bluuebunny/crossref_metadata_2025_split huggingface dataset:
Contingency: the likely spectrum of injuries based upon a review of three recent undeveloped theatres of operations - CORPORATE, TELIC 1 and HERRICK 4
Authors: Lewin I J S 
Published: February 2021

AbstractContingency operations are by their nature unpredictable and high-risk, with undeveloped logistical support, and medical provision is no exception. Can the contingency experiences of the last three decades help to predict the type of casualties that may be seen in future contingency operations? By reviewing published casualty statistics available from Operations CORPORATE, TELIC 1 and HERRICK 4 it can be demonstrated, unsurprisingly, that gunshot wounds and blast injuries dominate battle injuries, but that disease non-battle injuries also constitute a significant draw on medical provision, particularly gastrointestinal illness in hot environments. Planning for medical support for future contingency operations should anticipate this. Disease non-battle injuries have the potential to render a large proportion of a force combat-ineffective, requiring preventative measures to avoid overwhelming the available medical facilities. When operations occur in populated areas civilian casualties are likely to pose difficulties to medical support, due to issues with onward evacuation and a wider case mix, such as paediatrics.
Sports & Exercise Medicine
Authors: Heil K M , Keenan A C M 
Published: February 2021

AbstractIn recent years, small scale counter-insurgency and expeditionary operations have frequently taken place in mountainous, high-altitude areas. Preparation of soldiers for these environments has typically focussed on extended stays at altitude to ensure physiological acclimatisation. However, with the likelihood that future UK deployments may be unpredictable and thus with little time for preparation, is there a means by which the same acclimatisation may be achieved? The field of athletics has been researching such adaptations since the rise of the elite North African long-distance runners in the 1960s. These athletes all lived high above sea level and had become accustomed to performing in the relatively hypoxic environment found at high altitudes. The research has focussed on eliciting physiological acclimatisation in as short a time as possible, while maintaining the ability to train at the correct intensity. In the following review of altitude training we highlight areas for future investigation and assess whether protocols developed for athletes can be applied to military personnel.
Special Feature: Sports & Exercise Medicine
Authors: Harvey-Kelly K F , Kanakaris N K , Obakponovwe O , West R , Roberts C S , Giannoudis P V 
Published: February 2021

AbstractBackgroundPelvic fractures (PFX) reflect high-energy trauma with high mortality and morbidity.AimWe attempted to determine: whether there is a decrease in levels of sporting and physical activity in patients with operatively-treated PFX; risk factors for decreased sporting activity; any correlation between sporting activity and quality of life in this group.MethodsRetrospective demographics on mechanism of injury, fracture type, associated injury and injury severity score, as well as prospective documentation of the level and frequency of sporting activity, were collected from adult patients treated operatively for a PFX between 2007 and 2010, using a specifically designed questionnaire. Quality of life before and after injury was also recorded using the EuroQol-5D health-outcome tool.Results80 patients without pre-existing musculoskeletal disability were enrolled. The mean age was 44.9 years (18-65). The mean follow-up was 30.5 months (12-39). A decrease in level and frequency of sporting activity was observed. It was associated with lower-extremity associated injuries, but not with injury severity score, PFX severity, PFX type, age, or timing of follow-up. Sporting activity before injury predicted higher levels of sporting participation after injury. Decreased sporting activity after injury was associated with decreased EuroQol-5D score.ConclusionsPatients should be counselled on the likelihood of a reduction in sporting activities after surgically treated PFX. A larger multi-centre study is needed to further expand on the evidence of the true impact of PFX and its associated injuries on sporting activity.
Maritime in transit care
Authors: Bott G , Barnard J , Prior K 
Published: February 2021

AbstractOperation GRITROCK saw the first operational deployment of the Maritime In Transit Care team from the Role 2 (Enhanced) (R2(E)) Medical Treatment Facility, which is able to provide Damage Control Surgery and the limited holding of patients, situated on board RFA ARGUS. Whilst the Medical Emergency Response Team demonstrated the capability of advanced military Pre-Hospital Emergency Care (PHEC) on Op HERRICK, the need to provide a similar high level of care on contingency operations was recognised. Op GRITROCK allowed for the continued exploration of a maritime capability from an established R2(E) platform whilst providing medical evacuation capability for a significant population at risk distributed over a large Joint Operation Area. Although the patient load during the operation was low, key lessons were learnt and opportunities identified to further develop the newly recognised sub-speciality of PHEC, both medically and logistically, and these will be discussed in this article.
The management of acute seizures in Naval Service personnel
Authors: McLellan M , Freshwater DA 
Published: February 2021

AbstractSeizures are a relatively common Emergency Department (ED) presentation among young adult populations, considered for the purpose of this report as being aged 15-59. Due to the varied aetiologies involved, understanding of the potential causes and their presentation is key to managing these patients. Although seizure incidence within the United Kingdom (UK) Armed Forces population is generally low, it is not negligible. Therefore, awareness of the initial management is required by all those involved in patient care from the Medical Assistant (MA) at the Role 1 facility, through to the senior doctors at Role 3 establishments.All management should be in line with the Clinical Guidelines for Operations (CGOs) and Advanced Life Support (ALS) principles, with resuscitation, seizure control and patient stabilisation taking precedence initially. Ultimately, the use of laboratory testing and imaging at a Role 3 setting will be required to accurately confirm a diagnosis. Information obtained during these assessments may serve to assist the Naval Service Medical Board of Survey (NSMBOS) in determining suitability for continued Service retention and employment.
Recent changes in hypoxia training at the Royal Air Force Centre of Aviation Medicine
Authors: Wrigley A 
Published: February 2021

AbstractHypoxia training at the Royal Air Force Centre of Aviation Medicine (RAF CAM) has traditionally involved the use of a hypobaric chamber to induce hypoxia. While giving the student experience of both hypoxia and decompression, hypobaric chamber training is not without risks such as decompression sickness and barotrauma. This article describes the new system for hypoxia training known as Scenario-Based Hypoxia Training (SBHT), which involves the subject sitting in an aircraft simulator and wearing a mask linked by hose to a Reduced Oxygen Breathing Device (ROBD). The occupational requirements to be declared fit for this new training method are also discussed.
The interpretation and management of abnormal liver function tests
Authors: Simpson MA , Freshwater DA 
Published: February 2021

AbstractLiver function tests (LFTs) are frequently requested as part of routine health assessments on serving members of the Royal Navy (RN). In common with many investigations there are a number of abnormal results in healthy individuals (0.5 - 9% depending on test and study population). There are established patterns of LFT derangement such as cholestatic derangement, hepatocellular derangement, and failure of synthetic function. There can be indicators to the cause of the derangement by assessing the ratios of elevated assays in relation to one another. This article aims to address the definition, potential causes and further investigation of common patterns of LFT derangement found in primary care in the RN.
Hepatitis B infection following deployment to Angola
Authors: Croft A M , Ollerton J E , Fear N T 
Published: February 2021

AbstractWe describe the clinical illness and longterm follow up of two British personnel who acquired hepatitis B infection during a 3-month UN mission to Angola. Medical officers need to be familiar with this viral illness, which may present in military personnel after any exercise in or deployment to the tropics or subtropics.
The influence of military threats on the design and use of the Royal Naval Hospital Haslar
Authors: Buxton P J 
Published: February 2021

AbstractThe twin demands of the medical and security requirements influenced the original design of RNH Haslar. Over time the structure was altered to accommodate changes in the military threat and these changes can be identified from original plans and the extant structures. The use of spatial analysis, through the use of justified access graphs, can provide insights into the way the building was used and how it influenced the relationships between the staff and the patients.
The management of open globe eye injuries: a discussion of the classification, diagnosis and management of open globe eye injuries
Authors: Ritson J E , Welch J 
Published: February 2021

AbstractEye injuries occurred in 10% of UK military major trauma cases in Iraq and Afghanistan between 2004 and 2008, with 33% of these eye injuries open globe in nature(1). This article will consider the diagnosis, classification and management of open globe injuries in the role 1/ pre-hospital environment.
Ocean enemy’s lasting sting: chronic cutaneous reaction after Cnidarian attack
Authors: Naumann D , Hejmadi R K , Evriviades D 
Published: February 2021

AbstractCnidaria stings cause a wide range of cutaneous and systemic symptoms, normally occurring shortly after the venomous insult (1). We report a case of worsening cutaneous reaction over an eight-year period following a Cnidaria attack sustained whilst maritime swimming. The lesion was characterised by severe, ulcerating chronic inflammation that required wide local excision and skin grafting. Prevention and early identification of Cnidaria envenomation is important for those treating maritime swimmers.
An invisible enemy: Panton-Valentine Leukocidin Staphylococcus Aureus on deployed troops
Authors: Johnstone P , Matheson AS 
Published: February 2021

AbstractOver the last seven years Primary Care establishments in the Royal Navy and Royal Marines have dealt with a number of severe and fatal infections caused by Panton-Valentine leukocidin (PVL) producing Staphylococcus aureus, and appear to be seeing these infections more commonly than their civilian colleagues. This retrospective study looked at the levels of PVL S. aureus isolated in deployed personnel during Op HERRICK 14 to determine if the levels seen in British military troops are higher than the national average. We found that the percentage of PVL positive S. aureus isolates sent to the UK HPA reference laboratory from the Camp Bastion laboratory during OP Herrick 14 was 41%, considerably higher rate than the UK civilian rate. Future research, including a larger study into the carriage levels of PVL S. aureus in the military will hopefully shed more light on the spread and transmission of this potentially deadly bacterium.
Secondary prevention medication persistence and prognosis of acute ischaemic stroke or transient ischaemic attack
Authors: Zhang Lei , Shi Junfeng , Pan Yuesong , Li Zixiao , Yan Hongyi , Liu Chelsea , Lv Wei , Meng Xia , Wang Yongjun 
Published: February 2021

IntroductionThe risk of disability and mortality is high among recurrent stroke, which highlights the importance of secondary prevention measures. We aim to evaluate medication persistence for secondary prevention and the prognosis of acute ischaemic stroke or transient ischaemic attack (TIA) in China.MethodsPatients with acute ischaemic stroke or TIA from the China National Stroke Registry II were divided into 3 groups based on the percentage of persistence in secondary prevention medication classes from discharge to 3 months after onset (level I: persistence=0%, level II: 0%<persistence<100%, level III: persistence=100%). The primary outcome was recurrent stroke. The secondary outcomes included composite events (stroke, myocardial infarction or death from cardiovascular cause), all-cause death and disability (modified Rankin Scale score=3–5) from 3 months to 1 year after onset. Recurrent stroke, composite events and all-cause death were performed using Cox regression model, and disability was identified through logistic regression model using the generalised estimating equation method.Results18 344 patients with acute ischaemic stroke or TIA were included, 315 (1.7%) of whom experienced recurrent strokes. Compared with level I, the adjusted HR of recurrent stroke for level II was 0.41 (95% CI 0.31 to 0.54) and level III 0.37 (0.28 to 0.48); composite events for level II 0.41 (0.32 to 0.53) and level III 0.38 (0.30 to 0.49); all-cause death for level II 0.28 (0.23 to 0.35) and level III 0.20 (0.16–0.24). Compared with level I, the adjusted OR of disability for level II was 0.89 (0.77 to 1.03) and level III 0.82 (0.72 to 0.93).ConclusionsPersistence in secondary prevention medications, especially in all classes of medications prescribed by the physician, was associated with lower hazard of recurrent stroke, composite events, all-cause death and lower odds of disability in patients with acute ischaemic stroke or TIA.
Body mass index and clinical outcomes in patients with intracerebral haemorrhage: results from the China Stroke Center Alliance
Authors: Cao Zhentang , Liu Xinmin , Li Zixiao , Gu Hongqiu , Jiang Yingyu , Zhao Xingquan , Wang Yongjun 
Published: February 2021

Background and aimObesity paradox has aroused increasing concern in recent years. However, impact of obesity on outcomes in intracerebral haemorrhage (ICH) remains unclear. This study aimed to evaluate association of body mass index (BMI) with in-hospital mortality, complications and discharge disposition in ICH.MethodsData were from 85 705 ICH enrolled in the China Stroke Center Alliance study. Patients were divided into four groups: underweight, normal weight, overweight and obese according to Asian-Pacific criteria. The primary outcome was in-hospital mortality. The secondary outcomes included non-routine discharge disposition and in-hospital complications. Discharge to graded II or III hospital, community hospital or rehabilitation facilities was considered non-routine disposition. Multivariable logistic regression analysed association of BMI with outcomes.Results82 789 patients with ICH were included in the final analysis. Underweight (OR=2.057, 95% CI 1.193 to 3.550) patients had higher odds of in-hospital mortality than those with normal weight after adjusting for covariates, but no significant difference was observed for patients who were overweight or obese. No significant association was found between BMI and non-disposition. Underweight was associated with increased odds of several complications, including pneumonia (OR 1.343, 95% CI 1.138 to 1.584), poor swallow function (OR 1.351, 95% CI 1.122 to 1.628) and urinary tract infection (OR 1.532, 95% CI 1.064 to 2.204). Moreover, obese patients had higher odds of haematoma expansion (OR 1.326, 95% CI 1.168 to 1.504), deep vein thrombosis (OR 1.506, 95% CI 1.165 to 1.947) and gastrointestinal bleeding (OR 1.257, 95% CI 1.027 to 1.539).ConclusionsIn patients with ICH, being underweight was associated with increased in-hospital mortality. Being underweight and obese can both increased risk of in-hospital complications compared with having normal weight.
Renormalized Schwinger–Dyson functional
Authors: Guadagnini Enore , Urso Vittoria 
Published: February 2021

AbstractWe consider the perturbative renormalization of the Schwinger–Dyson functional, which is the generating functional of the expectation values of the products of the composite operator given by the field derivative of the action. It is argued that this functional plays an important role in the topological Chern–Simons and BF quantum field theories. It is shown that, by means of the renormalized perturbation theory, a canonical renormalization procedure for the Schwinger–Dyson functional is obtained. The combinatoric structure of the Feynman diagrams is illustrated in the case of scalar models. For the Chern–Simons and the BF gauge theories, the relationship between the renormalized Schwinger–Dyson functional and the generating functional of the correlation functions of the gauge fields is produced.
Quintessential inflation for exponential type potentials: scaling and tracker behavior
Authors: Aresté Saló Llibert , Haro Jaume 
Published: February 2021

AbstractWe will show that for exponential type potentials of the form $$V(\varphi )\sim e^{-\gamma \varphi ^n/M_{pl}^n}$$

V

(
φ
)

∼

e

-
γ

φ
n

/

M

pl

n

, which are used to depict quintessential inflation, the solutions whose initial conditions take place during the slow roll phase in order to describe correctly the inflationary period, do not belong for large values of the parameter n to the basin of attraction of the scaling solution – a solution of the scalar field equation whose energy density scale as the one of the fluid component of the universe during radiation or the matter domination period –, meaning that a late time mechanism to exit this behavior and depict correctly the current cosmic acceleration is not needed. However, in such cases, namely n large enough, these potentials cannot correctly depict the current cosmic acceleration. This is the reason why the potential must be improved introducing another parameter -as the one in the well-known Peebles–Vilenkin quintessential inflation model, which depends on two parameters, one to describe inflation and the other one to correctly depict the present accelerated evolution – able to deal with the late time acceleration of our universe.
The rhythms of the night: increase in online night activity and emotional resilience during the spring 2020 Covid-19 lockdown
Authors: Castaldo Maria , Venturini Tommaso , Frasca Paolo , Gargiulo Floriana 
Published: February 2021

Abstract
Context
The lockdown orders established in multiple countries in response to the Covid-19 pandemic are arguably one of the most widespread and deepest shock experienced by societies in recent years. Studying their impact trough the lens of social media offers an unprecedented opportunity to understand the susceptibility and the resilience of human activity patterns to large-scale exogenous shocks. Firstly, we investigate the changes that this upheaval has caused in online activity in terms of time spent online, themes and emotion shared on the platforms, and rhythms of content consumption. Secondly, we examine the resilience of certain platform characteristics, such as the daily rhythms of emotion expression.

Data
Two independent datasets about the French cyberspace: a fine-grained temporal record of almost 100 thousand YouTube videos and a collection of 8 million Tweets between February 17 and April 14, 2020.

Findings
In both datasets we observe a reshaping of the circadian rhythms with an increase of night activity during the lockdown. The analysis of the videos and tweets published during lockdown shows a general decrease in emotional contents and a shift from themes like work and money to themes like death and safety. However, the daily patterns of emotions remain mostly unchanged, thereby suggesting that emotional cycles are resilient to exogenous shocks.
Sensitivity to invisible scalar decays at CLIC
Authors: Mekala K. , Zarnecki A. F. , Grzadkowski B. , Iglicki M. 
Published: February 2021

AbstractWe studied the possibility of constraining production of new scalar particles at CLIC running at 380 GeV and 1.5 TeV, assuming the associated production of Higgs-like neutral scalar with $$\mathrm{Z}{}{} $$

Z

boson and its invisible decays. The analysis is based on the Whizard event generation and fast simulation of the CLIC detector response with Delphes. We considered $${\mathrm{e}{}{}}^{+} {\mathrm{e}{}{}}^{-} $$

e

+

e

-

background processes but also relevant $$\upgamma {}{} \upgamma {}{} $$

γ

γ

and $$\upgamma {}{} \mathrm{e}{}{} ^{\pm }$$

γ

e

±

interactions. The approach consisting of a two-step analysis was used to optimise separation between signal and background processes. First, a set of preselection cuts was applied; then, multivariate analysis methods were employed to optimise the significance of observations. We first estimated the expected limits on the invisible decays of the 125 GeV Higgs boson, which were then extended to the cross section limits for production of an additional neutral scalar, assuming its invisible decays, as a function of its mass. Extracted model-independent branching ratio and cross section limits were then interpreted in the framework of the Higgs-portal models to set limits on the mixing angle between the SM-like Higgs boson and the new scalar of the “dark sector”.
Risks to the Public
Authors: Neumann Peter G. 
Published: February 2021

Edited by PGN (Risks Forum Moderator, with contribu- tions by others as indicated. Opinions are individual rather than organizational, with usual disclaimers implied. We ad- dress problems relating to software, hardware, people, and other circumstances relevant to computer systems. Ref- erences (R i j) to the online Risks Forum denote RISKS vol i number j. Cited RISKS items generally identify contributors and sources, together with URLs. Official RISKS archives are available at www.risks.org, with nice html formatting and search engine courtesy of Lindsay Mar- shall at Newcastle:; http://catless.ncl.ac.uk/Risks/i.j.html (also ftp://www.sri.com/risks). CACM Inside Risks: http://www.csl.sri.com/neumann/insiderisks.html
Mini-editorial (PGN)
This is now my 45th year with involvement in SEN. When can I quit? Sadly, the risks continue to be pervasive, and avoiding them is highly relevant to what principled software/system engineering should entail. We need ap- proaches to systems that consider trustworthiness as a col- lection of -ilities all of which can be critical, and which in many cases are intricately related; they cannot be solved in isolation. Trustworthiness requires reliablity, security, and much more especially when human safety is in- volved. And every system is likely to have critical aws that can be exploited or triggered accidentally. My Octo- ber 2020 CACM Inside Risks column, A Holistic View of Fu- ture Risks (http://www.csl.sri.com/neumann/cacm250.pdf) attempts to illustrate some of that. If you have not seen it, I would welcome some feedback.