bluuebunny/crossref_metadata_2025_split huggingface dataset:
Comparison of the Effects of Motion and Environment Conditions on Accuracy of Handheld and Finger-Based Pulse Oximeters
Authors: Mark Noy , Lyubin Anat , Gerasi Refael , Ofir Dror , Tsur Avishai M , Chen Jacob , Bader Tarif 
Published: January 2021

ABSTRACT

Introduction
The most common cause of preventable death on the battlefield is significant blood loss, eventually causing decrease in tissue oxygen delivery. Pulse oximeters (POs) are widely used by the Israeli Defense Forces to obtain fast and noninvasive information about peripheral oxygen saturation (SpO2). However, POs are produced by different manufacturers and therefore include different sensors and are based on distinctive algorithms. This makes them susceptible to different errors caused by factors varying from environmental conditions to the severity of injury. The objectives of this study were to compare the reliability of different devices and their accuracy under various conditions.

Material and Methods
Six POs underwent performance analysis. The finger-based category included: MightySat by Masimo, Onyx II by Nonin, and CMS50D by Contec. The handheld category comprised: RAD5 by Masimo, 9847 model by Nonin, and 3301 model by BCI. Several environmental and physiological parameters were altered using the ProSim8 simulator by Fluke biomedical, forming unique test cases under which the devices were tested in stationary and motion conditions.

Results
All finger-based POs showed higher error rates of PO SpO2 and heart rate measurements in motion conditions, regardless of the manufacturer. However, newer devices in the handheld category were not affected. Results presented in Phase II showed that the SpO2 measurement error in all the devices was affected by pigmentation. However, the CMS50D, considered a low-cost device, had a significantly higher error size than other devices. In the devices that were influenced both by pigmentation and the finger cleanliness factors, the combined detected error size was clinically significant. The pigmentation, ambient light, and finger cleanliness also had a significant effect on the heart rate measurement in the CMS50D model, unlike the handheld devices, which were not affected. During Phase II, neither the Nonin nor the Masimo devices were deemed to have a significant advantage.

Conclusion
Considering measurement limitations of POs used is extremely important. Use of handheld devices should be favored for use in motion conditions. Technologically advanced and/or recently developed devices should be preferred because of evolving algorithms, which decrease or eliminate the error factors. The “dirty finger” effect on the measurement error cannot be neglected and therefore the action of finger cleaning should be considered part of the treatment protocol.
Particle Analysis by Scanning Electron Microscopy With Energy Dispersive X-Ray Analysis in Pulmonary Pathology Specimens From U.S. Military Service Members Deployed During the Global War on Terror 2002 to 2015
Authors: Strausborger Stacy L , Jenkins H Marie , Franks Teri J , Lewin-Smith Michael R 
Published: January 2021

ABSTRACT

Introduction
Between 2001 and 2015, 2.77 million U.S. military service members completed over 5 million deployments to Southwest Asia. There are concerns that deployment-related environmental exposures may be associated with adverse pulmonary health outcomes. Accurate pulmonary diagnosis often requires histopathological biopsy. These lung biopsies are amenable to chemical analysis of retained particulates using scanning electron microscopy with energy dispersive X-ray analysis (SEM/EDXA).

Method
A retrospective review of SEM/EDXA data collected in conjunction with pathologic diagnostic consultations at the Joint Pathology Center from 2011 to 2016 was conducted. Sections adjacent to those obtained for pathologic diagnosis were prepared for SEM/EDXA particle analysis, which provides qualitative identification of elements present in each particle and semiquantitative estimations of elemental weight percent. The review includes comparison of the particle analysis data and diagnostic findings, the particle count for the standard field analyzed, and types of particles identified.

Results
Nonneoplastic lung biopsy specimens from 25 deployed and 7 nondeployed U.S. service members were analyzed as part of the Joint Pathology Center pathologic consultations. The major exogenous particle types identified in both groups include aluminum silicates, other silicates, silica, and titanium dioxide. Endogenous particle types identified include calcium salts and iron-containing particles consistent with hemosiderin. These particles are present in deployed and nondeployed service members and are particle types commonly identified in lung biopsy specimens from urban dwelling adults. Rare particles containing other elements such as cerium and iron alloys were identified in some cases. Possible sources of these materials include diesel fuel and occupational and other environmental exposures.

Conclusion
Scanning electron microscopy with energy dispersive X-ray particle analysis of inhaled particulates retained in lung tissue from deployed service members identifies particles commonly present in inhaled dust. In this small case series, we were not able to detect particle profiles that were common and unique to deployed patients only.
Early Detection of Hypotension Using a Multivariate Machine Learning Approach
Authors: Rashedi Navid , Sun Yifei , Vaze Vikrant , Shah Parikshit , Halter Ryan , Elliott Jonathan T , Paradis Norman A 
Published: January 2021

ABSTRACT

Introduction
The ability to accurately detect hypotension in trauma patients at the earliest possible time is important in improving trauma outcomes. The earlier an accurate detection can be made, the more time is available to take corrective action. Currently, there is limited research on combining multiple physiological signals for an early detection of hemorrhagic shock. We studied the viability of early detection of hypotension based on multiple physiologic signals and machine learning methods. We explored proof of concept with a small (5 minutes) prediction window for application of machine learning tools and multiple physiologic signals to detecting hypotension.

Materials and Methods
Multivariate physiological signals from a preexisting dataset generated by an experimental hemorrhage model were employed. These experiments were conducted previously by another research group and the data made available publicly through a web portal. This dataset is among the few publicly available which incorporate measurement of multiple physiological signals from large animals during experimental hemorrhage. The data included two hemorrhage studies involving eight sheep. Supervised machine learning experiments were conducted in order to develop deep learning (viz., long short-term memory or LSTM), ensemble learning (viz., random forest), and classical learning (viz., support vector machine or SVM) models for the identification of physiological signals that can detect whether or not overall blood loss exceeds a predefined threshold 5 minutes ahead of time. To evaluate the performance of the machine learning technologies, 3-fold cross-validation was conducted and precision (also called positive predictive value) and recall (also called sensitivity) values were compared. As a first step in this development process, 5 minutes prediction windows were utilized.

Results
The results showed that SVM and random forest outperform LSTM neural networks, likely because LSTM tends to overfit the data on small sized datasets. Random forest has the highest recall (84%) with 56% precision while SVM has 62% recall with 82% precision. Upon analyzing the feature importance, it was observed that electrocardiogram has the highest significance while arterial blood pressure has the least importance among all other signals.

Conclusion
In this research, we explored the viability of early detection of hypotension based on multiple signals in a preexisting animal hemorrhage dataset. The results show that a multivariate approach might be more effective than univariate approaches for this detection task.
Previous Military Medical Exposure as a Motivator for a Medical Career
Authors: Manor Uri , Allon Raviv , Gan-Or Hadar , Yahal Orr , Benov Avi , Chen Jacob 
Published: January 2021

ABSTRACT

Introduction
A variety of factors influence the motivation to choose a medical career; however, the influence of premedical experiences on health professional trainees’ choices is a neglected one. We hypothesize that medical exposure during service in the Israeli Air Force special operations forces (SOFs) has an impact on motivation for medical studies. The Israeli scenario, in which career choice is anteceded by substantial military experience, allows us to examine this hypothesis.

Materials and Methods
We conducted a retrospective cohort study among physicians and medical students who served as operators in the Israeli Air Force SOF; Unit 669 (an airborne combat search and rescue unit), and Shaldag (an airborne SOF unit). All medical students and physicians enlisted between January 2001 and December 2010 were eligible for enrollment.

Results
Of over 700 operators screened, 3.7% of Shaldag veterans and 11.1% of Unit 669 veterans had started or finished medical school (P-value &lt; 0.001). Overall, 49 veterans answered the questionnaire and enrolled in the study, of whom 17 (34.7%) were Shaldag veterans and 32 (65.3%) were Unit 669 veterans. Subjective questions implied a significant effect of the service in Unit 669 on career choice. Paramedics had a relative risk of becoming physicians of 7.37 when compared to nonparamedic operators, irrespective of their original unit.

Conclusions
Medical exposure of Unit 669 operators during military service significantly contributed to their motivation for becoming physicians. Thus, military service in this setting acts de facto as an effective medical immersion program. This adds another factor to the myriad of factors that motivate young adults in their choice of a medical career.
Point-of-Care Tomosynthesis Imaging of the Wrist
Authors: Inscoe Christina R , Lee Yueh , Billingsley Alex J , Puett Connor , Nissman Daniel , Lu Jianping , Zhou Otto 
Published: January 2021

ABSTRACT

Introduction
Musculoskeletal injury to extremities is a common issue for both stateside and deployed military personnel, as well as the general public. Superposition of anatomy can make diagnosis difficult using standard clinical techniques. There is a need for increased diagnostic accuracy at the point-of-care for military personnel in both training and operational environments, as well as assessment during follow-up treatment to optimize care and expedite return to service. Orthopedic tomosynthesis is rapidly emerging as an alternative to digital radiography (DR), exhibiting an increase in sensitivity for some clinical tasks, including diagnosis and follow-up of fracture and arthritis. Commercially available digital tomosynthesis systems are large complex devices. A compact device for extremity tomosynthesis (TomoE) was previously demonstrated using carbon nanotube X-ray source array technology. The purpose of this study was to prepare and evaluate the prototype device for an Institutional Review Board-approved patient wrist imaging study and provide initial patient imaging results.

Materials and Methods
A benchtop device was constructed using a carbon nanotube X-ray source array and a flat panel digital detector. Twenty-one X-ray projection images of cadaveric specimens and human subjects were acquired at incident angles from −20 to +20 degrees in various clinical orientations, with entrance dose calibrated to commercial digital tomosynthesis wrist scans. The projection images were processed with an iterative reconstruction algorithm in 1 mm slices. Reconstruction slice images were evaluated by a radiologist for feature conspicuity and diagnostic accuracy.

Results
The TomoE image quality was found to provide more diagnostic information than DR, with reconstruction slices exhibiting delineation of joint space, visual conspicuity of trabecular bone, bone erosions, fractures, and clear depiction of normal anatomical features. The scan time was 15 seconds and the skin entrance dose was verified to be 0.2 mGy.

Conclusions
The TomoE device image quality has been evaluated using cadaveric specimens. Dose was calibrated for a patient imaging study. Initial patient images depict a high level of anatomical detail and an increase in diagnostic value compared to DR.
Purposeful Misalignment of Severed Nerve Stumps in a Standardized Transection Model Reveals Persistent Functional Deficit With Aberrant Neurofilament Distribution
Authors: Lee Jung Il , Gurjar Anagha A , Talukder M A Hassan , Rodenhouse Andrew , Manto Kristen , O’Brien Mary , Karuman Zara , Govindappa Prem Kumar , Elfar John C 
Published: January 2021

ABSTRACT

Background
Functional recovery following primary nerve repair of a transected nerve is often poor even with advanced microsurgical techniques. Recently, we developed a novel sciatic nerve transection method where end-to-end apposition of the nerve endings with minimal gap was performed with fibrin glue. We demonstrated that transected nerve repair with gluing results in optimal functional recovery with improved axonal neurofilament distribution profile compared to the end-to-end micro-suture repair. However, the impact of axonal misdirection and misalignment of nerve fascicles remains largely unknown in nerve-injury recovery. We addressed this issue using a novel nerve repair model with gluing.

Methods
In our complete “Flip and Transection with Glue” model, the nerve was “first” transected to 40% of its width from each side and distal stump was transversely flipped, then 20 µL of fibrin glue was applied around the transection site and the central 20% nerve was completely transected before fibrin glue clotting. Mice were followed for 28 days with weekly assessment of sciatic function. Immunohistochemistry analysis of both sciatic nerves was performed for neurofilament distribution and angiogenesis. Tibialis anterior muscles were analyzed for atrophy and histomorphometry.

Results
Functional recovery following misaligned repair remained persistently low throughout the postsurgical period. Immunohistochemistry of nerve sections revealed significantly increased aberrant axonal neurofilaments in injured and distal nerve segments compared to proximal segments. Increased aberrant neurofilament profiles in the injured and distal nerve segments were associated with significantly increased nerve blood-vessel density and branching index than in the proximal segment. Injured limbs had significant muscle atrophy, and muscle fiber distribution showed significantly increased numbers of smaller muscle fibers and decreased numbers of larger muscle fibers.

Conclusions
These findings in a novel nerve transection mouse model with misaligned repair suggest that aberrant neurofilament distributions and axonal misdirections play an important role in functional recovery and muscle atrophy.
Utility of Point of Care Ultrasound in Humanitarian Assistance Missions
Authors: Sullivan John F , Polly Matheus , Roman John W , Milder Edmund A , Carter E , Lennon Robert P 
Published: January 2021

ABSTRACT

Introduction
Point of care ultrasound (POCUS) is increasingly used in primary care in the USA and has been shown to provide significant benefit to care in deployed military settings and during disaster relief efforts. It is less studied as a tool during humanitarian assistance missions. We sought to determine the utility of POCUS in a humanitarian assistance setting during the February 2019 joint U.S.–Brazilian hospital assistance mission aboard the Hospitalar Assistance Ship Carlos Chagas along the Madeira River in the Brazilian Amazon.

Materials and Methods
Point of care ultrasound was offered as a diagnostic modality to primary care physicians during the course of a month-long mission. A handheld IVIZ ultrasound machine was loaned for use during this mission by Sonosite. A P21v phased array (5-1 MHz) or an L38v linear (10-5 MHz) transducer was used for scanning. Requests for POCUS examinations, their findings, and changes in patient management were recorded.

Results
Point of care ultrasound examinations were requested and performed in 24 of 814 (3%) outpatient primary care visits. Ten of these studies (42% of POCUS examinations, 1.2% of all patient visits) directed patient management decisions, in each case preventing unnecessary referral.

Conclusions
In this austere setting, POCUS proved to be an inexpensive, effective tool at preventing unnecessary referrals. Future medical humanitarian assistance missions may likewise find POCUS to be a primary care force-multiplier.
Recombinant Human MG53 Protein Protects Against Alkaline-Induced Corneal Injuries in Mice
Authors: Guo Owen , Ju Brent , Shawver McKinley H , Geng Bingchuan , Wei Siqi , Early Terriah , Yi Frank , Tan Tao , Chandler Heather L , Ma Jianjie , Zhu Hua 
Published: January 2021

ABSTRACT

Introduction
The current study was designed to test the potential role of recombinant human MG53 (rhMG53) protein on protecting against alkaline-induced corneal injury in mice.

Materials and Methods
A round filter paper with 2-mm diameter was soaked in 1 mol/L of NaOH solution. The mouse alkaline injury was generated by placing the filter paper directly on the cornea for 30 seconds and washed with 30-mL saline; 10 µL of rhMG53 solution (20 µg/mL) or saline control was topically administrated on the mouse corneas (twice per day for 10 days). Re-epithelialization was measured by fluorescein staining and imaged by a slit lamp equipped with a digital camera. Clinical neovascularization and opacity scores were measured every day after injury. Ten days after injury, mice were sacrificed and corneas were dissected out for flat mount staining of CD31 for neovascularization.

Results
MG53 was present in both dog aqueous humor and human tears. mg53-/- corneas were more susceptible to alkaline-induced corneal injury. Topical treatment of rhMG53 improved re-epithelialization, suppressed neovascularization, and fibrosis induced by alkaline injury.

Conclusions
rhMG53 may be an effective means to treat corneal wounding.
Development and Implementation of the Military Treatment Facility Engagement Committee (MTFEC) to Support Pragmatic Clinical Trials in the Military Health System
Authors: Scarton Dylan V , Roddy William T , Taylor Jerika A , Geda Mary , Brandt Cynthia A , Peduzzi Peter , Kerns Robert D , Pasquina Paul F 
Published: January 2021

ABSTRACT

Introduction
Within the population of military service members and veterans, chronic pain is highly prevalent, often complex, and frequently related to traumatic experiences that are more likely to occur to members of this demographic, such as individuals with traumatic brain injury or limb loss. In September 2017, the National Institutes of Health (NIH), Department of Defense (DOD), and Department of Veterans Affairs (VA) Pain Management Collaboratory (PMC) was formed as a significant and innovative inter-government agency partnership to support a multicomponent research initiative focusing on nonpharmacological approaches for pain management addressing the needs of service members, their dependents, and veterans.

Methods
A Pain Management Collaboratory Coordinating Center (PMC3) was also established to facilitate collective learning across 11 individually funded pragmatic clinical trials (PCTs) designed to optimize the impact of the PMC as an integrated whole. Although the DOD and VA health care systems are ideal sites for the enactment of PCTs, executing these trials within the local context of DOD military treatment facilities (MTFs) can present unique challenges. The Military Treatment Facility Engagement Committee (MTFEC) was created to support the efforts of the PMC3 in its role as a national resource for development and refinement of innovative tools, best practices, and other resources in the conduct of high impact PCTs.

Results
The MTFEC is composed of experts from each service who bring experiences in executing clinical pain management trials that can enhance the planning and execution of the PCTs. It provides expertise and leadership in the execution of research studies at within MTFs and within the DOD health care system, with guidance from PMC3 Directors and in collaboration with NIH, DOD, and VA program and scientific officers.

Discussion/Conclusion
Considering the importance of enacting large-scale, pragmatic studies to implement effective strategies in clinical practice for chronic pain management, the MTFEC has begun to actualize its purpose by identifying potential barriers and challenges to study implementation and exploring how the PMC can support and aid in the execution of PCTs by applying similar approaches to stakeholder and subject matter engagement for their research.
Localization of Arterial Bleeds Using Pulse Wave Reflections
Authors: Venugopal Prem , Marinelli Luca 
Published: January 2021

ABSTRACT

Introduction
Localization of internal arterial bleeds is necessary for treatment in the battlefield. In this article, we describe a novel approach that utilizes pulse wave reflections generated by a bleed to locate it.

Materials and Methods
To demonstrate our approach, velocity and diameter waveforms in the presence of bleeds were simulated using the 1D wave propagation equations in a straight-vessel model of the human thoracic aorta. The simulated waveforms were then decomposed into forward and backward components using wave intensity analysis. Reflections arising from the bleed were identified from the decomposed waveforms.

Results
Reflection generated by the bleed introduced a new feature in the backward component, compared to the normal, no-bleed condition. The bleed location could be determined from the time delay between this reflection feature and the forward wave creating it, and the pulse wave velocity in the vessel.

Conclusions
The findings of this study could be utilized by ultrasound for hemorrhage localization.
Demographic Variation in Military Life Stress and Perceived Support Among Military Spouses
Authors: Corry Nida H , Williams Christianna S , Radakrishnan Sharmini , McMaster Hope S , Sparks Alicia C , Briggs-King Ernestine , Karon Samantha S , Stander Valerie A 
Published: January 2021

ABSTRACT

Introduction
Military spouses play a critical role in supporting military service members, and thus, their experiences may have a significant impact on the well-being, readiness, and resilience of the U.S. Armed Forces. Research suggests that military spouses experience unique stressors as a result of military life, but few studies have assessed demographic factors associated with their experiences of military life and perceived support.

Materials and Methods
Using data from the Millennium Cohort Family Study, a nationwide survey of 9,872 married spouses of service members with 2 to 5 years of military service, this study examined differences in experiences of military life and perceived support across multiple understudied subgroups of military spouses. Key outcomes included military-related stressors (e.g., deployment-related experiences), perceived social support, and perceived military efforts to provide support.

Results
Military life stress and perceived support differed across military spouse, service member, and family characteristics. Results indicated that spouses who are older than age 35 or are married to enlisted service members in the Army, Navy, or Marines are more likely to experience heightened military stress or less perceived social support. Dual-military couples reported experiencing less stress associated with military life and perceiving more social support and support from the military, compared with spouses who have never served in the military.

Conclusion
These findings may help guide effective channeling of resources and outreach to potentially vulnerable military families.