bluuebunny/crossref_metadata_2025_split huggingface dataset:
A Paradigm Shift in Critical Care Infrastructure in Complex Settings: Evaluating an Ultraportable Operating Room to Improve Field Surgical Safety
Authors: Teodorescu Debbie L , Okajima Stephen , Moten Asad , Teodorescu Mike H M , El Hechi Majed , Gutierrez-Arango Samantha , Meier Karien , Smalley Robert J , King David R 
Published: January 2021

ABSTRACT

Introduction
Scarcity of operating rooms and personal protective equipment in far-forward field settings make surgical infections a potential concern for combat mortality and morbidity. Surgical and transport personnel also face infectious risks from bodily fluid exposures. Our study aimed to describe the serial, proof-of-concept testing of the SurgiBox technology: an inflatable sterile environment that addresses the aforementioned problems, fits on gurneys and backpacks, and drapes over incisions.

Materials and Methods
The SurgiBox environmental control unit and inflatable enclosure were optimized over five generations based on iterative feedback from stakeholders experienced in surgery in austere settings. The airflow system was developed by analytic modeling, verified through in silico modeling in SOLIDWORKS, and confirmed with prototype smoke-trail checking. Particulate counts evaluated the enclosure’s ability to control and mitigate users’ exposures to potentially infectious contaminants from the surgical field in various settings. SurgiBox enclosures were setup over a mannequin’s torso, in a configuration and position for either thoracic or abdominal surgery. A particle counter was serially positioned in sternotomy and laparotomy positions, as well as bilateral flank positions. This setup was repeated with open ports exposing the enclosure to the external environment. To simulate stress scenarios, sampling was repeated with enclosure measurements during an increase in external particulate concentration.

Results
The airflow technology effectively kept contaminants away from the incision and maintained a pressure differential to reduce particle entry. Benchtop testing demonstrated that even when ports were opened or the external environment had high contaminant burden, the enclosed surgical field consistently registered 0 particle count in all positions. Time from kit opening to incision averaged 54.5 seconds, with the rate-limiting step being connecting the environmental control unit to the enclosure. The portable kit weighted 5.9 lbs.

Conclusions
Analytic, in silico, and mechanical airflow modeling and benchtop testing have helped to quantify the SurgiBox system’s reliability in creating and maintaining an operating room-quality surgical field within the enclosure as well as protecting the surgical team outside the enclosure. More recent and ongoing work has focused on specifying optimal use settings in the casualty chain of care, expanding support for circumferential procedures, automating airflow control, and accelerating system setup. SurgiBox’s ultimate goal is to take timely, safe surgery to patients in even the most austere of settings.
MG53 as a Novel Therapeutic Protein to Treat Acute Lung Injury
Authors: Whitson Bryan A , Mulier Kristine , Li Haichang , Zhou Xinyu , Cai Chuanxi , Black Sylvester M , Tan Tao , Ma Jianjie , Beilman Greg J 
Published: January 2021

ABSTRACT

Introduction
Lung injury has several inciting etiologies ranging from trauma (contusion and hemorrhage) to ischemia reperfusion injury. Reflective of the injury, tissue and cellular injury increases proportionally with the injury stress and is an area of potential intervention to mitigate the injury. This study aims to evaluate the therapeutic benefits of recombinant human MG53 (rhMG53) protein in porcine models of acute lung injury (ALI).

Materials and Methods
We utilized live cell imaging to monitor the movement of MG53 in cultured human bronchial epithelial cells following mechanical injury. The in vivo efficacy of rhMG53 was evaluated in a porcine model of hemorrhagic shock/contusive lung injury. Varying doses of rhMG53 (0, 0.2, or 1 mg/kg) were administered intravenously to pigs after induction of hemorrhagic shock/contusive induced ALI. Ex vivo lung perfusion system enabled assessment of the isolated porcine lung after a warm ischemic induced injury with rhMG53 supplementation in the perfusate (1 mg/mL).

Results
MG53-mediated cell membrane repair is preserved in human bronchial epithelial cells. rhMG53 mitigates lung injury in the porcine model of combined hemorrhagic shock/contusive lung injury. Ex vivo lung perfusion administration of rhMG53 reduces warm ischemia-induced injury to the isolated porcine lung.

Conclusions
MG53 is an endogenous protein that circulates in the bloodstream. Therapeutic treatment with exogenous rhMG53 may be part of a strategy to restore (partially or completely) structural morphology and/or functional lung integrity. Systemic administration of rhMG53 constitutes a potential effective therapeutic means to combat ALI.
Quantifying Clinical Opportunities at the Navy Trauma Training Center
Authors: Schmied Blackman Virginia , Torres Tony , Stakley Jami A , Raiciulescu Sorana , Garcia Elizabeth , Ross Jeffrey L , Polk Travis M , Stotts Nancy A 
Published: January 2021

ABSTRACT

Introduction
Military-Civilian partnerships (MCPs), such as the Navy Trauma Training Center, are an essential tool for training military trauma care providers. Despite Congressional and military leadership support, sparse data exist to quantify participants’ clinical opportunities in MCPs. These preliminary data from an ongoing Navy Trauma Training Center outcomes study quantify clinical experiences and compare skill observation to skill performance.

Materials and Methods
Participants completed clinical logs after each patient encounter to quantify both patients and procedures they were involved with during clinical rotations; they self-reported demographic data. Data analyses included descriptive statistics and chi-square statistics to compare skills observed to skills performed between the first and second half of the 21-day course.

Results
A sample of 47 Navy personnel (30 corpsmen, 10 nurses, 3 physician assistants, 4 physicians) completed 551 clinical logs. Most logs (453/551) reflected experiences in the emergency department, where corpsmen and nurses each spent 102.0 hours, and physician assistants and physicians each spent 105.4 hours. Logs completed per participant ranged from 1 to 31, (mean = 8). No professional group was more likely than others to complete the clinical logs. Completion rates varied by cohort, both overall and by clinical role. Of emergency department logs, 39% reflected highest acuity patients, compared with 21% of intensive care unit logs, and 61% of operating room logs. Penetrating trauma was reported on 16.5% of logs. Primary and secondary trauma assessments were the most commonly reported clinical opportunities, followed by obtaining intravenous access and administration of analgesic medications. With few exceptions, logs reflected skill observation versus skill performance, a ratio that did not change over time.

Conclusion
Prospective real-time data of actual clinical activity is a crucial measure of the success of MCPs. These preliminary data provide a beginning perspective on how these experiences contribute to maintaining a skilled military medical force.
Prevention of Blast-induced Auditory Injury Using 3D Printed Helmet and Hearing Protection Device – A Preliminary Study on Biomechanical Modeling and Animal
Authors: Jiang Shangyuan , Gannon Ariana N , Smith Kyle D , Brown Marcus , Liang Junfeng , Gan Rong Z 
Published: January 2021

ABSTRACT

Introduction
Repeated blast exposures result in structural damage to the peripheral auditory system (PAS) and the central auditory system (CAS). However, it is difficult to differentiate injuries between two distinct pathways: the mechanical damage in the PAS caused by blast pressure waves transmitted through the ear and the damage in the CAS caused by blast wave impacts on the head or traumatic brain injury. This article reports a preliminary study using a 3D printed chinchilla “helmet” as a head protection device associated with the hearing protection devices (e.g., earplugs) to isolate the CAS damage from the PAS injuries under repeated blast exposures.

Materials and Methods
A finite element (FE) model of the chinchilla helmet was created based on micro-computed tomography images of a chinchilla skull and inputted into ANSYS for FE analysis on the helmet’s protection against blast over pressure. The helmet was then 3D printed and used for animal experiments. Chinchillas were divided into four cases (ears open, with earplug only, with both earplug and helmet, and with helmet only) and exposed to three blasts at blast over pressure of 15 to 20 psi. Hearing function tests (e.g., auditory brainstem response) were performed before and after blast on Day 1 and Days 4 and 7 after blasts.

Results
The FE model simulation showed a significant reduction in intracranial stress with the helmet, and the animal results indicated that both earplug and helmet reduced the severity of blast-induced auditory injuries by approximately 20 dB but with different mechanisms.

Conclusions
The biomechanical modeling and animal experiments demonstrated that this four-case study in chinchillas with helmet and hearing protection devices provides a novel methodology to investigate the blast-induced damage in the PAS and CAS.
Quality of Life After Open Abdominal Treatment With Vacuum-Assisted Wound Closure and Mesh-Mediated Fascial Traction
Authors: Schaaf Sebastian , Schwab Robert , Willms Arnulf 
Published: January 2021

ABSTRACT

Introduction
Little is known about the long-term outcome of open abdomen treatment with vacuum-assisted wound closure and mesh-3. Therefore, this study’s purpose is to evaluate this with a particular focus on incisional hernia development and quality of life (QoL).

Materials and Methods
Fifty-five patients who underwent vacuum-assisted wound closure and mesh-mediated fascial traction at our institution from 2006 to 2013 were prospectively enrolled in this study. After a median follow-up period of 3.8 years, 34 patients attended a follow-up examination, including the SF-36 QoL questionnaire.

Results
The fascial closure rate was 74% (intention-to-treat) and 89% (per-protocol). Enteroatmospheric fistulae occurred in 1.8%. In-hospital mortality was 16.4%, and during the follow-up period, it was 27.4%. Incisional hernias developed in 35% of the cases.
The SF-36 physical role (54.6 ± 41.0 (0-100), P &lt; 0.01), physical functioning (68.4 ± 29.5 (0-100), P = 0.01), and physical component summary (41.6 ± 13.0 (19-62), P = 0.01) scores for the patient population were significantly lower than normative scores. The mental dimensions of QoL showed no differences.
A subgroup analysis revealed that the lower scores for physical role, physical functioning, and physical component summary only existed in the subgroup of incisional hernia patients. In contrast, physical and mental SF-36 scores of patients without incisional hernias did not differ from the normative scores.

Conclusions
Vacuum-assisted wound closure and mesh-mediated fascial traction seems to result in low complication rates. However, incisional hernias occur in 35%, which are the leading cause of reduced QoL. Measures to further improve this rate, such as prophylactic meshes, have to be evaluated.
Neck Vertebral Level-specific Forces and Moments Under G-x Accelerative Loading
Authors: Purushothaman Yuvaraj , Humm John , Jebaseelan Davidson , Yoganandan Narayan 
Published: January 2021

ABSTRACTIntroductionIt is important to determine the local forces and moments across the entire cervical spine as dysfunctions such as spondylosis and acceleration-induced injuries are focused on specific levels/segments. The aims of the study were to determine the axial and shear forces and moments at each level under G-x accelerative loading for female and male spines.MethodsA three-dimensional finite element model of the male head-cervical spinal column was developed. G-x impact acceleration was applied using experimental data from whole body human cadaver tests. It was validated with experimental head kinematics. The model was converted to a female model, and the same input was applied. Segmental axial and shear forces and moments were obtained at all levels from C2 to T1 in male and female spines.ResultsThe time of occurrence of peak axial forces in male and female spines ranged from 37 to 41 ms and 31 to 35 ms. The peak times for the shear forces in male and female spines ranged from 65 to 86 ms and 58 to 78 ms. The peak times for the bending moment ranged from 79 to 91 ms for male and 75 to 83 ms for female spines. Other data are given.ConclusionsAll metrics reached their peaks earlier in female than male spines, representing a quicker loading in the female spine. Peak magnitudes were also lower in the female spines. Moments and axial forces varied differently compared to the shear forces in the female spine, suggesting that intersegmental loads vary nonuniformly. Effects of head inertia contributed to the greatest increase in axial force under this impact acceleration vector. Because female spines have a lower biomechanical tolerance to injury, female spines may be more vulnerable to injury under this load vector.
Fast-Running Tools for Personalized Monitoring of Blast Exposure in Military Training and Operations
Authors: Przekwas Andrzej , Garimella Harsha T , Chen Z J , Zehnbauer Tim , Gupta Raj K , Skotak Maciej , Carr Walter S , Kamimori Gary H 
Published: January 2021

ABSTRACT

Introduction
During training and combat operations, military personnel may be exposed to repetitive low-level blast while using explosives to gain entry or by firing heavy weapon systems such as recoilless weapons and high-caliber sniper rifles. This repeated exposure, even within allowable limits, has been associated with cognitive deficits similar to that of accidental and sports concussion such as delayed verbal memory, visual-spatial memory, and executive function. This article presents a novel framework for accurate calculation of the human body blast exposure in military heavy weapon training scenarios using data from the free-field and warfighter wearable pressure sensors.

Materials and Methods
The CoBi human body model generator tools were used to reconstruct multiple training scenes with different weapon systems. The CoBi Blast tools were used to develop the weapon signature and estimate blast overpressure exposure. The authors have used data from the free-field and wearable pressure sensors to evaluate the framework.

Results
Carl-Gustav and 0.50 caliber sniper training scenarios were used to demonstrate and validate the developed framework. These simulations can calculate spatially and temporally resolved blast loads on the whole human body and on specific organs vulnerable to blast loads, such as head, face, and lungs.

Conclusions
This framework has numerous advantages including easier model setup and shorter simulation times. The framework is an important step towards developing an advanced field-applicable technology to monitor low-level blast exposure during heavy weapon military training and combat scenarios.
Biomechanically Based Correlate for Localized Lung Contusion From Nonlethal Blunt Impact Projectiles
Authors: Cui Jianxia , Rapo Mark , Mathews Kiran , Webber Charles , Ng Laurel 
Published: January 2021

ABSTRACT

Introduction
Injury mechanics of blunt impact projectiles differ from those experienced in whole body motor vehicle collisions because the effects are localized around the point of impact, and thus, injury thresholds based upon gross chest kinematics (e.g., force, velocity) may not be applicable across impact types. Therefore, knowledge of biomechanically based tissue injury correlates for blunt impact projectiles are needed to better guide design and development of protective systems as well as assess injury risks from blunt impact projectile weapons.

Materials and Methods
In this study, subject-specific swine finite element models were used to quantify the tissue-level stresses and strains resulting from high speed projectile impact. These tissue-level injury doses were correlated to pathology injury outcomes to produce injury risk curves for lung contusion. Details of the pathology data and finite element results are provided in Appendix 1. Survival analysis regression methods were applied to develop lung injury regression curves and a number of statistical methods were used to evaluate several biomechanical metrics as correlates to lung contusion. Uncertainty and sensitivity analyses were used to further confirm the selection of the correlate.

Results
Statistical analysis revealed that normalized strain-energy density was the best correlate for prediction of lung tissue damage. Going further, normalized strain-energy density also proved to be suitable for prediction of the percentage of contused lung volume, a more meaningful medical diagnosis. As expected, peak strain-energy density is most sensitive to muscle-skin properties, as quantified through a comprehensive uncertainty and sensitivity analysis over three sets of projectile weights and speeds.

Conclusions
Normalized strain-energy density was found to be the best correlate for prediction of lung tissue damage and correlate well to extent of contused lung volume.
Superior Monitoring of Chemical Exposure Using Nanoconfinement Technology
Authors: Apblett Allen , Materer Nicholas , Kadossov Evgueni , Shaikh Shoaib 
Published: January 2021

ABSTRACT

Introduction
Military personnel are exposed to a broad range of potentially toxic compounds that can affect their health. These hazards are unpredictable because military service occurs in a wide array of uncontrolled environments. Therefore, a novel sorbent was developed that allows the fabrication of lightweight personal samplers that are both capable of sorbing an extremely wide range of organic chemical types and able to stabilize reactive compounds.

Materials and Methods
OSU-6, a nanoporous silica, was provided by XploSafe LLC. The sorption capacity for several volatile organic compounds, the temperatures required for thermal desorption of adsorbed compounds, and the sampling rates for targeted analytes were determined.

Results
The uptake capacity was found to be on average 1.5 g/g of sorbent. Analytes were not only held tightly but also could be desorbed upon heating the sorbate to temperatures below 150°C. Sampling rates for volatile organic compound by an OSU-6 sampler badge were on average, 5.7 times higher than those for a commercially available activated carbon badge. Theoretical calculations showed that sorption of volatile organic compounds on the surface of the tightly curved pore walls in OSU-6 is because of exceptionally strong cumulative addition of Van der Waals forces. Analytes could readily be analyzed by either solvent extraction or thermal desorption gas chromatography/mass spectrometry techniques. Excellent sampling rates, high concentrations of analytes in the OSU-6 sorbent matrix, and high desorption efficiencies (recoveries) were obtained using the thermal desorption method.

Conclusions
The performance of the OSU-6 sorbent makes it highly capable of meeting the need for personal samplers that enable Individual Longitudinal Exposure Records development. It can adsorb an extremely wide array of different volatile organic compounds, it can stabilize reactive compounds, it has high sampling rates coupled with high capacity that provide both sensitivity and resistance to saturation, and it is unique in being very amenable to thermal desorption in combination with having strong sorbate binding and high capacity and surface area.
Disability Status Attenuates Treatment Effects in an Intensive Outpatient Program for PTSD
Authors: Hoyt Tim , Shumaker Brianna E Staley 
Published: January 2021

ABSTRACT

Introduction
The utilization of intensive outpatient programs for the treatment of military-related post-traumatic stress disorder (PTSD) has increased through initiatives both inside and outside the military health care system. However, research in veteran populations suggest that patients concurrently undergoing disability evaluation may not respond well to such interventions. This study evaluates the relationship between disability separation and endorsement of PTSD symptoms during treatment at an intensive outpatient program.

Methods
Patients in this retrospective study were 81 service members enrolled in a half-day, 6-week intensive outpatient program for PTSD. Sixty-seven percent (n = 54) were concurrently enrolled in the integrated disability evaluation system and were pending medical separation. Fifty-two percent (n = 42) also received a 4-week skills training intervention before beginning PTSD treatment. Patients completed the PTSD Checklist before, during, and after the treatment program as an index of PTSD symptoms.

Results
A significant interaction effect was observed in which PTSD symptoms throughout program enrollment differed as a function of enrollment in the integrated disability evaluation system. Patients undergoing disability evaluations did not show significant changes in endorsed PTSD symptoms during program enrollment, whereas significant decreases in PTSD symptoms were observed in patients not undergoing disability evaluations. These effects controlled for lost treatment days as a result of training or other appointments.

Conclusions
These results provide preliminary data indicating that participation in disability separation may attenuate the effect of PTSD treatment and endorsement of PTSD symptoms in an intensive outpatient setting.
Efficacy of Hemostatic Gauzes in a Swine Model of Prolonged Field Care with Limb Movement
Authors: Landers Grace D , Townsend Cassandra , Gaspary Micah , Kachur Ryan , Thorne Brian , Stuart Sean , Henao Jose , Zarow Gregory J , Natarajan Ramesh , Boboc Michael 
Published: January 2021

ABSTRACTIntroductionProlonged field care for junctional wounds is challenging and involves limb movement to facilitate transport. No studies to date have explored the efficacy of gauze products to limit rebleeding in these scenarios.Materials and MethodsWe randomly assigned 48 swine to QuikClot Combat Gauze, ChitoGauze, NuStat Tactical, or Kerlix treatment groups (12 each) and then inflicted a severe groin injury by utilizing a modified Kheirabadi model of a 6-mm femoral artery punch followed by unrestricted bleeding for 60 seconds. We reassessed rebleed following limb movement at 30 minutes of stabilization and 4 hours after stabilization.ResultsSwine treated with Combat Gauze proved to have the lowest incidence of rebleeding, and conversely, NuStat Tactical had the highest incidence of rebleeding at wounds after limb movement. Importantly, rebleeds occurred at a rate of 25%-58% across all swine treatment groups at 30 minutes postinjury and 0%-42% at 270 minutes postinjury demonstrating that limb movements universally challenge hemostatic junctional wounds.ConclusionsOur findings highlight the difficulty of controlling hemorrhage from junctional wounds with hemostatic gauze in the context of prolonged field care and casualty transport. Our research can guide selection of hemorrhage control gauze when patients have prolonged field extraction or difficult transport. Our data demonstrates the frequency of junctional wound rebleeding after movement and thus the importance of frequent patient reassessment.