bluuebunny/crossref_metadata_2025_split huggingface dataset:
Augmented Reality as a Medium for Improved Telementoring
Authors: Rojas-Muñoz Edgar , Andersen Dan , Cabrera Maria Eugenia , Popescu Voicu , Marley Sherri , Zarzaur Ben , Mullis Brian , Wachs Juan P 
Published: March 2019

AbstractCombat trauma injuries require urgent and specialized care. When patient evacuation is infeasible, critical life-saving care must be given at the point of injury in real-time and under austere conditions associated to forward operating bases. Surgical telementoring allows local generalists to receive remote instruction from specialists thousands of miles away. However, current telementoring systems have limited annotation capabilities and lack of direct visualization of the future result of the surgical actions by the specialist. The System for Telementoring with Augmented Reality (STAR) is a surgical telementoring platform that improves the transfer of medical expertise by integrating a full-size interaction table for mentors to create graphical annotations, with augmented reality (AR) devices to display surgical annotations directly onto the generalist’s field of view. Along with the explanation of the system’s features, this paper provides results of user studies that validate STAR as a comprehensive AR surgical telementoring platform. In addition, potential future applications of STAR are discussed, which are desired features that state-of-the-art AR medical telementoring platforms should have when combat trauma scenarios are in the spotlight of such technologies.
Fast Fourier Transformation of Peripheral Venous Pressure Changes More Than Vital Signs with Hemorrhage
Authors: Bonasso Patrick C , Dassinger Melvin S , McLaughlin Brady , Burford Jeffrey M , Sexton Kevin W 
Published: March 2019

Abstract
Vital signs are included in the determination of shock secondary to hemorrhage; however, more granular predictors are needed. We hypothesized that fast Fourier transformation (FFT) would have a greater percent change after hemorrhage than heart rate (HR) or systolic blood pressure (SBP). Using a porcine model, nine 17 kg pigs were hemorrhaged 10% of their calculated blood volume. Peripheral venous pressure waveforms, HR and SBP were collected at baseline and after 10% blood loss. FFT was performed on the peripheral venous pressure waveforms and the peak between 1 and 3 hertz (f1) corresponded to HR. To normalize values for comparison, percent change was calculated for f1, SBP, and HR. The mean percent change for f1 was an 18.8% decrease; SBP was a 3.31% decrease; and HR was a 0.95% increase. Using analysis of variance, FFT at f1 demonstrates a statistically significant greater change than HR or SBP after loss of 10% of circulating blood volume (p = 0.0023). Further work is needed to determine if this could be used in field triage to guide resuscitation.
Relationships and Evidence-Based Theoretical Perspectives on Persisting Symptoms and Functional Impairment Among Mild Traumatic Brain Injury and Behavioral Health Conditions
Authors: Herrold Amy A , Smith Bridget , Aaronson Alexandra L , Coleman John , Pape Theresa L -B 
Published: March 2019

Abstract
The purpose of this study is to characterize and describe the relationships between symptoms and functional impairment following mild traumatic brain injury (mTBI) and behavioral health conditions (BHCs) in order to inform evidence-based theories on why symptoms and functional impairments persist in some individuals but not others. This is a retrospective, multi-site, cross-sectional study utilizing data collected from a total of 289 Operation Iraqi Freedom/Operation Enduring Freedom Veterans who were classified into diagnostic groups using the symptom attribution and classification algorithm and the VA clinical reminder and comprehensive traumatic brain injury evaluation. The Neurobehavioral Symptom Inventory was used to assess mTBI symptom number and severity. The World Health Organization Disability Assessment Schedule 2.0 was used to assess functional impairment. Symptom profiles differed between diagnostic groups irrespective of symptom attribution method used. Veterans with both mTBI and BHCs and those with BHCs alone had consistently greater number of symptoms and more severe symptoms relative to no symptom and symptoms resolved groups. Symptom number and severity were significantly associated with functional impairment. Both symptom number and functional impairment were significantly associated with the number of mTBI exposures. Together, these results informed evidence-based theories on understanding why symptoms and functional impairment persist among some OEF/OIF Veterans.
The Joint Pathology Center/Vision Center of Excellence Approach to Analyzing Intra-Ocular “Foreign Bodies”
Authors: Lewin-Smith Michael R , Strausborger Stacy L , Jenkins H Marie , Merezhinskaya Natalya , Latkany Paul A , Mazzoli Robert A , Colyer Marcus H , Mines Michael J 
Published: March 2019

Abstract

Background
The Military Health System recognizes the importance of analyzing “foreign bodies” removed from US service members through several policy documents. This activity focuses on detecting potentially toxic metals. Intra-ocular “foreign bodies” (IOFBs) represent a small, clinically important subset. The development of ocular metallosis with iron and copper fragments is a specific local reaction to IOFBs. The results of the compositional analysis of removed IOFBs can influence clinical management decisions aimed at optimizing the preservation of sight.

Method
The Joint Pathology Center (JPC) and Vision Center of Excellence (VCE) have established a pathway for the analysis of IOFBs removed from Department of Defense and Veterans Health Administration patients. The analysis of IOFBs uses analytical methods to provide information about the fragments’ surface elemental and molecular composition.

Results
Metallic specimens analyzed included iron and copper-containing fragments. Non-metallic IOFBs analyzed include glass, plastic (polyurethane), and nitro-cellulose fragments.

Conclusion
The JPC/VCE approach to analyzing IOFBs promotes uniform handling and shipping of specimens to minimize contamination. The analytical approach allows for the characterization of IOFBs with a wide variety of compositions. The results support clinical management decisions aimed at optimal treatment for the preservation of patients’ visual acuity.
Autoimmunity-Associated Gut Commensals Modulate Gut Permeability and Immunity in Humanized Mice
Authors: Balakrishnan Baskar , Luckey David , Taneja Veena 
Published: March 2019

Abstract

Objective
Although the etiology of rheumatoid arthritis (RA) is unknown, recent studies have led to the concept that gut dysbiosis may be involved in onset. In this study, we aimed to determine if human gut commensals modulate the immune response and gut epithelial integrity in DQ8 mice.

Methods
DQ8 mice were orally gavaged with RA-associated (Eggerthella lenta or Collinsella aerofaciens) and non-associated (Prevotella histicola or Bifidobacterium sp.) on alternate days for 1 week in naïve mice. Some mice were immunized with type II collagen and oral gavage continued for 6 weeks and followed for arthritis. Epithelial integrity was done by FITC-Dextran assay. In addition, cytokines were measured in sera by ELISA and various immune cells were quantified using flow cytometry.

Results
Gut permeability was increased by the RA-associated bacteria and was sex and age-dependent. In vivo and in vitro observations showed that the RA-non-associated bacteria outgrow the RA-associated bacteria when gavaged or cultured together. Mice gavaged with the RA-non-associated bacteria produced lower levels of pro-inflammatory MCP-1 and MCP-3 and had lower numbers of Inflammatory monocytes CD11c+Ly6c+, when compared to controls. E. lenta treated naïve mice produce Th17 cytokines.

Conclusions
Our studies suggest that gut commensals influence immune response in and away from the gut by changing the gut permeability and immunity. Dysbiosis helps the growth of RA-associated bacteria and reduces the beneficial bacteria.
Development of a Mobile Motion Capture (MO2CA) System for Future Military Application
Authors: Parks Melissa , Chien Jung Hung , Siu Ka-Chun 
Published: March 2019

Abstract
State-of-the-art three-dimensional motion analysis systems, which are utilized to predict, diagnose, and treat many musculoskeletal and neurological disorders, are expensive and space consuming. These systems have only been widely used in large research facilities because of their lack of this transportability. Since device portability is a critically important in the military, most small military hospitals are therefore deprived of these systems. The purpose of this study was to develop a mobile motion capture system, MO2CA, to automatically detect the movement of the human body. Twenty healthy young adults participated in this study. Colored tape was attached on the heel, and subjects walked on the treadmill at three different speeds: preferred, fast, and slow. Two motion capture systems were used concurrently: Qualisys (100 Hz) and MO2CA (60 Hz). Four dependent variables were: stride length, stride time, stride length variability, and stride time variability. Paired t-tests, Pearson correlation, and Bland–Altman plots were used to investigate the statistical differences between two systems. No significant differences were found for all dependent variables. Regression and Bland–Altman plots showed strong agreements between the two systems. Our MO2CA shows a potential for real-time tracking of biomechanical changes in gait, which is extremely important for military use.
Correlates of Depression in U.S. Military Service Members With a History of Mild Traumatic Brain Injury
Authors: Kennedy Jan E , Lu Lisa H , Reid Matthew W , Leal Felix O , Cooper Douglas B 
Published: March 2019

AbstractObjectivesPost-traumatic stress disorder (PTSD) and traumatic brain injury (TBI) are identified as signature injuries of the Wars in Iraq and Afghanistan. Statistics have confirmed a high incidence of PTSD among military personnel with mild TBI (mTBI) who served in these conflicts. Although receiving less attention, individuals with a history of mTBI are also at increased risk for depressive disorders. This study examines the incidence and correlates of depression in service members with a history of mTBI received an average of 4–1/2 years prior to evaluation.MethodsRetrospective analysis of 184 service members with a history of mTBI extracted from a data repository maintained at a military medical center.ResultsOne-third of the sample (34.2%) was clinically diagnosed with a depressive disorder in the month preceding evaluation. Of those with depression, 81% (51 of 63) were also diagnosed with PTSD. Proportionately more women than men had depression. Depression was more common among those who were undergoing a Military Evaluation Board and those who served in more than three combat deployments.ConclusionsResults confirm chronically elevated the rates of depressive disorders and PTSD comorbidity among service members with a history of mTBI. Depression screening and treatment within the Military Health System should remain a priority for service members reporting a remote history of mTBI. Individuals with chronic PTSD, women, service members undergoing MEB and those who served in greater than three combat deployments are at particular risk.
Impact of Tinnitus on Military Service Members
Authors: Henry James A , Griest Susan E , Blankenship Cody , Thielman Emily J , Theodoroff Sarah M , Hammill Tanisha , Carlson Kathleen F 
Published: March 2019

Abstract

Objectives
The Noise Outcomes in Servicemembers Epidemiology (NOISE) Study is obtaining longitudinal data to evaluate the effects of noise and other exposures on auditory function in military personnel. A gap in the literature is the lack of studies concerning how active-duty Service members might be impacted by having tinnitus. The present study reports NOISE Study data that address this gap.

Methods
Data are reported from current Service members and recently-separated (within 2.5 years) Veterans, enabling a direct comparison of results between active and post-military samples. Data were collected from two sites: VA Portland Health Care System, Portland, OR and Department of Defense Hearing Center of Excellence, San Antonio, TX. Participants completed comprehensive audiometric testing and numerous questionnaires.

Results
Results are presented from n = 428 participants across the two sites, including 246 Veterans and 182 Service members. The data reveal that, for both Service members and Veterans, the presence of tinnitus has effects on job performance, concentration, anxiety, depression, and sleep.

Conclusions
This study has revealed that, for these samples of study participants, tinnitus has an impact on military Service members that is comparable to how it affects Veterans who have completed their military service within the previous 2.5 years.
Low-Level Primary Blast Induces Neuroinflammation and Neurodegeneration in Rats
Authors: Li Yansong , Yang Zhangsheng , Liu Bin , Valdez Celina , Chavko Mikulas , Cancio Leopoldo C 
Published: March 2019

AbstractObjectiveMild blast traumatic brain injury is commonly prevalent in modern combat casualty care and has been associated with the development of neurodegenerative conditions. However, whether primary lower level blast overpressure (LBOP) causes neurodegeneration and neuroinflammation remains largely unknown. The aim of our present study was to determine whether LBOP can cause neuroinflammation and neurodegeneration.MethodsAnesthetized rats were randomly assigned to LBOP group (70 kPa, n = 5) or sham group (without blast, n = 5). Histopathological and cytokine changes in brain tissue at 5 days post-injury were evaluated by hematoxylin-eosin staining and Bioplex assay, respectively.ResultsHistopathological assessment revealed neuronal degeneration and increased density of inflammatory cells in frontal and parietal cortex, hippocampus and thalamus in rats exposed to LBOP. LBOP exposure significantly elevated levels of pro-inflammatory cytokines (EPO, IL-1β, IL-6, IL-12, IL-18, and TNF-α) and chemokines (GRO and RANTES) as well as of an anti-inflammatory cytokine (IL-13) in the frontal cortex.ConclusionsThis study reveals a role of neuroinflammation in neurodegeneration after mild blast traumatic brain injury. Therapies that target this process might in warfighters might function either by attenuating the development of post-traumatic stress disorder, chronic traumatic encephalopathy and Alzheimer’s disease, or by slowing their progression.
The Impact of Affective States on Postconcussive Symptoms in a TBI Population
Authors: Garcia Katelyn , Moore Brian , Kim Grace , Dsurney John , Chan Leighton 
Published: March 2019

AbstractThe occurrence of persistent postconcussive symptoms (PCS) associated with traumatic brain injury (TBI) is an increasing cause of disability and lost productivity. The reasons for these persistent symptoms in a percentage of even mild TBI are poorly understood. The existence of comorbid conditions such as post-traumatic stress disorder or other traumatic injuries may be factors that impact the presence of PCS. We expect that greater levels of affective symptoms will be associated with increases in PCS assessed on the Neurobehavioral Symptom Inventory (NSI). TBI subjects (N = 69) who were seen 1 year post-injury were recruited from a larger cohort study of TBI. Subjects were administered the NSI, Brief Symptom Inventory-18 (BSI-18) and the Post Traumatic Stress Disorder Checklist (PCL). Data were analyzed using Spearman’s rho correlations and analysis of variances. We found significant correlations between the four NSI factors and the three BSI factors and the PCL total score. Mild TBI subjects were found to have the highest correlations between affective and somatic symptoms. These findings support our hypothesis that affective states are associated with higher PCS reporting and that early identification and treatment may decrease PCS.
A Mobile Device Dual-Task Paradigm for the Assessment of mTBI
Authors: Linder Susan M , Koop Mandy Miller , Ozinga Sarah , Goldfarb Zachary , Alberts Jay L 
Published: March 2019

AbstractResearch ObjectiveDual-task performance, in which individuals complete two or more activities simultaneously, is impaired following mild traumatic brain injury. The aim of this project was to develop a dual-task paradigm that may be conducive to military utilization in evaluating cognitive-motor function in a standardized and scalable manner by leveraging mobile device technology.MethodsFifty healthy young adult civilians (18–24 years) completed four balance stances and a number discrimination task under single- and dual-task conditions. Postural stability was quantified using data gathered from iPad’s native accelerometer and gyroscope. Cognitive task difficulty was manipulated by presenting stimuli at 30, 60, or 90 per minute. Performance of cognitive and balance tasks was compared between single- and dual-task trials.ResultsCognitive performance from single- to dual-task paradigms showed no significant main effect of balance condition or the interaction of condition by frequency. From single- to dual-task conditions, a significant difference in postural control was revealed in only one stance: tandem with eyes closed, in which a slight improvement in postural stability was observed under dual-task conditions.ConclusionThe optimal dual-task paradigm to evaluate cognitive-motor performance with minimal floor and ceiling effects consists of tandem stance with eyes closed while stimuli are presented at a rate of one per second.
Combat-Related Extremity Wounds: Injury Factors Predicting Early Onset Infections
Authors: Stewart Laveta , Shaikh Faraz , Bradley William , Lu Dan , Blyth Dana M , Petfield Joseph L , Whitman Timothy J , Krauss Margot , Greenberg Lauren , Tribble David R 
Published: March 2019

AbstractWe examined risk factors for combat-related extremity wound infections (CEWI) among U.S. military patients injured in Iraq and Afghanistan (2009–2012). Patients with ≥1 combat-related, open extremity wound admitted to a participating U.S. hospital (≤7 days postinjury) were retrospectively assessed. The population was classified based upon most severe injury (amputation, open fracture without amputation, or open soft-tissue injury defined as non-fracture/non-amputation wounds). Among 1271 eligible patients, 395 (31%) patients had ≥1 amputation, 457 (36%) had open fractures, and 419 (33%) had open soft-tissue wounds as their most severe injury, respectively. Among patients with traumatic amputations, 100 (47%) developed a CEWI compared to 66 (14%) and 12 (3%) patients with open fractures and open soft-tissue wounds, respectively. In a Cox proportional hazard analysis restricted to CEWIs ≤30 days postinjury among the traumatic amputation and open fracture groups, sustaining an amputation (hazard ratio: 1.79; 95% confidence interval: 1.25–2.56), blood transfusion ≤24 hours postinjury, improvised explosive device blast, first documented shock index ≥0.80, and &gt;4 injury sites were independently associated with CEWI risk. The presence of a non-extremity infection at least 4 days prior to a CEWI diagnosis was associated with lower CEWI risk, suggesting impact of recent exposure to directed antimicrobial therapy. Further assessment of early clinical management will help to elucidate risk factor contribution. The wound classification system provides a comprehensive approach in assessment of injury and clinical factors for the risk and outcomes of an extremity wound infection.
Implementing the Knowledge Assessment of CPT Critical Skills (KACCS) Scale
Authors: Atuel Hazel R , Ursich Luci , Schuyler Ashley , Berg Dax , Kintzle Sara , Castro Carl 
Published: March 2019

Abstract
Cognitive processing therapy (CPT) has been endorsed as an evidence-based therapy for PTSD. It is currently being implemented within the Veterans Health Administration (VA) as a manualized, trauma-focused psychotherapy in line with recommendations from the most recent VA/DOD Clinical Practice Guideline for the management of PTSD. While research on CPT implementation has focused on individual factors that facilitate or hinder adoption, little is known on whether trainees retain core concepts of CPT. The present research addresses this gap in the literature by conducting a validation study of the Knowledge Assessment of CPT Critical Skills (KACCS) Scale among known user groups of CPT (no experience, immediate user, expert user) and, subsequently, an implementation study of the KACCS Scale among clinician trainees participating in an online CPT training. The validation study found that the KACCS Scale can discriminate among various CPT user groups (no experience, intermediate, expert), while the implementation study found that the KACCS Scale provides specific information on core concepts that have been learned at the end of training. The KACCS Scale could benefit from further validation studies and, subsequently, be added to the current CPT instrumentation to monitor learning and retention of core concepts at various training periods (initial workshop, consultation, booster workshop).
Modeling Framework Used to Analyze and Describe Junctional Tourniquet Skills
Authors: Bauchwitz Benjamin R , Curley Taylor , Kwan Calvin , Niehaus James M , Pugh Carla M , Weyhrauch Peter W 
Published: March 2019

AbstractMedical educators have acknowledged the importance of simulation training in developing procedural skills. While simulation training in other disciplines has benefitted from evaluations of users’ skill acquisition, the majority of medical training simulators continue to be developed from overly simplified descriptions of procedures, such as techniques prescribed by existing instructional material. Our objective was to use a modeling framework to characterize the skill of various users in applying junctional tourniquets in order to design an effective training simulator. We recorded 46 medical first responders performing training exercises applying a junctional tourniquet and used coded video and sensor data to identify the hierarchy of actions they performed in the process. The model provides several insights into trainee performance, such as the way in which advanced users perform more tasks in parallel, or areas where advanced users employ situational awareness to identify ways they can deviate from recommended protocol to improve outcomes. The model successfully identifies variations in tourniquet application technique that correlates with improvement on clinically relevant metrics including application speed, pressure applied, and tourniquet placement stability. This methodology can improve medical training simulations by indicating changes during the course of learning a new task, such as helpful deviations from instructional protocol.