bluuebunny/crossref_metadata_2025_split huggingface dataset:
“Let Me Confess”: Confession, Complicity, and #MeToo in Junot Díaz'sThis is How You Lose Herand “The Silence: The Legacy of Childhood Trauma”
Authors: McHugh-Dillon Ruth 
Published: February 2021

AbstractConfession plays a crucial yet ambivalent role in Junot Díaz’s fiction and paratexts. While scholarship has emphasized confession as a powerful means of witnessing male misbehavior, the #MeToo era urges readers to question who or what, beyond mere representation, confession serves. I suggest that protagonist Yunior’s compulsive confessions of lying, cheating and womanizing in This is How You Lose Her (2012) expose how his sense of self is split between an authoritarian Dominican past and an oppressive US present. Yunior’s macho behavior conjures the historical specter of Dominican strongman dictator, Trujillo, while his confessions make readers complicit in his immorality, echoing Trujillo’s manipulation of information for control. Forging this uneasy textual intimacy between reader and narrator further underscores mainstream expectations, in the US present, that minority writers “confess” their intimate lives for entertainment, conscribing how and what they express. Yet Yunior’s narrative also conscribes female representation by centering—and then absolving—male misbehavior through a confession that looks like a dialogue (addressing “you”) but in fact functions as a monologue. I also interrogate Díaz’s authorial interviews and apply Lili Loofbourow’s idea of the “male self-pardon” to Díaz’s autobiographical essay “The Silence: The Legacy of Childhood Trauma” (2018), in which he reveals surviving childhood sexual assault and confesses that he subsequently “hurt” intimate female partners. I argue that confession—whether Yunior’s or Díaz’s—perpetuates a masculine monologue that marginalizes women’s voices. Masculine confessions reach for intimacy but fail when they cannot imagine women as fully as men.
Whole-genome Sequencing of SARS-CoV-2: Using Phylogeny and Structural Modeling to Contextualize Local Viral Evolution
Authors: Nazario-Toole Ashley E , Xia Hui , Gibbons Thomas F 
Published: February 2021

ABSTRACT

Introduction
The outbreak of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has created a global pandemic resulting in over 1 million deaths worldwide. In the Department of Defense (DoD), over 129,000 personnel (civilians, dependents, and active duty) have been infected with the virus to date. Rapid estimations of transmission and mutational patterns of virus outbreaks can be accomplished using whole-genome viral sequencing. Deriving interpretable and actionable results from pathogen sequence data is accomplished by the construction of phylogenetic trees (from local and global virus sequences) and by the creation of protein maps, to visualize and predict the effects of structural protein amino acid mutations.

Materials and Methods
We developed a sequencing and bioinformatics workflow for molecular epidemiological SARS-CoV-2 surveillance using excess clinical specimens collected under an institutional review board exempt protocol at Joint Base San Antonio, Lackland AFB. This workflow includes viral RNA isolation, viral load quantification, tiling-based next-generation sequencing, sequencing and bioinformatics analysis, and data visualization via phylogenetic trees and protein mapping.

Results
Sequencing of 37 clinical specimens collected at JBSA/Lackland revealed that by June 2020, SAR-CoV-2 strains carrying the 614G mutation were the predominant cause of local coronavirus disease 2019 infections. We identified 109 nucleotide changes in the coding region of the SARS-CoV-2 genome (which lead to 63 unique, non-synonymous amino acid mutations), one mutation in the 5ʹ-untranslated region (UTR), and two mutations in the 3ʹUTR. Furthermore, we identified and mapped six additional spike protein amino acid changes—information which could potentially aid vaccine design.

Conclusion
The workflow presented here is designed to enable DoD public health officials to track viral evolution and conduct near real-time evaluation of future outbreaks. The generation of molecular epidemiological sequence data is critical for the development of disease intervention strategies—most notably, vaccine design. Overall, we present a streamlined sequencing and bioinformatics methodology aimed at improving long-term readiness efforts in the DoD.
The Potential Role of Functional Motor Competence to Promote Physical Military Readiness: A Developmental Perspective
Authors: Silvey Kyle , Porter Jason , Sacko Ryan S , Hand Amy F , Terlizzi Bryan M , Abrams Thomas C , Stodden David F 
Published: February 2021

ABSTRACT
Decreased physical fitness in military recruiting populations is problematic for the development of physical military readiness (PMR) and presents a threat to national security. The demonstration of low levels of fitness may be an indicator of a more foundational problem in the physical development of military recruits. We propose the development of functional motor competence (FMC) across childhood and adolescence as a necessary antecedent to advanced PMR training and military-specific tasks (i.e., rucking and obstacle course navigation) and as an integral part of sustained PMR. The development of FMC supports increases in cardiovascular and muscular endurance through repeated efforts performed during practice and in sport, as well as muscular power as many FMC movements mimic plyometrics in a strength in conditioning sense. We posit that an inadequate foundation in FMC will serve as a barrier to achieving sufficient PMR and combat success of the fighting force. We propose three possible solutions to ensure sufficient PMR levels through the implementation of developmentally appropriate FMC-based training. First would be promoting FMC-based training in junior reserve officer training corp and ROTC programs. Second would be a more global approach, on the scale of the National Defense Education Act, specifically focusing on promoting quality daily physical education that could reach millions of children. Third, individual branches could begin promoting the tenets of foundational FMC training concepts in their physical training manuals, which ideally would address FMC before and throughout basic training, as well as subsequent active duty training.
Shallow Water Diving-Associated Alveolar Hemorrhage in an Active Duty Sailor: A Case Report
Authors: Inman Brannon L , Bridwell Rachel E , Cibrario Amber , Goss Sarah , Oliver Joshua J 
Published: February 2021

ABSTRACTBreath-hold diving is a common practice as a part of military dive training. An association between prior lung injury and a propensity for lung barotrauma may have the potential to impact mission readiness for combat divers, Pararescue, Combat Controllers, Army Engineer divers, and various units in Naval Special Warfare and Special Operations. Barotrauma is a common complication of diving, typically occurring at depths greater than 30 m (98.4 ft). Individuals with abnormal lung anatomy or function may be at increased risk of barotrauma at shallower depths than those with healthy lungs, rendering these service members unfit for certain missions. We describe the case of a 25-year-old male, with a remote history of polytrauma and resultant pulmonary pleural adhesions, whose dive training was complicated by lung barotrauma at shallow depths. In missions or training utilizing breath-hold diving, the association with secondary alterations in lung or thoracic anatomy and function may limit which service members can safely participate.
Anterior Mediastinal Mass Causing Intermittent Atrial Fibrillation
Authors: Spanier Adam M , Evans Garrett R , Hiller Hugh M 
Published: February 2021

ABSTRACT
Mediastinal masses are a rare finding in the emergency department and typically present with vague chest complaints such as chest discomfort, chest pain, or dyspnea. Rarely do these tumors present with dysrhythmias, and when dysrhythmias are present, they typically arise secondary to endocrine or metabolic effects exerted by the tumor. Here we report a case of a patient who presented to the emergency department with atrial fibrillation with rapid ventricular response, concomitant with a history of recurrent palpitations that were previously aborted with self-induced vagal maneuvers. Upon further investigation, the patient had an anterior mediastinal mass, diagnosed as a thymoma, suspected to be contributing to his presenting dysrhythmia through mass effect.
Identifying Best Practices in Pharmacy Experience: An Analysis of Military Treatment Facilities With the Highest Pharmacy Patient Experience Scores
Authors: Frazier Chantell , Marshall-Aiyelawo Kimberley , Gliner Melissa , Holden Craig , Fowler Tara , Black Cydny 
Published: February 2021

ABSTRACT

Introduction
Pharmacy patient experience within military treatment facilities (MTFs) is a significant indicator of healthcare quality, as hospital admissions correlate with medication use (Budnitz et al., 2006) and pharmacists have a unique opportunity to influence patients’ health (Dalton & Byrne, 2017). To improve patient care across the military health system (MHS), we investigated best practices within MTF pharmacies with the highest patient experience scores.

Materials and Methods
Researchers performed semi-structured telephone interviews with pharmacists, pharmacy technicians, and patient experience officers from three of the highest ranked MTF pharmacies according to outpatient satisfaction survey results to glean “best practice” approaches to patient care. Researchers utilized the Gioia approach as a guiding theory for qualitative analysis of the interview data, and the study was excluded from a requirement to obtain institutional review board approval due to the number of respondents in accordance with the Paperwork Reduction Act of 1980 guidelines.

Results
Interview participants from highly rated pharmacies emphasized the importance of communication among and between staff and patients, staff engagement and morale, and supportive leadership at their facilities for creating a positive patient experience and clinical environment.

Conclusion
These findings provide valuable insights to improve public health in military-connected populations through improved patient care practices in pharmacies across the MHS. Initiatives aimed at improving health care for pharmacy patients should prioritize improved communication and structural support for team members to create patient-friendly environments, which enables pharmacists and technicians to connect with patients and positively impact health outcomes. Limitations include lack of comparison data for lower performing pharmacies; future research will explore practices at lower ranking pharmacies to provide insights into communication practices, environments, and staff relationships impacting patient experience scores as well as the role patient demographics (e.g., retirees vs. active duty) and characteristics including facility size play in potential improvements.
Bidirectional Ventricular Tachycardia in a Young Female: A Case of Andersen-Tawil Syndrome
Authors: Ransom Jacob L , Wong Ka C , Kircher Jacqueline , Usry Courtney , Larson Christopher 
Published: February 2021

ABSTRACTBidirectional ventricular tachycardia (VT) is a rare ventricular dysrhythmia with a limited differential diagnosis that includes digitalis toxicity, catecholaminergic polymorphic VT, aconite poisoning, and genetic channelopathy syndromes, specifically, Andersen–Tawil syndrome (ATS). We present a case of a young female with palpitations found to have bidirectional VT on cardiac event monitor and strong family history of cardiac dysrhythmias. Her physical examination findings included minor dysmorphic features of mandibular hypoplasia, hypertelorism, and clinodactyly. The patient was clinically diagnosed with ATS and started on a beta-blocker for control of ectopy. A second Holter review demonstrated markedly decreased burden of ventricular ectopy compared to the initial monitoring. She was referred for genetic testing, which revealed a KCNJ2 mutation. Bidirectional VT is an uncommon ventricular dysrhythmia that has a limited differential diagnosis, one of which is ATS—a rare genetic disorder that results from mutations in the KCNJ2 gene. The condition is frequently associated with developmental, skeletal, and cardiac abnormalities. Although there are no strong recommendations that exist for treatment of ventricular dysrhythmias associated with this genetic disorder, we demonstrate a case of clinical improvement in a patient with ATS by using the beta-blocker metoprolol succinate. Furthermore, we propose that ATS patients may not need exercise restrictions as overall ventricular ectopy burden decreased with exercise and there was no prolongation of the QT interval. This patient will continue to follow up in our clinic to reassess symptom burden and for continued monitoring for the development of any new features.
Treatment of Mal de Debarquement Syndrome in a Computer-Assisted Rehabilitation Environment
Authors: Hoppes Carrie W , Vernon Michael , Morrell Rebecca L , Whitney Susan L 
Published: February 2021

ABSTRACT
Individuals with mal de debarquement syndrome (MdDS) describe symptoms of swaying, rocking, and/or bobbing after sea or air travel. These symptoms may be because of maladaptation of the vestibulo-ocular reflex (VOR) to roll of the head during rotation. Dai and colleagues have developed a treatment paradigm that involves passive roll of the patient’s head while watching optokinetic stripes, resulting in adaption of the VOR and improvement of MdDS. The purpose of this case report is to describe replication of this treatment paradigm in a virtual reality environment with successful resolution of symptoms in two visits. A 39-year-old female reported swaying and rocking after returning from a 7-day cruise. The patient was treated with two sessions in a computer-assisted rehabilitation environment (CAREN). The patient canceled her third visit because of complete resolution of her symptoms. Her Global Rating of Change was +7 (on a 15-point scale of −7 to +7). She had returned to her prior level of function. This case report is the first to describe use of the CAREN for effective treatment of MdDS by replicating the treatment paradigm developed by Dai and colleagues.
What’s limbs got to do with it? Real-world movement correlates with feelings of ownership over virtual arms during object interactions in virtual reality
Authors: Lavoie Ewen , Chapman Craig S 
Published: February 2021

Abstract
Humans will initially move awkwardly so that the end-state of their movement is comfortable. But, what is comfortable? We might assume it refers to a particular physical body posture, however, humans have been shown to move a computer cursor on a screen with an out-of-sight hand less efficiently (curved) such that the visual representation appears more efficient (straight). This suggests that movement plans are made in large part to satisfy the demands of their visual appearance, rather than their physical movement properties. So, what determines if a body movement is comfortable—how it feels or how it looks? We translated an object-interaction task from the real-world into immersive virtual reality (IVR) to dissociate a movement from its visual appearance. Participants completed at least 20 trials in two conditions: Controllers—where participants saw a visual representation of the hand-held controllers and Arms—where they saw a set of virtual limbs. We found participants seeing virtual limbs moved in a less biomechanically efficient manner to make the limbs look similar to if they were interacting with a real-world object. These movement changes correlated with an increase in self-reported feelings of ownership over the limbs as compared to the controllers. Overall this suggests we plan our movements to provide optimal visual feedback, even at the cost of being less efficient. Moreover, we speculate that a detailed measurement of how people move in IVR may provide a new tool for assessing their degree of embodiment. There is something about seeing a set of limbs in front of you, doing your actions, that affects your moving, and in essence, your thinking.
Nerve Graft Length and Recovery of Elbow Flexion Muscle Strength in Patients With Traumatic Brachial Plexus Injuries: Case Series
Authors: Socolovsky Mariano , di Masi Gilda , Bonilla Gonzalo , Lovaglio Ana , Krishnan Kartik G 
Published: February 2021

Abstract

BACKGROUND
Traumatic brachial plexus injuries cause long-term maiming of patients. The major target function to restore in complex brachial plexus injury is elbow flexion.

OBJECTIVE
To retrospectively analyze the correlation between the length of the nerve graft and the strength of target muscle recovery in extraplexual and intraplexual nerve transfers.

METHODS
A total of 51 patients with complete or near-complete brachial plexus injuries were treated with a combination of nerve reconstruction strategies. The phrenic nerve (PN) was used as axon donor in 40 patients and the spinal accessory nerve was used in 11 patients. The recipient nerves were the anterior division of the upper trunk (AD), the musculocutaneous nerve (MC), or the biceps branches of the MC (BBs). An index comparing the strength of elbow flexion between the affected and the healthy arms was correlated with the choice of target nerve recipient and the length of nerve grafts, among other parameters. The mean follow-up was 4 yr.

RESULTS
Neither the choice of MC or BB as a recipient nor the length of the nerve graft showed a strong correlation with the strength of elbow flexion. The choice of very proximal recipient nerve (AD) led to axonal misrouting in 25% of the patients in whom no graft was employed.

CONCLUSION
The length of the nerve graft is not a negative factor for obtaining good muscle recovery for elbow flexion when using PN or spinal accessory nerve as axon donors in traumatic brachial plexus injuries.
Modified Sternocleidomastoid Sparing Approach for Vertebral Artery (V1) to Common Carotid Artery Transposition: 2-Dimensional Operative Video
Authors: Travers Sarah , Siddiq Farhan 
Published: February 2021

Abstract
Vertebral artery (VA) V1 segment to common carotid artery (CCA) transposition is an uncommon operation with existing literature describing dissection of the sternoclavicular head of the sternocleidomastoid (SCM) muscle.
1,2
We present a modified approach for transposition without cutting the SCM. Our patient is a 76-yr-old female with history of a previous cerebellar stroke. Despite taking aspirin, she presented with another stroke resulting in severe dysarthria, vertigo, and gait disturbance. Magnetic resonance imaging (MRI) demonstrated several cerebellar infarcts. Catheter angiography demonstrated bilateral vertebral artery occlusion with filling from ascending cervical branches and a dominant left VA. We planned a left V1 to CCA transposition with a modified SCM-sparing approach for which the patient provided written informed consent. She was positioned supine with neck extended and face turned to the right. Neuromonitoring was utilized. A linear incision along the anterior border of the SCM was made, stopping 1.5 cm above the clavicular head. Neurovascular structures of the carotid sheath were dissected circumferentially and mobilized medially. The longus coli muscle over the C6 lateral mass was reflected medially. The vertebral artery was dissected to expose the maximum possible length. The inferior thyroid artery was sacrificed for better exposure. VA was ligated and transected. CCA was clamped. VA to CCA bypass was performed in a standard fashion. Surgical site was closed. The patient clinically did well postoperatively with immediate symptom improvement. Our video demonstrates an SCM-sparing technique of V1 to CCA transposition, which can be a less-extensive operation compared to the traditional approaches, which require transection of SCM head.
Microsleep disturbances are associated with noradrenergic dysfunction in Parkinson’s disease
Authors: Doppler Christopher E J , Smit Julia A M , Hommelsen Maximilian , Seger Aline , Horsager Jacob , Kinnerup Martin B , Hansen Allan K , Fedorova Tatyana D , Knudsen Karoline , Otto Marit , Nahimi Adjmal , Borghammer Per , Sommerauer Michael 
Published: February 2021

AbstractStudy ObjectivesParkinson’s disease (PD) commonly involves degeneration of sleep-wake regulating brainstem nuclei; likewise, sleep-wake disturbances are highly prevalent in PD patients. As polysomnography macroparameters typically show only minor changes in PD, we investigated sleep microstructure, particularly cyclic alternating pattern (CAP), and its relation to alterations of the noradrenergic system in these patients.MethodsWe analyzed 27 PD patients and 13 healthy control (HC) subjects who underwent overnight polysomnography and 11C-MeNER positron emission tomography for evaluation of noradrenaline transporter density. Sleep macroparameters, as well as CAP metrics, were evaluated according to the consensus statement from 2001. Statistical analysis comprised group comparisons and correlation analysis of CAP metrics with clinical characteristics of PD patients as well as noradrenaline transporter density.ResultsPD patients and HC subjects were comparable in demographic characteristics (age, sex, body mass index) and polysomnography macroparameters. CAP rate as well as A index differed significantly between groups, with PD patients having a lower CAP rate (46.7 ± 6.6% versus 38.0 ± 11.6%, p = 0.015) and lower A index (49.0 ± 8.7/hour versus 40.1 ± 15.4/hour, p = 0.042). In PD patients, both CAP metrics correlated significantly with diminished noradrenaline transporter density in arousal prompting brainstem nuclei (locus coeruleus, raphe nuclei) as well as arousal propagating brain structures like thalamus and bitemporal cortex.ConclusionsSleep microstructure is more severely altered than sleep macrostructure in PD patients and is associated with widespread dysfunction of the noradrenergic arousal system.
Neural Representations of Death in the Cortical Midline Structures Promote Temporal Discounting
Authors: Yanagisawa Kuniaki , Kashima Emiko S , Shigemune Yayoi , Nakai Ryusuke , Abe Nobuhito 
Published: February 2021

AbstractDeath is an important reminder that our lives are finite. Although some studies have shown that thinking about one’s own death increases temporal discounting (i.e., the devaluing of future rewards), the underlying neural mechanisms are still unknown. In a functional magnetic resonance imaging experiment, we compared the neural and behavioral processes of temporal discounting across four conditions involving distinct types of future thinking (death related, negative, neutral, and positive). Replicating prior research, the behavioral evidence showed that temporal discounting increased when thinking about one’s own future death. Multivoxel pattern analysis showed that death-related future thinking was decoded in default mode regions, including the inferior parietal lobule, precuneus, and medial prefrontal cortex (MPFC). When future thinking was death related (vs. negative), increased temporal discounting was associated with a higher decoding accuracy in the precuneus and MPFC. The present findings suggest that death-related neural representations are distributed across default mode regions, and neural populations in the cortical midline structures play a crucial role in the integration of one's own death into economic decision-making.