bluuebunny/crossref_metadata_2025_split huggingface dataset:
Tele-TB: Using TeleMedicine to Increase Access to Directly Observed Therapy for Latent Tuberculosis Infection
Authors: Donahue Megan L , Eberly Matthew D , Rajnik Michael 
Published: January 2021

ABSTRACT

Introduction
Treatment of latent tuberculosis infection (LTBI) decreases risk of progression to active tuberculosis. Traditional treatment regimens required either daily isoniazid for 9 months, with historically poor compliance, or 12-week directly observed therapy (DOT) with isoniazid and rifapentine, with improved compliance but additional challenges of coordinating weekly clinic visits, further complicated if patients must travel a great distance for care.

Materials and Methods
Our referral area is complicated by congested traffic often resulting in one-way commutes, which can exceed 2 hours. These travel times would be prohibitive for conducting weekly in-clinic DOT. In an effort to improve access to DOT, we implemented TeleMedicine LTBI DOT (vDOT) within a military pediatric infectious diseases clinic. Patients aged 24 months or older diagnosed with LTBI were referred for possible enrollment into our vDOT clinic. All patients without contraindications for receiving isoniazid and/or rifapentine were offered LTBI treatment via weekly vDOT or daily treatment with isoniazid or rifampin. The first visit for vDOT patients was performed in person to discuss treatment options, demonstrate use of TeleMedicine software, and ensure the patient was able to take the medications. Baseline information about patients and travel time to our facility was determined.

Results
To date, 16 patients have completed LTBI therapy using vDOT. Average one-way travel time to our facility for patients was 51 minutes. Actual time spent in most vDOT encounters was less than 10 minutes. Appointments were arranged to take place outside usual school and work hours so patients could complete vDOT with minimal interruptions to daily life, resulting in 100% treatment compliance and completion.

Discussion
Conducting LTBI DOT using TeleMedicine is a viable and time-saving measure that still allows for high levels of patient compliance and treatment completion while minimizing interruptions to academic and work schedules.
Longitudinal Relationship of Combat Exposure With Mental Health Diagnoses in the Military Health System
Authors: Campbell Marjorie S , O’Gallagher Kevin , Smolenski Derek J , Stewart Lindsay , Otto Jean , Belsher Bradley E , Evatt Daniel P 
Published: January 2021

ABSTRACT

Introduction
Combat deployment is associated with mental and physical health disorders and functional impairment. Mental health (MH) diagnoses such as adjustment and anxiety disorders have received little research attention but may reflect important postdeployment sequelae. The purpose of this study was to investigate the association of combat exposure with the acquisition of a wide range of mental health diagnoses over 2 years.

Materials and Methods
This retrospective longitudinal study utilized multiple administrative Military Health System datasets compiled for all individuals who entered active duty in the U.S. Army from FY2005 to FY2011. A total eligible cohort of 289,922 Service members was stratified into three mutually exclusive groups according to their deployment status after 2 years in service: Deployed, Combat-Exposed; Deployed, Not-Combat-Exposed; and Not Deployed. Outcomes of interest were new mental health diagnoses grouped into six categories—posttraumatic stress disorder, anxiety, adjustment, mood, substance use disorders, and any MH diagnosis. Survival analyses over 2 years were conducted and adjusted hazard ratios were calculated.

Results
Combat exposure in the first 2 years of military service was associated with significantly higher rates of a wide range of mental health diagnoses over a two-year follow-up period, compared with deployment with no combat exposure and no deployment. Adjusted cumulative failure proportions demonstrated that approximately a third of the Combat-Exposed group, a quarter of the Not-Combat-Exposed, and a fifth of the Not Deployed groups received a MH diagnosis over 2 years. For all groups, cumulative failure proportions and incidence rates were highest for adjustment disorder and lowest for posttraumatic stress disorder diagnoses.

Conclusions
Researchers and providers should be alerted to the impact of combat exposure and the wide range of MH conditions and diagnoses that may represent important postdeployment sequelae.
Modeling Zika Vaccination Combined With Vector Interventions in DoD Populations
Authors: Burgess Colleen , Nelis Lis , Huang Cassie 
Published: January 2021

ABSTRACT

Introduction
Zika virus (ZIKV) is a mild febrile illness generally transmitted via the bite of infected Aedes species mosquitoes, including Aedes aegypti, with the potential to cause neurological complications. Nearly 200 U.S. military installations are located within areas where Aedes mosquitos are found, putting thousands of personnel at risk for infection with ZIKV. This analysis aims to quantify the benefits of interventions, including vaccination, to decrease the risk of ZIKV on U.S. military installations.

Methods
The authors developed a dynamic transmission model to test the “effectiveness” of vaccination, personal protective measures (PPM), and mosquito control at reducing morbidity within U.S. military populations. ZIKV transmission was modeled as a compartmental susceptible-exposed-infected-recovered model tracking interactions between humans and mosquitos and incorporating seasonality of mosquito populations and the potential for herd immunity. The model included two-dose vaccination as well as symptomatic and asymptomatic infection. The model was calibrated against 2016 public health data in Puerto Rico; sensitivity analyses were performed on model parameters and interventions.

Results
The greatest reduction in total modeled ZIKV cases resulted from vaccination combined with mosquito control and PPM. All three interventions at their highest estimated level of efficiency reduced ZIKV cases by 99.9% over the baseline case of low-level adherence to PPM. The addition of vaccination had limited additional benefit over effective vector control and PPM since the significant lag to vaccine-induced protection limited effectiveness of vaccination.

Conclusions
Given the current vaccine, the model predicted that up to 92.8% of Zika cases occurring in deployment settings over a 10-year period could be prevented by adding vaccination to current low-level PPM. Combining vaccination with other interventions can reduce cases further. A location-specific cost-benefit analysis would be a valuable contribution to outbreak control policy as it could evaluate the economic impact of the interventions versus the reduced level of illness and downtime in this setting.
Retention of Coagulation Factors and Storage of Freeze-Dried Plasma
Authors: Flaumenhaft Elissa J , Khat Terry , Marschner Susanne 
Published: January 2021

ABSTRACT

Introduction
Terumo BCT is developing a system to produce a freeze-dried plasma product, Terumo’s freeze-dried plasma (TFDP), that is stored in a rugged, light-weight plastic package suitable for field use, which retains a stable level of specific coagulation factors and proteins within clinical range, when stored for up to 2 years at room temperature and 4°C.

Materials and Methods
Plasma frozen within 24 hours of phlebotomy (PF24) were thawed, sampled, and individually lyophilized to produce a corresponding TFDP unit. Fresh frozen plasma (FFP) units were thawed, sampled, pooled in groups of 10 units (also sampled) and lyophilized to produce 2 lots of TFDP. Each TFDP unit was reconstituted with water for injection (WFI) and tested for pH, prothrombin time, activated partial thromboplastin time, factors V and VIII, fibrinogen, protein C, and protein S. Results were compared with PF24/FFP. Additional FFP units were thawed, sampled, pooled, divided to generate 2 TFDP units for each time point (1, 2, 3, 6, 12, 18, and 24 months, one each stored at 4°C and 25°C) and lyophilized. Postlyophilization, TFDP units were stored at 4°C or 25°C, reconstituted with WFI, and tested for the factors listed above. Residual moisture content of the lyophilized plasma was also tested.

Results
Coagulation factor activity of TFDP was ±20% of PF24/FFP. Pooling standardized variation in TFDP coagulation factor activities, which were within clinical ranges postlyophilization. The pH of TFDP and PF24/FFP were within required range. Residual moisture content of TFDP was &lt;2%.

Conclusions
The TFDP process had no negative impact on coagulation factor activity. Input plasma and anticoagulant type did not affect TFDP quality. Pooling FFP normalized factor variability in TFDP and did not negatively impact product quality. The TFDP is stable for up to 24 months at room and refrigerated temperatures. Terumo’s freeze-dried plasma is comparable to PF24/FFP. It does not require complex logistics or time-consuming thawing. Terumo’s freeze-dried plasma may be suitable for rapid treatment of coagulopathies with logistical advantages over PF24/FFP.
Development and Validation of a Mobile Application to Detect Visual Dysfunction Following Mild Traumatic Brain Injury
Authors: Linder Susan M , Koop Mandy Miller , Tucker Diane , Guzi Karen , Gray Daniel C , Alberts Jay L 
Published: January 2021

ABSTRACTIntroductionFollowing mild traumatic brain injury, visual dysfunction is a common occurrence, yet the condition often goes undiagnosed. A mobile application was developed to measure aspects of visual acuity and oculomotor function. The aim of this project was to validate the newly developed suite of outcomes conducive for use in the field to detect visual dysfunction.Materials and MethodsA custom mobile application was developed on an Apple iPad using iOS operating system software version 11.0 in Objective C to measure near point of convergence (NPC), distance visual acuity, reading fluency, and self-rated convergence insufficiency (CI). To determine construct validity, 50 healthy young adults were administered NPC and distance visual acuity assessments using the iPad and standard clinical approaches. A ruler measurement was obtained simultaneous to the iPad NPC measurement to determine measurement accuracy. All testing was administered by a licensed optometrist and the order of testing (iPad versus clinical) was randomized.ResultsThe correlation coefficient between the iPad and clinical measurements of NPC was 0.893, while iPad and ruler measurement was 0.947. Modest accordance was found between iPad and wall chart measures assessing distance visual acuity. A ceiling effect was evident with use of a wall chart to determine distance visual acuity. Healthy young adults scored a mean (SD) of 13.0 (7.4) on the Convergence Insufficiency Symptom Survey. Reading fluency was highly variable with a mean (SD) of 291 (119) words per minute.ConclusionsiPad measures of NPC were highly correlated with clinical measures, while visual acuity measured with the iPad showed modest correlation. Nonetheless, the suite of visual assessments provide value as screening tools, and when used in combination with reading fluency assessment and self-reported CI may be effective in identifying visual dysfunction following mild traumatic brain injury.
PV[O]H: Noninvasive Enabling Technology, New Physiological Monitoring, and Big Data
Authors: Rice David , Bebernes Jeff , Cormier Jonathan , Fayos John , Fillioe Seth , Peterson Charles M , Houk Michael , Ammenheuser Howard , Chaiken Joseph 
Published: January 2021

ABSTRACT

Introduction
Measures of normal and abnormal physiology are interrelated and vary continuously. Our ability to detect and predict changes in physiology in real time has been limited in part by the requirement for blood sampling and the lack of a continuous data stream of various “signals”, i.e., measurements of vital signs. It is important to determine which signals are most revealing for detection and treatment of, e.g., internal bleeding, managing fluid balance for mission/combat readiness, and hydration. Although our current algorithm for PV[O]H reflects changes in hematocrit and blood and plasma volumes, additional algorithms utilizing the whole raw PV[O]H data stream, along with other variables, can be constructed. We present a working prototype demonstrating that acceptable size, power, and complexity footprints for military needs can be achieved. Results of previous studies involving humans have demonstrated that PV[O]H can provide simultaneous, noninvasive, in vivo continuous monitoring of hematocrit, vascular volume, hemoglobin oxygen saturation, pulse rate, and breathing rate using a single light source with a reporting frequency of every 3 seconds.

Materials and Methods
We have engineered an instrument implementing the PV[O]H algorithm in which (1) single channel photodetectors replace multichannel detection; (2) optical filters replace gratings; (3) battery power is used; and (4) sufficient computation with input/output capability moderated by application specific graphical user interfaces, and compatible with all cloud, wireless environment, and local protocols is implemented.

Results
We have engineered a complete version of a two-probe PV[O]H system meeting military needs and have fabricated a first version. Testing of subsystems, calibration, and optical characterization of the optical probes are underway.

Conclusions
Simultaneous noninvasive continuous monitoring of peripheral vessels using a previous PV[O]H system demonstrates large, physiology revealing data sets. The technologies enable the methodical search for relevant physiological signals allowing the use of discriminant analysis, Bayesian approaches, and artificial intelligence to create predictive algorithms enabling timely interventions in medical care and troop training.
Comparative Finite Element Modeling Study of Anterior Cervical Arthrodesis Versus Cervical Arthroplasty With Bryan Disc or Prodisc C
Authors: Choi Hoon , Purushothaman Yuvaraj , Baisden Jamie L , Rajasekaran Deepak , Jebaseelan Davidson , Yoganandan Narayan 
Published: January 2021

ABSTRACT

Introduction
Cervical disc arthroplasty (CDA), a motion-preserving alternative to anterior cervical discectomy and fusion (ACDF), is used in military patients for the treatment of disorders such as spondylosis. Since 2007, the FDA has approved eight artificial discs. The objective of this study is to compare the biomechanics after ACDF and CDA with two FDA-approved devices of differing designs under head and head supported mass loadings.

Materials and Methods
A previously validated osteoligamentous C2-T1 finite element model was used to simulate ACDF and two types of CDA (Bryan and Prodisc C) at the C5-C6 level. The hybrid loading protocol associated with in vivo head and head supported mass was used to apply flexion and extension loading. First, intact spine was subjected to 2 Nm of flexion extension and the range of motion (ROM) was measured. Next, for each surgical option, flexion-extension moments duplicating the same ROM as the intact spine were determined. Under these surgery-specific moments, ROM and facet force were obtained at the index level, and ROM, facet force, and intradiscal pressure at the rostral and caudal adjacent levels.

Results
ACDF led to increased motion, force and pressures at the adjacent levels. Prodisc C led to increased motion and facet force at the index level, and decreased motion, facet force, and intradiscal pressure at both adjacent levels. Bryan produced less dramatic biomechanical alterations compared with ACDF and Prodisc C. Numerical results are given in the article.

Conclusions
Recognizing that ROM is a clinical measure of spine stability/performance, CDA demonstrates a more physiological biomechanical response than ACDF, although the exact pattern depends on the implant design. Anterior and posterior column load-sharing patterns were different between the two implants and may affect implant selection based on the anatomical and pathological state at the index and adjacent levels.
Perceptions of Gender and Race Equality in Leadership and Advancement Among Military Family Physicians
Authors: Massaquoi Mariama A , Reese Tyler R , Barrett John , Nguyen Dana 
Published: January 2021

ABSTRACTIntroductionThere is increasing interest in assessing gender and race-based disparities in academic medicine and healthcare leadership in civilian medicine and the U.S. Military Health System. Approximately 15% of U.S. active duty service members are women, and racial minorities are 30% of the total active duty force. This study evaluates the following factors among uniformed services family physicians: gender and race representation in attaining early career leadership positions during training and 2 years postresidency; perceptions regarding leadership opportunities and career advancement.MethodsRegistered attendees (n = 300) of the 2016 Uniformed Services Academy of Family Physicians Annual Meeting were given a voluntary and anonymous online questionnaire. The main outcomes measured were early leadership assignments and perceptions about command/leadership support, gender roles in leadership assignment, confidence to achieve leadership goals, and being passed over for leadership positions.ResultsSixty-eight percent of registered attendees completed the study questionnaire. Statistically significant results, adjusting for service, grade, race, and gender, were that non-Caucasian family physicians were less likely to be chief residents (odds ratio 0.23, 95% CI 0.01-1.00) and less likely to have leadership positions within 2 years postresidency (odds ratio 0.30, 95% CI 0.10-0.91). Female family physicians were more likely to agree that gender has a role in assigning leadership positions (odds ratio 2.33, 95% CI 1.01-5.39). There were no differences in perceptions of command support for leadership; confidence in achieving desired leadership level; or in being passed over for leadership positions.ConclusionsThis study provides important information about perceived gender and race equality among uniformed services family physicians. Key findings included that non-Caucasian military family physicians were less likely to attain junior leadership positions or be assigned to academic settings; and female respondents were more likely to agree that gender has a role in assignment of leadership positions. Evaluating composite personnel records of services’ family physicians would provide invaluable information to complement this study.
An Observation of Application of Structural Brain Injury Devices for Traumatic Brain Injury Evaluation in Austere Military Prehospital Settings
Authors: Koreerat Nicholas R , Giese Russell 
Published: January 2021

ABSTRACT

Introduction
Military units lack the ability to quickly, objectively, and accurately assess individuals that have suffered a closed head injury for structural brain injury and functional brain impairments in forward settings, where neurological assessment equipment and expertise may be lacking. With acute traumatic brain injury patients, detached medical providers are often faced with a decision to wait and observe or medically evacuate, both of which have cascading consequences. Structural brain injury assessment devices, when employed in forward environments, have the potential to reduce the risk of undiagnosed and/or mismanaged traumatic brain injuries given their high negative predictive value and suggested increased specificity compared to common subjective clinical decision rules. These handheld devices are portable and have an ease of use, from combat medic to physician, allowing for use in austere environments, safely keeping soldiers with their teams when able and suggesting further evaluation via computed tomography (CT) scan when warranted.

Methods
Data collected on 13 encounters at 5 locations were retrospectively analyzed using descriptive statistics.

Results
A total number of 13 examinations were performed using the BrainScope One device during the 9-month deployment. The Structural Injury Classification was negative for 11 of the patients. Two of the 11 patients underwent head CT scans, which confirmed the absence of intracranial hemorrhage. Of the two positive Structural Injury Classification exams, one was CT negative and no CT was performed for the other based on clinical judgment.

Conclusion
The data from this study suggest that structural brain injury devices may provide value by ruling out serious brain injury pathology while limiting excessive medical evacuations from austere settings, where neurological assessment equipment and expertise may be lacking, reducing unnecessary head CT scans.
Results of the Behavioral Health Readiness Evaluation and Decision-Making Instrument Study
Authors: Curley Justin M , Nugent Katie L , Clarke-Walper Kristina M , Penix Elizabeth A , Macdonald James B , McDonald Jennifer L , Wilk Joshua E 
Published: January 2021

ABSTRACT

Introduction
Recent reports have demonstrated behavioral health (BH) system and individual provider challenges to BH readiness success. These pose a risk to winning on the battlefield and present a significant safety issue for the Army. One of the most promising areas for achieving better BH readiness results lies in improving readiness decision-making support for BH providers. The Walter Reed Army Institute of Research (WRAIR) has taken the lead in addressing this challenge by developing and empirically testing such tools. The results of the Behavioral Health Readiness Evaluation and Decision-Making Instrument (B-REDI) field study are herein described.

Methods
The B-REDI study received WRAIR Institutional Review Board approval, and BH providers across five U.S. Army Forces Command installations completed surveys from September 2018 to March 2019. The B-REDI tools/training were disseminated to 307 providers through random clinic assignments. Of these, 250 (81%) providers consented to participate and 149 (60%) completed both initial and 3-month follow-up surveys. Survey items included a wide range of satisfaction, utilization, and proficiency-level outcome measures. Analyses included examinations of descriptive statistics, McNemar’s tests pre-/post-B-REDI exposure, Z-tests with subgroup populations, and chi-square tests with demographic comparisons.

Results
The B-REDI resulted in broad, statistically significant improvements across the measured range of provider proficiency-level outcomes. Net gains in each domain ranged from 16.5% to 22.9% for knowledge/awareness (P = .000), from 11.1% to 15.8% for personal confidence (P = .001-.000), and from 6.2% to 15.1% for decision-making/documentation (P = .035-.002) 3 months following B-REDI initiation, and only one (knowledge) failed to maintain a statistically significant improvement in all of its subcategories. The B-REDI also received high favorability ratings (79%-97% positive) across a wide array of end-user satisfaction measures.

Conclusions
The B-REDI directly addresses several critical Army BH readiness challenges by providing tangible decision-making support solutions for BH providers. Providers reported high degrees of end-user B-REDI satisfaction and significant improvements in all measured provider proficiency-level domains. By effectively addressing the readiness decision-making challenges Army BH providers encounter, B-REDI provides the Army BH health care system with a successful blueprint to set the conditions necessary for providers to make more accurate and timely readiness determinations. This may ultimately reduce safety and mission failure risks enterprise-wide, and policymakers should consider formalizing and integrating the B-REDI model into current Army BH practice.