bluuebunny/crossref_metadata_2025_split huggingface dataset:
Quantification of Dual-task Performance in Healthy Young Adults Suitable for Military Use
Authors: Penko Amanda L , Linder Susan M , Miller Koop Mandy , Dey Tanujit , Alberts Jay L 
Published: January 2021

ABSTRACTIntroductionDual-task performance, in which an individual performs two tasks simultaneously, is compromised following mild traumatic brain injury (mTBI). Proficient dual-task performance is essential in a military setting for both military member safety and execution of skilled tasks. To address the unique needs of military members, a portable dual-task assessment was developed incorporating an auditory dual-task task as a novel assessment module utilizing mobile-device technology. The aim of this study was to develop and validate a dual-task mobile device-based application that accurately quantifies cognitive and motor function.Materials and MethodsFifty, healthy, military-age civilians completed three cognitive tasks in single- and dual-task conditions with eyes open and closed: visual Stroop, auditory Stroop at 1.5- and 2.5-second stimulus presentation, and number discrimination. All dual-task conditions required the maintenance of postural stability while simultaneously completing a cognitive task.ResultsThere were no differences between single- and dual-task conditions for cognitive performance on any of the tests, and a ceiling effect was observed for the visual Stroop and auditory Stroop 1.5-second stimulus presentation (P &gt; .05). Significant differences in postural stability were observed between the eyes-open and eyes-closed conditions in all single- and dual-task conditions (P &lt; .01). Significant differences in postural stability were observed between the eyes-open single-task condition and all dual-task conditions (P &lt; .01).ConclusionsBased on the performance of healthy young adults, the number discrimination task may be optimal for detecting subtle changes in dual-task performance. The detected differences found between the eyes-open and eyes-closed conditions provide discriminatory value and insight into the reliance of vision of postural stability performance. While dual-task cognitive performance was not observed in this healthy population, individuals with mTBI may exhibit decreased dual-task performance. The independent evaluation of cognitive and motor function under dual-task conditions has the potential to transform the management and treatment of mTBI.
Brain Injury: What Influences the Beliefs U.S. Service Members Have About Reporting and Seeking Care?
Authors: Jorgensen-Wagers Kendra , Young Vanessa , Collins Dawn , Chavez Bianca , Lenski Dayna , Khokhar Bilal 
Published: January 2021

ABSTRACT

Introduction
Despite the recent Department of Defense emphasis on traumatic brain injury (TBI) education and improvements in treatment, social, and attitudinal beliefs instilled in the military community hinder seeking medical assistance at the time of injury. This survey research presents injury reporting and care seeking behavioral patterns of service members (SMs) stationed in the Landstuhl catchment area in the context of TBI. This descriptive study investigated whether sociocultural factors influence health decision-making among SMs stationed abroad and how these compare to the SMs stationed in Fort Bliss and Fort Hood.

Materials and Methods
A total of 969 of U.S. Army, Air Force, and Navy SMs completed a voluntary and anonymous 2- to 5-minute paper survey during the month of March 2019. As a result of illegibility and incompleteness, 15 survey responses were removed from the total sample.

Results
Data analyses show three main findings about SMs in the Landstuhl catchment area: (a) older population (25-34, ≥48%; 18-24, 26.1%; +35, 25.4%) when compared to Fort Hood and Fort Bliss (≥48%; 18-24); (b) more years in service (7-13 years; 30.2%) versus 6 years or less in both Fort Hood and Fort Bliss (≥69%); (c) 54.8% of participants did not think TBI requires care versus 63.5% in both Fort Bliss and Fort Hood.

Conclusion
Results suggest that TBI beliefs and influences are constant variables hindering health decision-making choices in the military population. Beliefs about thinking that the injury does not require care, fear to jeopardize the career, and knowledge about TBI and treatments vary among the respondents and all these components influence treatment-seeking behaviors. The findings provide a preliminary framework to further investigate the role of culture in reporting and seeking treatment behaviors among SMs.
The Advanced Modular Manikin Open Source Platform for Healthcare Simulation
Authors: Hananel David , Silverglate Dan , Burke Dan , Riggs Benjamin , Norfleet Jack , Sweet Robert M 
Published: January 2021

ABSTRACTIntroductionCurrent thinking in healthcare education stipulates a holistic approach with a focus on patient management, bringing together technical skills, decision-making, and team performance. In parallel, training opportunities with actual patients have diminished, and the number of different interventions to master has increased. Training on simulators has become broadly accepted; however, requirements for such training devices have outpaced the development of new simulators. The Department of Defense (DoD) targeted this gap with a development challenge. This article introduces the Advanced Modular Manikin (AMM) platform and describes the path followed to address the challenge.Materials and MethodsUnder Contract # W81XWH-14-C-0101, our interdisciplinary team of healthcare providers, educators, engineers, and scientists, together with partners in industry and the government collaborated to establish a set of comprehensive requirements and develop an overarching system architecture and specifications to meet healthcare simulation needs. In order to instantiate the architecture and investigate usability of the platform, a demonstration modular manikin was created that incorporated physical and digital peripherals.ResultsThe system architecture and corresponding data models have been completed and published as open source. A developer’s tool kit has been created, including instructional materials and required hardware and software for interested parties to develop AMM-compatible modules. A reference manikin was created based on the platform specifications and successfully supported a usability study that was performed by the American College of Surgeons, Education Division at the Naval Medical Center San Diego.ConclusionsThe formal release of a functional modular, interoperable open-source healthcare simulation platform is complete. Next steps involve a strategy for maintaining the open standards and verification of AMM-compatibility for modules. Increasing awareness of this powerful tool and prioritization of module-development to address the wide range of healthcare education needs could lead to a renaissance in military and civilian healthcare simulation-based training.
An Analysis of the Effectiveness of High-level Disinfection for Surgical Instruments Used by Department of Defense Austere Surgical Teams
Authors: Hune Samantha R , DiGeorge Foushee Ann-Marie , Ervin Meredith C , Anderson Stephen J , Ervin Mark D , Mallory Amber M 
Published: January 2021

ABSTRACT

Introduction
The purpose of this investigation was to evaluate the efficacy of currently employed commercial disinfectants in a simulated austere surgical environment similarly faced by ground surgical teams in forward deployed positions. Severe contamination of traumatic combat wounds along with limitations of operations in austere environments may result in available disinfectants providing inadequate surgical instrument decontamination.

Materials and Methods
The study consisted of nine experimental groups and two control groups evaluating hemostatic forceps found in kits of ground surgical teams. Hemostats were contaminated in a manner replicating the use in austere wartime surgery, cleaned by manual debridement and soaked in a disinfectant. Initially, instruments were debrided in one of three initial liquids (potable water, sterile water, or potable water with Envirocleanse A) and subsequently treated with one of three terminal disinfectants (Cidex OPA, CaviCide, or Neutral Disinfectant Cleaner). Treated hemostats were placed in sterile wire-closure bags for various storage times and tested for viable bacteria measured by colony-forming units.

Results
Our findings indicated that mechanical debridement in water, independent of Envirocleanse A, followed by soaking in any of the three terminal disinfectants achieved a marked reduction in recovered bacteria from hemostats regardless of storage length. Of the three disinfectants tested, Cidex OPA appeared to be the most robust in terms of decontamination, followed by CaviCide and Neutral Disinfectant Cleaner.

Conclusions
This study supports the conclusion that all evaluated disinfectants are capable of rapidly producing instruments with minimal bacterial contaminants when standard sterilization is unavailable. Therefore, when lifesaving surgical intervention must be performed in a deployed environment, austere surgical teams can confidently utilize either product with minimal risk of infection. However, of the disinfectants, Cidex OPA appears to be most effective in reducing bacterial contamination for both rapid and slow turnover of instrument usage, and thus, the disinfectants are recommended for application when sterilization is not available.
Carcinoma Ex-Pleomorphic Adenoma Diagnosis During Global Health Engagement Operations
Authors: Haltiner Caitlin C , Betz Sasha , Smith Jenny , Nelson Brenda , Ambrosio Art A 
Published: January 2021

ABSTRACTIntroductionIn global health engagement settings, performance of oncologic surgery is evaluated by understanding the host nation healthcare capacity to include inpatient care support and the available postoperative adjunctive therapy to include chemotherapy and radiation therapy.Materials and MethodsWe present a case during Pacific Partnership 2018 of a patientwith a malignant facial mass diagnosed postoperatively. A literature review was conducted, searching specifically for cases related to pleomorphic adenoma (PA), carcinoma ex-PA, cases of misdiagnosis, and global health engagement operations.ResultsThe patient presented without constitutional symptoms, clinical lymphadenopathy, or cranial nerve VII weakness with a preoperative host nation diagnosis of a benign salivary neoplasm (PA). Postoperatively, a gross total resection of the mass was diagnosed as high-grade adenocarcinoma—a carcinoma ex-PA of the parotid gland. Oncologic staging was noted to be advanced at T3N0, and the patient was referred back to the host nation surgeons for radiation oncology consultation and clinical surveillance to follow.DiscussionDiagnosis of carcinoma ex-PA—a rare form of salivary gland malignancy—is not always straightforward because of its high degree of cellular heterogeneity, leading to inconsistencies in preoperative sampling results. This case addresses the preoperative diagnostic challenges associated with this type of malignancy, different types of possible treatment modalities aimed at reducing postoperative morbidity, and the preoperative and postoperative challenges that are critical to address during health engagement operations.
Enabling Technology for Remote Prosthetic Alignment Tuning
Authors: Boone David A , Chang Sarah R 
Published: January 2021

ABSTRACT

Introduction
This research has resulted in a system of sensors and software for effectively adjusting prosthetic alignment with digital numeric control. We called this suite of technologies the Prosthesis Smart Alignment Tool (ProSAT) system.

Materials and Methods
The ProSAT system has three components: a prosthesis-embedded sensor, an alignment tool, and an Internet-connected alignment expert system application that utilizes machine learning to analyze prosthetic alignment. All components communicate via Bluetooth. Together, they provide for numerically controlled prosthesis alignment adjustment. The ProSAT components help diagnose and guide the correction of very subtle, difficult-to-see imbalances in dynamic gait. The sensor has been cross-validated against kinetic measurement in a gait laboratory, and bench testing was performed to validate the performance of the tool while adjusting a prosthetic socket based on machine learning analyses from the software application.

Results
The three-dimensional alignment of the prosthetic socket was measured pre- and postadjustment from two fiducial points marked on the anterior surface of the prosthetic socket. A coordinate measuring machine was used to derive an alignment angular offset from vertical for both conditions: pre- and postalignment conditions. Of interest is the difference in the angles between conditions. The ProSAT tool is only controlling the relative change made to the alignment, not an absolute position or orientation.
Target alignments were calculated by the machine learning algorithm in the ProSAT software, based on input of kinetic data samples representing the precondition and where a real prosthetic misalignment condition was known a priori. Detected misalignments were converted by the software to a corrective adjustment in the prosthesis alignment being tested. We demonstrated that a user could successfully and quickly achieve target postalignment change within an average of 0.1°.

Conclusions
The accuracy of a prototype ProSAT system has been validated for controlled alignment changes by a prosthetist. Refinement of the ergonomic form and technical function of the hardware and clinical usability of the mobile software application are currently being completed with benchtop experiments in advance of further human subject testing of alignment efficiency, accuracy, and user experience.
A “Smart” Biosensor-Enabled Intravascular Catheter and Platform for Dynamic Delivery of Propofol to “Close the Loop” for Total Intravenous Anesthesia
Authors: Chaum Edward , Lindner Ernő 
Published: January 2021

ABSTRACT

Background
Target-controlled infusion anesthesia is used worldwide to provide user-defined, stable, blood concentrations of propofol for sedation and anesthesia. The drug infusion is controlled by a microprocessor that uses population-based pharmacokinetic data and patient biometrics to estimate the required infusion rate to replace losses from the blood compartment due to drug distribution and metabolism. The objective of the research was to develop and validate a method to detect and quantify propofol levels in the blood, to improve the safety of propofol use, and to demonstrate a pathway for regulatory approval for its use in the USA.

Methods
We conceptualized and prototyped a novel “smart” biosensor-enabled intravenous catheter capable of quantifying propofol at physiologic levels in the blood, in real time. The clinical embodiment of the platform is comprised of a “smart” biosensor-enabled catheter prototype, a signal generation/detection readout display, and a driving electronics software. The biosensor was validated in vitro using a variety of electrochemical methods in both static and flow systems with biofluids, including blood.

Results
We present data demonstrating the experimental detection and quantification of propofol at sub-micromolar concentrations using this biosensor and method. Detection of the drug is rapid and stable with negligible biofouling due to the sensor coating. It shows a linear correlation with mass spectroscopy methods. An intuitive graphical user interface was developed to: (1) detect and quantify the propofol sensor signal, (2) determine the difference between targeted and actual propofol concentration, (3) communicate the variance in real time, and (4) use the output of the controller to drive drug delivery from an in-line syringe pump. The automated delivery and maintenance of propofol levels was demonstrated in a modeled benchtop “patient” applying the known pharmacokinetics of the drug using published algorithms.

Conclusions
We present a proof-of-concept and in vitro validation of accurate electrochemical quantification of propofol directly from the blood and the design and prototyping of a “smart,” indwelling, biosensor-enabled catheter and demonstrate feedback hardware and software architecture permitting accurate measurement of propofol in blood in real time. The controller platform is shown to permit autonomous, “closed-loop” delivery of the drug and maintenance of user-defined propofol levels in a dynamic flow model.
An Analysis of Prolonged, Continuous Ketamine Infusions
Authors: Schauer Steven G , Naylor Jason F , Davis William T , Borgman Matthew A , April Michael D 
Published: January 2021

AbstractIntroductionOpioids carry high risk of dependence, and patients can rapidly build tolerance after repetitive dosing. Low-dose ketamine is an analgesic agent alternative that provides more hemodynamic stability. We sought to describe the effects of prolonged ketamine use in non-burn patients.Materials and MethodsWe queried the electronic health system at the Brooke Army Medical Center for patient encounters with ketamine infusions lasting &gt;72 hours. We abstracted data describing demographics, vital signs, ketamine infusion dose and duration, and discharge diagnoses potentially relevant to ketamine side effects.ResultsWe identified 194 subjects who met the study inclusion criteria. The median age was 39 years, most were male (67.0%), and most were primarily admitted for a non-trauma reason (59.2%). The mean ketamine drip strength was 43.9 mg/h (95% CI, 36.7-51.1; range 0.1-341.6) and the mean drip length was 130.8 hours (95% CI, 120.3-141.2; range 71-493). Most subjects underwent mechanical ventilation (56.1%) at some point during the infusion and most survived to hospital discharge (83.5%). On a per-day basis, the average heart rate was 93 beats per minute, systolic blood pressure was 128 mmHg, diastolic blood pressure was 71 mmHg, oxygen saturation was 96%, and respiratory rate was 22 respirations per minute.ConclusionsWe demonstrate that continuous ketamine infusions provide a useful adjunct for analgesia and/or sedation. Further development of this adjunct modality may serve as an alternative agent to opioids.
Technological innovation in a police organization: Lessons learned from the National Police of the Netherlands
Authors: Ernst Sander , ter Veen Hanneke , Kop Nicolien 
Published: January 2021

AbstractPolice organizations internationally explore and experiment with new technologies to improve their performance and in response to new forms of crime. The police in the Netherlands experiment with various forms of innovative technology. Previous research has shown that social, organizational, and technological factors are important for effective use and deployment of technology by the police. However, the precise factors and mechanisms underlying the promotion or inhibition of technological innovations within the police are not clear. This study aims to provide empirical knowledge about these mechanisms by providing insight into the processes through which technological innovation develops within the police in the Netherlands. From January 2017 to February 2018, 13 technological innovation projects were subjected to a longitudinal process study. The results show that innovation processes within the police organization are often inhibited by organizational factors, whereas social factors can stimulate and promote these processes.
A 10-item Fugl-Meyer Motor Scale Based on Machine Learning
Authors: Lin Gong-Hong , Huang Chien-Yu , Lee Shih-Chieh , Chen Kuan-Lin , Lien Jenn-Jier James , Chen Mei-Hsiang , Huang Yu-Hui , Hsieh Ching-Lin 
Published: January 2021

AbstractObjectiveThe Fugl-Meyer motor scale (FM) is a well-validated measure for assessing upper extremity and lower extremity motor functions in people with stroke. The FM contains numerous items (50), which reduces its clinical usability. The purpose of this study was to develop a short form of the FM for people with stroke using a machine-learning methodology (FM-ML) and compare the efficiency (ie, number of items) and psychometric properties of the FM-ML with those of other FM versions, including the original FM, the 37-item FM, and the 12-item FM.MethodsThis observational study with follow-up used secondary data analysis. For developing the FM-ML, the random lasso method of ML was used to select the 10 most informative items (in terms of index of importance). Next, the scores of the FM-ML were calculated using an artificial neural network. Finally, the concurrent validity, predictive validity, responsiveness, and test–retest reliability of all FM versions were examined.ResultsThe FM-ML used fewer items (80% fewer than the FM, 73% fewer than the 37-item FM, and 17% fewer than the 12-item FM) to achieve psychometric properties comparable with those of the other FM versions (concurrent validity: Pearson r = 0.95–0.99 vs 0.91–0.97; responsiveness: Pearson r = 0.78–0.91 vs 0.33–0.72; and test–retest reliability: intraclass correlation coefficient = 0.88–0.92 vs 0.93–0.98).ConclusionThe findings preliminarily support the efficiency and psychometric properties of the 10-item FM-ML.ImpactThe FM-ML has potential to substantially improve the efficiency of motor function assessments in patients with stroke.
Predictive Factors for Patients’ Failure to Show for Initial Outpatient Physical Therapist Evaluation
Authors: Briggs Matthew S , Ulses Christine , VanEtten Lucas , Mansfield Cody , Ganim Anthony , Hand Brittany N , Quatman-Yates Catherine C 
Published: January 2021

Abstract

Objective
The objective of this study was to examine primary factors that may predict patients’ failure to show at initial physical therapist evaluation in an orthopedic and sports outpatient setting.

Methods
A retrospective analysis of patients’ demographic data for physical therapist evaluations between January 2013 and April 2015 was performed. A binary logistic regression model was used to evaluate the odds of a no-show at evaluation. Demographic variables of age, employment status, days waited for the appointment, payer source, and distance traveled to the clinic were analyzed. Independent variables were considered significant if the 95% CIs of the odds ratios (ORs) did not include 1.0.

Results
A total of 6971 patients were included in the final analysis, with 10% (n = 698) of the scheduled patients having a no-show event for their initial evaluation. The following factors increased the odds of patients having a no-show event: days to appointment (OR = 1.058; 95% CI = 1.042–1.074), unemployment status (OR = 1.96; 95% CI = 1.41–2.73), unknown employment status (OR = 3.22; 95% CI = 1.12–8.69), Medicaid insurance (OR = 4.87; 95% CI = 3.43–6.93), Medicare insurance (OR = 2.22; 95% CI = 1.10–4.49), unknown payer source (OR = 262.84; 95% CI = 188.72–366.08), and distance traveled 8 or more kilometers (OR = 1.31; 95% CI = 1.01–1.70). Female sex (OR = 0.73; 95% CI = 0.57–0.95) and age 40 years or older (OR = 0.44; 95% CI = 0.33–0.60) decreased the odds of a no-show event.

Conclusions
Results from this study indicate there may be some demographic factors that are predictive of patients failing to attend their first physical therapist visit.

Impact
Understanding the predictive factors and identifying potential opportunities for improvements in scheduling processes might help decrease the number of patients failing to show for their initial physical therapy appointment, with the ultimate goal of positively influencing patient outcomes.