover, we contacted the National Consumer Affairs Center of Japan for further information about angle grinder injuries. Results: Nine of the 15 patients used angle grinders improperly, of which only three patients were aware of the risk of injury. The details of the nine patients were as follows: the types of injuries: complete finger amputation (n = 2), partial finger amputation (n = 1), tendon injury with phalangeal fracture (n = 5), and tendon injury alone, (n = 1); the causes of accidents: kickback (n = 7) and glove entanglement (n = 2); and the accident situations: on-the-job (n = 5) and do-it-yourself (n = 4). Conclusions: The primary cause of angle grinder injury caused by cutting wood was a lack of user knowledge that an angle grinder cannot be used as a cutting tool. Appropriate feedback from hand surgeons are necessary to urge manufacturers to take safety measures.