bluuebunny/crossref_metadata_2025_split huggingface dataset:
Section 718 (Telemedicine): Virtual Health Outcomes From Regional Health Command Europe
Authors: Waibel Kirk H , Cain Steven M , Huml-VanZile Michelle , Kreciewski Nicolette , Hall Todd E , Nelson Keely , Everitt-Johnson Lauren , Black Irma , Keen Ronald S 
Published: March 2019

Abstract

Background
Section 718 of the Fiscal Year 2017 (FY17) National Defense Authorization Act (NDAA) outlines many reportable telemedicine outcomes. While the Military Health System Data Repository (MDR) and the Management and Reporting Tool M2 provide some telemedicine analyses, there are many outcomes that neither the MDR nor M2 provide. Understanding patient and provider attitudes towards telehealth and specialty-specific usage may assist initial or ongoing telehealth lines of effort within Defense Health Agency Medical Treatment Facilities (DHA MTFs).

Methods
A retrospective descriptive analysis of synchronous virtual health (VH) encounters and results from three internally developed telehealth surveys for calendar year (CY) 2016 was conducted.

Results
Three thousand seven hundred and seventy-eight synchronous VH visits for 2,962 unique patients were completed by 142 providers located within 27 distinct specialty clinics. 89.8% of patients were adults and 75.9% were Active Duty. Skill type I and II medical providers conducted 1,827 new consultations, 1,187 follow-up visits, and 371 readiness exams. Overall, specialty-specific VH use ranged from less than 1% to 39.9%. Patient satisfaction was 98% while provider satisfaction ranged from 91% to 93%. Additionally, significant intangible savings were recognized.

Conclusion
Regional medical centers conducting synchronous VH will require both internal and external data sources to report Section 718 outcomes required by Congress. As the anticipated demand for direct provider-to-patient telehealth increases, understanding these outcomes may aid initial and ongoing efforts in other military treatment facilities conducting synchronous VH.
More Than Just Counting Deaths: The Evolution of Suicide Surveillance in the Canadian Armed Forces
Authors: Rolland-Harris Elizabeth 
Published: March 2019

AbstractSuicide prevention and surveillance are of primary concern to the Canadian Armed Forces (CAF) and to the CAF Health Services (CFHS). Suicide surveillance has been conducted on behalf of the CFHS by the Directorate of Force Health Protection for nearly 30 years. Over time, multiple changes have occurred within CAF: changes in its military role (from a primarily peacekeeping role to one also involving active combat), changes in operational tempo, temporal changes in at-risk subpopulations, as well as increased awareness and concern with suicide and suicide prevention. This has resulted in the annual reporting of CAF suicide rates and the evolution of the report’s content to respond to the needs of its end users.More recently, Regular Force Army and Combat Arms males have been identified as being at significantly higher risk of suicide, relative to their counterparts, as well as to the Canadian general population. However, this trend has been fairly stable.To optimize the use of limited epidemiologic resources and to shift the focus from the rates themselves towards a better understanding of what they represent and how they can be modified, the suicide surveillance portfolio is evolving to include complementary data sources and elements.This paper describes the different data sources that constitute the CAF’s enhanced suicide surveillance portfolio, the value-added evidence generated by the use of complementary data collection methods and sources, and how this evidence is used by CAF leadership in their efforts to prevent suicide amongst those who serve.
Comparison of AR, ITS, CBT, and Didactic Training and Evaluation of Retinopathy-Based Diagnosis
Authors: Bergeron Bryan , Hagen Michael , Peterson Lars , Dworkin Ross , Bono Charles , Graham Todd , Williams Mary 
Published: March 2019

Abstract

Research objective
To test the relative efficacy of adaptive and fixed simulator training vs. adaptive and fixed computer-based training (CBT) vs. traditional lecture.

Methods
Ninety-two board certified Family Physicians were given a pretest, followed by training under one of five randomly assigned training conditions: (i) adaptive CBT; (ii) non-adaptive CBT; (iii) adaptive simulator; (iv) non-adaptive simulator; and (v) lecture. Subjects were given a post-test immediately after training and again in 6 weeks. In the adaptive groups, the content presented to subjects was a function of the subjects’ knowledge and performance, under control of a MOODLE LMS. In the lecture component, a physician projected images identical to the images in the CBT component of the study.

Results
No significant differences (p = 0.89 for ANOVA) in baseline knowledge between the five groups, based on pretest scores; In each of the five groups, our intervention resulted in immediate changes in knowledge (95% CI), based on analysis of pretest and PostTest1 scores; and, with the exception of subjects with non-adaptive, simulator intervention, all groups had significant decay in knowledge between the first and second post-tests (95% CI).

Conclusion
Periodic simulator intervention could result in significant knowledge retention over extended periods of time.
Human Papillomavirus Vaccination Rates of Military and Civilian Male Respondents to the Behavioral Risk Factors Surveillance System Between 2013 and 2015
Authors: Collins Mary K , Tarney Christopher , Craig Eric R , Beltran Thomas , Han Jasmine 
Published: March 2019

Abstract

Objective
To evaluate human papillomavirus (HPV) vaccination rates among men in the USA and to compare vaccination rates among men who had served in the military to those reporting no previous military service.

Methods
We performed a cross-sectional analysis using Behavioral Risk Factor Surveillance System (BRFSS) data from the 2013 to 2015 to analyze HPV vaccination rates for vaccine eligible adult men. The BRFSS is a multistage, cross-sectional telephone survey conducted nationally by state health departments. Univariable and logistic regression analyses were performed to examine the relationship between military service and HPV vaccination status was assessed as well as the number of HPV vaccination doses received.

Results
A total of 5,274 participants were analyzed representing a weighted estimate of 1.5 million HPV vaccine eligible men in the USA. The vaccination rate among veterans was 25.3% (95% confidence interval (CI), 18.8–33.3%) compared to 15.9% (95% CI, 14.3–17.6%) for civilians (p &lt; 0.01). Veterans were more likely to report having received at least one dose of the HPV vaccine compared to civilian men (adjusted odds ratios [aOR] = 2.7, 95% CI, 1.7%-4.1%, p &lt; 0.001).

Conclusions
Veteran men are more likely to have received HPV vaccination than similarly aged civilian men. However, for both civilians and veterans, the HPV vaccination coverage remains low when compared to their female counterparts.
Percutaneous Peripheral Nerve Stimulation to Control Postoperative Pain, Decrease Opioid Use, and Accelerate Functional Recovery Following Orthopedic Trauma
Authors: Ilfeld Brian M , Ball Scott T , Cohen Steven P , Hanling Steven R , Fowler Ian M , Wongsarnpigoon Amorn , Boggs Joseph W 
Published: March 2019

AbstractOrthopedic trauma is a significant military problem, causing several of the most disabling conditions with high rates of separation from duty and erosion of military readiness. The objective of this report is to summarize the findings of case series of a non-opioid therapy—percutaneous peripheral nerve stimulation (PNS) – and describe its potential for postoperative analgesia, early opioid cessation, and improved function following orthopedic trauma. Percutaneous PNS has been evaluated for the treatment of multiple types of pain, including two case series on postoperative pain following total knee replacement (n = 10 and 8, respectively) and a case series on postamputation pain (n = 9). The orthopedic trauma induced during TKR is highly representative of multiple types of orthopedic trauma sustained by Service members and frequently produces intense, prolonged postoperative pain and extended opioid use following surgery. Collectively, the results of these three clinical studies demonstrated that percutaneous PNS can provide substantial pain relief, reduce opioid use, and improve function. These outcomes suggest that there is substantial potential for the use of percutaneous PNS following orthopedic trauma.
Impact of Multi-Disciplinary Care and Clinical Coach Coordinators on Participant Satisfaction and Retention in TBI Clinical Trials: A TEAM-TBI Study
Authors: Mesley Matthew S , Edelman Kathryn , Sharpless Jane , Borrasso Allison , Billigen Julia B , Puffer Ross , Williams Dana , Benso Steven , Puccio Ava M , Schneider Walt , Soose Ryan , Beers Sue , Kontos Anthony , Collins Michael , Okonkwo David O 
Published: March 2019

Abstract

Background
Targeted Evaluation Action and Monitoring of Traumatic Brain Injury (TEAM-TBI) is a monitored, multiple interventional research identifying clinical profiles and assigns individualized, evidence-based treatment program. The objective of the current study was to assess overall participant satisfaction of the multi-disciplinary care team and approach.

Methods
Between 2014 and 2017, 90 participants completed the 4-day TEAM-TBI clinical intake evaluation resulting in individualized treatment recommendations followed by a six-month intervention phase follow-up. Inclusion criteria were: age 18–60, history of chronic TBI (&gt;6 months post-injury) with refractory clinical sequelae at screening (Post-Concussion Symptom Scale [PCSS] score &gt;30).

Results
A total of 85/90 (94%) participants completed the survey at baseline focusing on intake evaluation and approach; 90% of eligible participants also completed the follow-up time-point. Hundred percent of participants had a mean score of &gt;4 across all questions at the initial time point.”

Conclusions
The multi-disciplinary care approach and individualized treatment plans of the TEAM-TBI study yielded high participant retention and satisfaction scores. The Clinical Coach component of the trial was one of the highest rated aspects of the program and was associated with participant motivation and high retention rates.
Comparison of a Novel Trainer to a Traditional Swine Model for Training Providers in Lateral Canthotomy and Cantholysis
Authors: Herder Penelope Anne P , Lu Michelle M , LaPorta Anthony J , Ross David W , Calvano Christopher J , Enzenauer Robert W 
Published: March 2019

AbstractResearch ObjectiveMilitary personnel are at greater risks of head and facial traumas and permanent blindness from orbital compartment syndrome in modern warfare. Rapid treatment must be implemented with a low-risk surgical remedy: lateral canthotomy and cantholysis (LCC). Traditional training of LCC is primarily performed using an animal tissue trainer (ATT); however, limitations to these types of trainers exist. Therefore, our research objectives were focused on highlighting the effectiveness, benefits, and vision-saving potential of learning LCC on a synthetic trainer.MethodsParticipants included 22 second-year medical students and 6 healthcare professionals. A pre-quiz assessed baseline knowledge. Next, an experienced ophthalmologist provided an overview and instruction. Subjects were randomized to either the synthetic trainer or the ATT and then switched to the other model for comparison. After performing LCC procedures on both models, a post-quiz and survey were administered.ResultsParticipants found the synthetic trainer easier to use than the ATT model (p &lt; 0.01). There was no statistically significant preference (p = 0.23), or preference of practical eye anatomy (p = 0.26) between the trainers. Post-quiz results demonstrated an overall improvement from pre-quiz scores for participants (p &lt; 0.001).ConclusionsThe synthetic trainer is comparable to the traditional swine model for training LCC procedures, and should be considered as a future training platform.
A Prospective Cohort Study of Vitamin D Supplementation in AD Soldiers: Preliminary Findings
Authors: McCarthy Mary S , Elshaw Evelyn B , Szekely Barbara M , Raju Dheeraj 
Published: March 2019

Abstract

Purpose
To explore response to vitamin D supplementation in active duty (AD) warfighters and translate findings into evidence-based health policy.

Background
Soldiers are at risk for musculoskeletal injuries and metabolic dysfunction that impact physical performance and military readiness; the link with low vitamin D status is unclear.

Methods
This prospective trial enrolled 152 soldiers; baseline 25 hydroxyvitamin (OH) D level determined assignment to a no-treatment control (CG) or treatment group (TG) receiving a vitamin D3 supplement for 90 days. Symptoms, diet, sun exposure, and blood biomarkers obtained at baseline (T1) and 3 months (T2).

Results
Cohort was predominantly white (58%) with a significant difference in racial distribution for vitamin D status. Mean (SD) 25(OH)D levels were 37.8 (5.6) ng/mL, 22.2 (5.0) ng/mL, and 22.9 (4.7) ng/mL for the CG, low dose TG, and high-dose TG at T1, respectively. Following three months of treatment, one-way ANOVA indicated a statistically significant difference between groups (F5,246 = 44.37; p &lt; 0.0001). Vitamin D intake was 44% of Recommended Dietary Allowance throughout the first phase of the trial. Patient-Reported Outcomes Measurement Information System scores improved in TG for fatigue and sleep, p &lt; 0.01.

Conclusions
Vitamin D deficiency is widespread in AD soldiers. Clinicians must intervene early in preventable health conditions impacting warfighter performance and readiness and recommend appropriate self-care strategies.
An Exploratory Pilot Study to Describe Shared Decision-Making for PTSD Treatment Planning: The Provider Perspective
Authors: Etingen Bella , Hill Jennifer N , Miller Laura J , Schwartz Alan , LaVela Sherri L , Jordan Neil 
Published: March 2019

Abstract

Objective
To describe current practices used by Veterans Administration (VA) mental health (MH) providers involved in post-traumatic stress disorder (PTSD) treatment planning to support engagement of veterans with PTSD in shared decision-making (SDM).

Methods
Semi-structured interviews with MH providers (n = 9) were conducted at 1 large VA, audio-recorded, and transcribed verbatim. Transcripts were analyzed deductively, guided by a published account of the integral SDM components for MH care.

Results
While discussing forming a cohesive team with patients, providers noted the importance of establishing rapport and assessing treatment readiness. Providers’ clinical knowledge/expertise, knowledge of the facility’s treatment options, knowledge of how to navigate the VA MH care system, and patient factors (goals/preferences, factors influencing treatment engagement) were noted as important to consider when patients and providers exchange information. When negotiating the treatment plan, providers indicated that conversations should include treatment recommendations and concurrent opportunities for personalization. They also emphasized the importance of discussions to finalize a mutually agreeable patient- and provider-informed treatment plan and measure treatment impact.

Conclusion
These results offer a preliminary understanding of VA MH providers’ facilitation of SDM for PTSD care. Findings may provide insights for MH providers who wish to engage patients with PTSD in SDM.
Aggregates and Quasi-Aggregates: A Study of Dodecaphony in Schnittke’s Music
Authors: Honarmand Amin 
Published: March 2019

Abstract
After practicing Schoenbergian dodecaphony for a short period of time, Alfred Schnittke began to employ the pitch-class aggregate in a free and personal way. In his music, aggregates occur melodically, harmonically, and in a combination of the two, and are often unrelated by traditional row transformations. While Schnittke’s approach to the aggregate changes throughout his oeuvre, three features remain consistent: symmetry, chromatic motions, and diatonic/tertian elements. In addition to an in-depth study of these properties, the uses of interval classes 1, 2, 3, and 5 will be examined in relation to the three features. Moreover, the concept of quasi-aggregates will be studied in relation to complete aggregates. The examples in this article were chosen from analyses of 100 passages taken from 54 works in all genres, spanning over 30 years of Schnittke’s mature oeuvre. Finally, an analysis of the first movement of the Piano Sonata No. 1 will examine aggregates in a broader context.
We can’t afford to turn a blind eye to myopia
Authors: Bourke C M , Loughman J , Flitcroft D I , Loskutova E , O’Brien C 
Published: March 2019

Abstract

Background
Myopia is becoming increasingly prevalent throughout the world. It is an overlooked but leading cause of blindness, particularly among the working aged population. Myopia is often considered benign because it is easily corrected with glasses, contact lenses or refractive surgery. Traditionally myopia has been classified into physiological and pathological subtypes based on the degree of myopia present. Higher levels of myopia are associated with increased risk of pathological complications but it is important to note that there is no safe level of myopia. Even low levels of myopia increase the risk of retinal detachment and other ocular comorbidities which will be discussed in detail later. The most serious complication, myopic maculopathy, is the only leading cause of blindness without an established treatment and therefore leads to inevitable loss of vision in some myopes, even at a young age.

Aim
To highlight the current myopia epidemic and the sight threatening complications associated with it.

Design
This is a commissioned review article. Data were gathered by performing a literature review, searching the PubMed database for recent articles regarding myopia.

Conclusions
Myopia is a potentially blinding disease. By identifying at risk individuals and intervening before they become myopic, eye care practitioners can prevent or delay spectacle use, reduce the risk of the myriad of myopic complications, thereby improve the patient’s quality of life and positively impact its socio-economic effects.
Immigration Status and Substance Use Disorder-related Mortality in Sweden: A National Longitudinal Registry Study
Authors: Lundgren Lena , Padyab Mojgan , Lucero Nancy M. , Blom-Nilsson Marcus , Nyström Siv , Carver-Roberts Tabitha , Sandlund Mikael 
Published: March 2019

Objectives:
First-generation immigrants, in many countries, are healthier than their native counterparts. This study examined the association between first- and second-generation immigrant status and alcohol- or drugs other than alcohol-related (primarily opioids) mortality for those with risky substance use.

Methods:
A Swedish longitudinal, 2003 to 2017, registry study combined Addiction Severity Index (ASI) assessment data with mortality data (n = 15 601). Due to missing data, the analysis sample for this study was 15 012. Multivariate models tested the relationship between immigration status and drugs other than alcohol or alcohol-related mortality, controlling for demographics and the 7 ASI composite scores (CS).

Results:
Age, a higher ASI CS for alcohol, a lower ASI CS family and social relationship, a lower ASI CS for drug use and a higher ASI CS for health significantly predicted mortality because of alcohol-related causes. Higher ASI CS for drugs other than alcohol, employment, and health, age, male sex, and immigration status predicted drugs other than alcohol, related mortality. Individuals born in Nordic countries, excluding Sweden, were 1.76 times more likely to die of drugs other than alcohol compared with their Swedish counterparts. Individuals born outside a Nordic country (most common countries: Iran, Somalia, Iraq, Chile) were 61% less likely to die of drugs other than alcohol compared with their Swedish counterparts. Those with parents born outside Nordic countries were 54% less likely to die of drugs other than alcohol.

Discussion:
Research is needed on why people with risky substance use from Nordic countries (not Sweden) residing in Sweden, have higher mortality rates because of drugs other than alcohol (primarily opioids drugs other than alcohol compared with the other population groups in our study). Findings indicate that ASI CSs are strong predictors of future health problems including mortality due to alcohol and other drug-related causes.
Brief Interventions for Cannabis Use in Healthcare Settings: Systematic Review and Meta-analyses of Randomized Trials
Authors: Imtiaz Sameer , Roerecke Michael , Kurdyak Paul , Samokhvalov Andriy V. , Hasan Omer S. M. , Rehm Jürgen 
Published: March 2019

Objectives:
The efficacy of brief interventions for cannabis use was assessed in a systematic review and meta-analyses.

Methods:
Systematic searches in academic databases were conducted, and reference lists of included studies were reviewed. Randomized trials were included that compared brief interventions with minimal control interventions for improving cannabis-specific outcomes among participants recruited from healthcare settings. Mean differences (MDs) based on change-from-baseline measurements were pooled using random-effects meta-analyses, with stratification by short term (≤3 months) and long term (>3 months).

Results:
Ten reports from 9 studies were included. Most studies were conducted in the United States, including participants who were adults and were recruited from primary care or emergency departments. There were no significant effects of brief interventions on cannabis-specific Alcohol, Smoking and Substance Involvement Screening Test (ASSIST) scores in the short term (MD −1.27 points; 95% confidence interval [CI] −3.75, 1.21; I
2 84.40%). The null pattern of findings was also observed for number of days of cannabis use in the past 30 days in the short term (MD −0.22 days; 95% CI −2.27, 1.82; I
2 60.30%) and long term (MD −0.28 days; 95% CI −2.42, 1.86; I
2 60.50%). The evidence base for other outcomes not subjected to meta-analyses was limited and mixed.

Conclusions:
Brief interventions did not result in reductions in cannabis-specific ASSIST scores or number of days of cannabis use, whereas the evidence base for other outcomes was limited and mixed. As such, brief interventions in healthcare settings may not be efficacious for cannabis use.