bluuebunny/crossref_metadata_2025_split huggingface dataset:
Strategic National Urban Forest Inventory for the United States
Authors: Edgar Christopher B , Nowak David J , Majewsky Mark A , Lister Tonya W , Westfall James A , Sonti Nancy F 
Published: December 2020

AbstractIn response to the strategic plan required by the Agricultural Act of 2014, the USDA Forest Service Forest Inventory and Analysis (FIA) program is initiating a strategic inventory of the nation’s urban forests. The inventory is designed to provide timely and credible data on urban forests, thereby meeting an expanding need for information on trees located in communities where more than 80% of people live. The program monitors the status and trends of trees in urban settings (i.e., urban forests), enabling assessment of their composition and structure, ecosystem services and values, health, and risk from pests and disease. At full implementation with funding, resources, and partnerships in place, the program as designed would provide annual updates of urban forest conditions on approximately 68 million acres of land and for 100 of the most populous cities in the United States. The traditional forestland inventory of FIA continues and is complemented by the new urban inventory providing the means for a more complete assessment of the tree and forest resources across the United States.
Sources of Stress and Psychological Health Outcomes for Remotely Piloted Aircraft Operators: A Comparison Across Career Fields and Major Commands
Authors: Bryant-Lees Kinsey B , Prince Lillian , Goodman Tanya , Chappelle Wayne , Thompson Billy 
Published: December 2020

ABSTRACT

Introduction
U.S. Air Force remotely piloted aircraft (RPA) operators perform a variety of around-the-clock global intelligence, surveillance, and reconnaissance (ISR) missions that are considered critical to operational effectiveness. The growing need for ISR operations has led to significant increases in operational tempo and workload, resulting in elevated operational stress, burnout, and psychological distress. These negative outcomes are linked to conditions such as long hours, low manning, lack of sleep, and communication issues. Through regular assessments and the implementation of additional resources (i.e., embedded health care providers), Air Force leadership is working to alleviate the stressors and maintain psychological well-being. Thus, the purpose of this study is to compare the levels of stress, and prevalence of burnout and psychological distress across RPA career fields within two major commands.

Materials and Methods
Assessments were completed by 571 RPA operators from 2 major commands: Air Force Special Operations Command (n = 158) and Air Combat Command (n = 413). RPA career fields included pilots (n = 331), sensor operators (n = 137), and intelligence operators (n = 103).

Results
Results revealed that high stress levels from an array of sources continue to result in increased risk of burnout and psychological distress for RPA operators. Several significant differences in sources of high stress across career fields and major commands are identified and discussed.

Conclusions
Overall, the results of this study highlight specific problem areas unique to certain subsets of the RPA community in need of targeted intervention and clarify several avenues for future research.
The Damage Control Resuscitation and Surgical Team: The New French Paradigm for Management of Combat Casualties
Authors: Luft Antoine , Pasquier Pierre , Soucanye de Landevoisin Emmanuel , Morel-Stum Nelly , Baillon Arthur , Louis Serge , Menini William , Sagalle Yannick , Gintte Julie , Bouquet Antoine , Avaro Jean-Philippe 
Published: December 2020

ABSTRACT

Introduction
The aim of this work was to introduce the new French forward resuscitation and surgical unit. It’s also to discuss the choices and waivers granted to fit the tactical context of modern conflicts and the current epidemiology of combat casualties.

Materials and Methods
A multidisciplinary task force of 11 people proceeded to the conception and the creation of a new military resuscitation and surgical unit. The preliminary work included a scoping review of the combat casualties’ epidemiology in modern conflicts and an analysis of the recent French medical–surgical treatment facilities lessons learned. In April 2019, a technical–operational evaluation was conducted to confirm all the technical, ergonomic, and organizational choices made during the design phase.

Results
The multidisciplinary task force resulted in the creation of the Damage Control Resuscitation and Surgical Team (DCRST). The DCRST focused on the resuscitation strategy, including transfusion of blood products, and the life-saving surgical procedures to be performed as close as possible to the point of injury. It was designed for the resuscitation of two patients: the life-saving surgery of two patients and the very short-term intensive care (&lt;12 hours) of four patients at the same time. The DCRST provided sufficient autonomy to provide take care of four T1 and four T2 or T3 casualties per day for 48 hours. It was armed with 23 soldiers. The technical equipment represented 5,300 kg and 27 m3. All the technical medical equipment could be stored in two 20-foot containers.

Conclusion
The DCRST represents a new paradigm in medical support of French military operations. It offers the advantage of two combat casualties’ surgical management at the same time, as close as possible to the combat zone. It responds to a 2-fold epidemiological and logistical challenge.
Molecular Monitoring of Enteropathogens in Sewage During NATO Exercise Trident Juncture 2018: Potential Tool in Early Outbreak Warning?
Authors: Ørmen Øyvind , Madslien Elisabeth Henie 
Published: December 2020

AbstractIntroductionOutbreaks of gastrointestinal disease among military service personnel can have severe impact on operational effectivity and force readiness. Thus, early outbreak detection is critical to minimize spread. This pilot study aimed to explore field-based molecular screening of sewage as a supplemental tool in early outbreak warning before disease is diagnosed in personnel seeking medical care.Materials and MethodsSewage from permanent (n = 3) and temporary (n = 3) military camps, hosting national and international military personnel, were sampled during the NATO Exercise TRJE18 taking place in southern Norway during fall 2018. Samples were screened for 22 gastrointestinal pathogens using multiplex PCR.ResultsMarkers of multiple enteropathogens were detected in samples from all locations with some variations in diversity. Yersinia enterocolitica, pathogenic Escherichia coli, adenovirus, and Giardia were detected in sewage from all six camps during the exercise. Agent diversity seemed to increase with population size, regardless of nationality. Only a minor outbreak (n = 6) of norovirus was reported in one of the permanent camps. From the same camp, genetic markers of norovirus were detected in sewage 2 days before outbreak notification. No other outbreaks of gastrointestinal disease were reported during the exercise, indicating that markers of several enteropathogens can be normally found in sewage from healthy soldier populations. Thus, discriminating between true outbreaks and nonrelevant “background levels” would be of critical importance for correct decision-making in operational contexts.ConclusionsMolecular screening of sewage allows rapid detection of multiple gastrointestinal pathogens in biological waste from military camps. However, background levels of pathogens challenges interpretation of qualitative analyses in outbreak situations. As such, quantitative measures, as well as high-resolution sequence-based methods, which allows strain identification and broader target spectrum, should be further explored in future studies.
Optimizing Fetal Aneuploidy Screening in an Austere Military Clinical Environment: A Prenatal Cost Comparison
Authors: Burrus Ashton D , Shaw-Williams Michelle M , Thagard Andrew S 
Published: December 2020

ABSTRACT

Introduction
Austere clinical settings, including remote military installations, face unique challenges in screening pregnant women for aneuploidy. The objective of this study was to compare the direct and indirect prenatal costs of traditional 2-part serum-based screening to cell-free DNA (cfDNA) for detection of trisomies 18 and 21 for a military treatment facility with limited in-house perinatal resources.

Materials and Methods
We identified Naval Hospital Guantanamo Bay as a surrogate for an austere clinical environment. A prenatal cost of care analysis incorporating direct and indirect expenses was performed to compare the 2 aneuploidy screening strategies for a theoretical cohort of 100 patients for detection of trisomies 18 and 21. The baseline aneuploidy uptake rate was determined using a historical cohort. Test performance characteristics were obtained from the contracting laboratory. Aneuploidy rates and costs were calculated using previously published data.

Results
Assuming a baseline screen uptake rate of 87%, initial screening using the traditional approach would directly cost $8,285.01 versus $44,140.32 with cfDNA. Considering indirect costs such as travel, consultative services, evaluation and follow-up testing of an abnormal screen result, and lost productivity, the cost difference narrows to $14,458.25 over a 5- to 6-year period. Cost equivalence is achieved when cfDNA is priced at $341.17 per test.

Conclusion
Cell-free DNA as an initial screening strategy offers enhanced detection rates for trisomies 18 and 21 but remains more costly than traditional screening when incorporating direct and indirect expenses. In a low volume setting with limited resources, the added cost may be justified given the implications of unrecognized aneuploidy.
Usability Assessment of the Rehabilitation Lower-limb Orthopedic Assistive Device by Service Members and Veterans With Lower Limb Loss
Authors: Symsack Allison , Gaunaurd Ignacio , Thaper Akshay , Springer Barbara , Bennett Christopher , Clemens Sheila , Lucarevic Jennifer , Kristal Anat , Sumner Matthew , Isaacson Brad , Pasquina Paul , Gailey Robert 
Published: December 2020

ABSTRACT

Introduction
Telehealth is an increasingly common approach to improve healthcare delivery, especially within the Veterans Health Administration and Department of Defense (DoD). Telehealth has diminished many challenges to direct access for clinical follow-up; however, the use of mobile telehealth for specialty rehabilitative care is emerging and is referred to as telerehabilitation. As early adopters of telehealth, the Veterans Affairs and DoD have supported collaborated efforts for programs designed to increase the access and quality of rehabilitative care while improving the functional ability of our service members (SMs) and veterans with lower limb amputation (LLA). The DoD and Veterans Health Administration collaborated on a Mobile Device Outcomes-based Rehabilitation Program (MDORP) to help injured SMs and veterans with LLA. The MDORP project utilized a mobile health system called the Rehabilitative Lower Limb Orthopedic Accommodating Device (ReLOAD) to assess walking quality. The ReLOAD system includes real-time auditory biofeedback to notify the user of their most prominent gait deviation and then recommends exercises that address specific balance and strength impairments. The purpose of this study was to describe the responses to a postintervention survey evaluating the feasibility and usability of ReLOAD completed by SMs and veterans with LLA who used the system for 5 months.

Materials and Methods
A link to an anonymous usability survey was emailed to all participants who completed MDORP. The survey was modeled after the System Usability Scale, with agreeableness to items rated on a 5-point Likert-style questionnaire in addition to open feedback. Data visualization of Likert-style questionnaires was conducted using ggplot2 and reshape2 statistical packages and was analyzed using R. We obtained institutional review board approval through both Miami Veterans Affairs Healthcare System and Walter Reed National Military Medical Center.

Results
The majority of participants reported that they would use the system again for home rehabilitation (65%) and that auditory biofeedback helped them walk better (59%). Participants also suggested that future work should include a greater variety of exercise options and the use of smart phones for the ReLOAD application in addition to the iPad tablet.

Conclusions
The participants provided positive and constructive feedback that will enhance the value and usability of telerehabilitation interventions like the ReLOAD system for future users.
An Analysis of Conflicts Across Role 1 Guidelines
Authors: Johnson Sarah A , Lauby Ryann S , Fisher Andrew D , Naylor Jason F , April Michael D , Long Brit , Schauer Steven G 
Published: December 2020

AbstractIntroductionRole 1 care is vital to patient survival and includes many echelons of care from point-of-injury first aid to medical attention at battalion aid stations. Many guidelines are written for Role 1 care providers to optimize care for different scenarios. Differences in the guidelines lead to confusion and discrepancies between the types of treatment medical care providers provide. Although the guidelines were written for different areas of care, uniformity between the guidelines is needed and will lead to a reduced mortality rate.Materials and MethodsIt was determined that the Tactical Combat Casualty Care Guidelines, Prolonged Field Care Guidelines, Joint Trauma System Clinical Practice Guidelines, and Standard Medical Operating Guidelines from medical evacuation were the military medical guidelines most relevant to Role 1 care. These Guidelines were compared side by side to determine the differences between them.ResultsAlthough the guidelines were largely similar, many major differences were found between them. Our online tables contain large inconsistences between guidelines including direct contradictions in conversion of junctional tourniquets and the administration of tranexamic acid.ConclusionsRole 1 care is vital to patient survival, including care from point of injury to battalion aid stations, but the guidelines available to instruct this care and the guidance on which personnel should provide this care are conflicting. This lack of clarity and consistency may adversely impact treatment outcomes. The reduction or elimination of conflicting information across the various guidelines, augmentation of guidance for pediatric care, more specific guidance for unique levels of care, and clearer delineation of the Role 1 phases of care (as well as which guidelines are most appropriate to each) should be considered as urgent priorities within the military medical community.
Curricular Change and Resiliency in the Era of Coronavirus (COVID-19): The Uniformed Services University of the Health Sciences (USU) Experience
Authors: Pock Arnyce R , Williams Pamela M , Maranich Ashley M , Landoll Ryan R , Witkop Catherine T , Reamy Brian V , Durning Steven J 
Published: December 2020

ABSTRACT

Introduction
The Coronavirus (COVID-19) pandemic has presented a myriad of organizational and institutional challenges. The Uniformed Services University of the Health Sciences, like many other front line hospitals and clinics, encountered a myriad of challenges in fostering and sustaining the education of students enrolled at the nation’s only military medical school. Critical to the function of any academic medical institution, but particularly one devoted to the training of future physicians for the Military Health System, was the ability to rapidly adapt, modify, and create new means of keeping medical students engaged in their core curricula and progressing toward full and timely attainment of established educational goals and objectives.

Methods
This article highlights some of the particular challenges faced by faculty and students during the first 6 months of the COVID-19 pandemic and describes how they were managed and/or mitigated.

Results
Six key “lessons learned” were identified and summarized in this manuscript. These lessons may be applicable to other academic institutions both within and outside of the Military Health System.

Conclusions
Recognizing and embracing these key tenets of academic change management can accelerate the generation of a cohesive, organizational response to the next pandemic or public health crisis.
Firearm Suicide Among Veterans of the U.S. Military: A Systematic Review
Authors: Theis Jason , Hoops Katherine , Booty Marisa , Nestadt Paul , Crifasi Cassandra 
Published: December 2020

ABSTRACT

Introduction
In the United States, firearm suicide represents a major cause of preventable, premature death among veterans. The purpose of this systematic review was to characterize the body of literature on veteran firearm suicide and identify areas for future research, which may facilitate the development of firearm suicide interventions in Veterans Health Administration (VHA) and non–Veterans Health Administration clinical settings.

Materials and Methods
All randomized controlled trials, quasi-experimental, naturalistic, observational, and case study designs published between January 1, 1990 and February 21, 2019 were included in our review. Following title and abstract review, 65 papers were included in our full-text review and 37 studies were included in our analysis. We based our approach on a modification of the Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines. Studies were grouped into broad, nonmutually exclusive categories: (1) heterogeneity of datasets and veteran status determination for inclusion, (2) service histories, (3) firearm ownership, storage, behaviors, and risk perceptions, (4) patient and clinician attitudes toward firearm restriction interventions, (5) firearm suicide risk factors by study population, and (6) assessments of clinical firearm interventions.

Results
This body of literature consists predominately of cross-sectional studies with mixed definitions and validation of veteran status, which revealed high concordance of increased risk of firearm suicide compared with nonveterans. Veterans have higher rates of firearm ownership than the general population, primarily citing personal protection as the reason for gun ownership. Veterans often exhibit risky firearm usage and storage behaviors but tend to favor measures that limit access to firearms by at-risk individuals. Despite this, there remains persistent hesitation among clinicians to screen and counsel veterans on firearm safety.

Conclusions
This systematic review highlights an urgent need to produce higher quality evidence and new data with standard definitions that are critical to inform clinical practice and enhance public health measures to reduce firearm suicide among veterans.
Multisystem Inflammatory Syndrome in Children during the COVID-19 Pandemic: A Case Report on Managing the Hyperinflammation
Authors: Cirks Blake T , Geracht Jennifer C , Jones Olcay Y , May Joseph W , Mikita Cecilia P , Rajnik Michael , Helfrich Alison M 
Published: December 2020

ABSTRACT
The novel human coronavirus of 2019, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has quickly swept throughout the entire world. As the ongoing pandemic has spread, recent studies have described children presenting with a multisystem inflammatory disorder sharing the features of Kawasaki disease (KD) and toxic shock syndrome, now named Multisystem Inflammatory Syndrome in Children (MIS-C). These cases report a similar phenotype of prolonged fever, multisystem involvement, and biomarkers demonstrating marked hyperinflammation that occurs temporally in association with local community spread of SARS-CoV-2. Herein, we describe the presentation, clinical characteristics, and management of an 11-year-old boy with prolonged fever, strikingly elevated inflammatory markers, and profound, early coronary artery aneurysm consistent with a hyperinflammatory, multisystem disease temporally associated with coronavirus disease 2019. We highlight our multidisciplinary team’s management with intravenous immunoglobulin, methylprednisolone, and an interleukin-1 receptor antagonist, anakinra, as a strategy to manage this multisystem, hyperinflammatory disease process.
Influence of Self-managed Rehabilitation on Work Efficiency in Active Duty Military With a Knee Injury
Authors: Talbot Laura A , Brede Emily , Metter E Jeffrey 
Published: December 2020

ABSTRACT

Introduction
Knee injuries associated with intense physical training are one of the most frequent injuries associated with medical encounters for military members. The purpose of this study was to evaluate four approaches to physiotherapy rehabilitation and their effects on work efficiency in active duty military with a knee injury. The four groups included neuromuscular electrical stimulation (NMES), walking with a weighted vest (WALK), combined NMES/Walk, and standard physiotherapy rehabilitation. All groups received standard physiotherapy rehabilitation.
We have previously reported that quadriceps muscle strength improved over 18 weeks in the study for the three interventions relative to standard rehabilitation alone. This report presents results from an examination of work efficiency as evaluated during a step test while measuring oxygen utilization.

Methods
A randomized controlled trial was conducted, with repeated outcome measures of work efficiency assessed at baseline, 3, 6, 12, and 18 weeks. The sample consisted of 67 active duty service members between the ages of 18 and 50 years with a knee injury. Participants were randomized to one of the four approaches to physiotherapy rehabilitation: (1) NMES was applied to the quadriceps muscle four times per week, for 30 minutes (15 minutes to each leg), consisting of 15 quadriceps muscle contractions per leg; (2) graduated strength walking using a weighted vest (WALK) was for 30 minutes, 3 to 4 days a week; (3) combined NMES with strength walking received both the NMES therapy and the weighted vest walking; and (4) standard physiotherapy consisted of progressive exercise with the number and type of sessions not controlled by the study. All four groups received the standard physiotherapy for a knee injury. The primary outcome was work efficiency, as measured by oxygen utilization during a 2-minute self-paced step test over 18 weeks. The primary analysis used repeated measures, linear mixed-effects models with a random effect for subject.

Results
Both the number of steps performed and gross work efficiency improved during the study for all three intervention groups. For gross work efficiency, standard rehabilitation improved 12%, WALK showed a 19% improvement, NMES increased by 24%, and the NMES/Walk group improved by 40%.

Conclusions
All groups showed improved submaximal exercise efficiency based on oxygen utilization, with the intervention groups showing a greater improvement in work efficiency as compared to standard rehabilitation. Knee injuries can be problematic for active duty members because of reduced mobility leading to deconditioning and associated declines in work efficiency. Rehabilitative programs, including those described in this study, may minimize loss of work efficiency and fitness and promote a quicker recovery.