bluuebunny/crossref_metadata_2025_split huggingface dataset:
Sweating the Little Things: Tourniquet Application Efficacy in Two Models of Pediatric Limb Circumference
Authors: El- Sherif Nibras , Lowndes Bethany , Franz Walter , Hallbeck M Susan , Belau Steven , Sztajnkrycer Matthew D 
Published: March 2019

AbstractBackgroundCurrent military recommendations include the use of tourniquets (TQ) in appropriate pediatric trauma patients. Although the utility of TQs has been well documented in adult patients, the efficacy of TQ application in pediatric patients is less clear. The current study attempted to identify physical constraints for TQ use in two simulated pediatric limb models.MethodsFive different TQ (Combat Application Tourniquet (CAT) Generation 6 and Generation 7, SOFTT (SOF Tactical Tourniquet), SOFTT-W (SOF Tactical Tourniquet – Wide), SWAT-T (Stretch Wrap and Tuck – Tourniquet) and a trauma dressing were evaluated in two simulated pediatric limb models. Model one employed four cardiopulmonary resuscitation (CPR) manikins simulating infant (Simulaids SaniBaby), 1 year (Gaumard HAL S3004), and 5 years (Laerdal Resusci Junior, Gaumard HAL S3005). Model two utilized polyvinyl chloride (PVC) piping with circumferences ranging from 4.25” to 16.5”. Specific end-points included tightness of the TQ and ability to secure the windlass (where applicable).ResultsIn both models, the ability to successfully apply and secure the TQ depended upon the simulated limb circumference. In the 1-year-old CPR manikin, all windlass TQs failed to tighten on the upper extremity, while all TQs successfully tightened at the high leg and mid-thigh. With the exception of the CAT7 and the SOFTT-W at the mid-thigh, no windlass TQ was successfully tightened at any extremity location on the infant. The SWAT-T was successfully tightened over all sites of all CPR manikins except the infant. No windlass TQ was able to tighten on PVC pipe 5.75” circumference or smaller (age &lt; 24 months upper extremity). All windlass TQs were tightened and secured on the 13.25” and 15.5” circumference PVC pipes (age 7–12 years lower extremity, age &gt;13 years upper extremity). The SWAT-T was tightened on all PVC pipes.DiscussionThe current study suggests that commercial windlass TQs can be applied to upper and lower extremities of children aged 5 years and older at the 50%th percentile for limb circumference. In younger children, windlass TQ efficacy is variable. Further study is required to better understand the limitations of TQs in the youngest children, and to determine actual hemorrhage control efficacy.
Naval Health Research Center Surveillance for Meningococcal Disease
Authors: Broderick Michael , Myers Christopher 
Published: March 2019

Abstract
Historically, meningococcal disease has had a devastating impact on U.S. military personnel, but since the introduction of a vaccine in the 1970s, rates have dropped over 90%.1 Department of Defense instructions mandate a meningococcal vaccine for all service personnel. In the last 5 years, rates of meningococcal disease in the military are similar to the U.S. general population. The active duty incidence was 0.21 cases per 100,000 person-years from 2013–2017. Six cases occurred in the 6 months between September 2016 and February 2017; of these, only one was determined to be a vaccine-covered strain. Ongoing surveillance shows vaccination has resulted in a dramatic reduction in meningococcal cases in the military; however, it also demonstrates cases continue to occur sporadically. The recent emergence of new cases reminds us that surveillance and accompanying research are important for evaluating changes in the disease and informing new vaccine development and policy.
Females Engaged in Elite Training Previously Only Open to Males: Exploring the Variables of Successful Outcomes
Authors: Givens Melissa L , Eklund Kathryn 
Published: March 2019

Abstract
To date, there has been no analysis of the skills or attributes predicting success in female trainees who undergo traditionally male elite military training. This retrospective case control study characterized variables specific to females in the Special Operations Combat Medic course. 20/39 males and 15/38 females successfully completed the course. Several objective variables of interest including height and body weight, marital status, dependents, and physical fitness scores revealed trends but marital status and dependents were the only variables that achieved statistical significance. Exploration of subjective measures also highlighted potential trends in upper body strength and personal versus behavioral issues. These variables should be explored further for applicability to altering selection criteria or adjusting training conditions to mitigate sex disparities without altering standards of performance or creating an imbalance of resource investment for intended returns. The variables identified in this sample can be explored in other populations as females are integrated in other previously closed realms of military service.
Prominent Injury Types in Vehicle Underbody Blast
Authors: Loftis Kathryn L , Mazuchowski Edward L , Clouser Mary C , Gillich Patrick J 
Published: March 2019

Abstract

Background
To fully understand the injury mechanisms during an underbody blast (UBB) event with military vehicles and develop new testing standards specific to military vehicles, one must understand the injuries sustained by the occupants.

Methods
Injury data from Service Members (SM) involved in UBB theater events that occurred from 2010 to 2014 were analyzed. Analysis included the investigation of prominent skeletal and visceral torso injuries. Results were categorized by killed-in-action (n = 132 SM) and wounded-in-action (n = 1,887 SM).

Results
Over 90% (553/606 SM) of casualties in UBB events with Abbreviated Injury Scale (AIS) 2+ injury sustained at least one skeletal fracture, when excluding concussion. The most frequent skeletal injuries from UBB were foot fractures (13% of injuries) for wounded-in-action and tibia/fibula fractures (10% of injuries) for killed-in-action. Only 1% (11/1037 SM) of all casualties with AIS 2+ injuries had visceral torso injuries without also sustaining skeletal fractures. In these few casualties, the coded injuries were likely due to trauma from a loading path other than direct UBB loading.

Conclusion
Skeletal fractures are the most frequent AIS 2+ injury resulting from UBB events. Visceral torso injuries are infrequent in individuals that survive and they generally occur in conjunction with skeletal injuries.
4-Aminopyridine as a Single Agent Diagnostic and Treatment for Severe Nerve Crush Injury
Authors: Noble Mark , Tseng Kuang-Ching (Chris) , Li Haiyan , Elfar John C 
Published: March 2019

AbstractBackgroundTraumatic peripheral nerve injury (TPI) is a major medical problem without effective treatment options. There is no way to diagnose or treat an incomplete injury and delays contribute to morbidity. We examined 4-aminopyridine (4-AP), a potassium-channel blocker as a possible treatment for TPI.MethodsWe used standard mouse models of TPI with functional outcomes including sciatic-functional-index, sensory indices, and electrodiagnostics; in addition to standard immunohistochemical, and electron microscopic correlates of axon and myelin morphology.ResultsSustained early 4-AP administration increased the speed and extent of behavioral recovery too rapidly to be explained by axonal regeneration. 4-AP also enhanced recovery of nerve conduction velocity, promoted remyelination, and increased axonal area post-injury. 4-AP treatment also enabled the rapid distinction between incomplete and complete nerve lesions.Conclusion4-AP singularly provides both a new potential therapy to promote durable recovery and remyelination in acute peripheral nerve injury and a means of identifying lesions in which this therapy would be most likely to be of value. The ability to distinguish injuries that may respond to extended therapy without intervention can offer benefit to wounded soldiers.
Anticipating the Sun’s heavy-element abundance
Authors: Gough D O 
Published: March 2019

Abstract
Much of our understanding of the internal structure of the Sun derives from so-called standard theoretical solar models. Unfortunately, none of those models agrees completely with observations. The discrepancy is commonly associated with chemical abundance, and has led to what is now called the solar abundance problem, the resolution of which has previously been out of sight. But now the Borexino Collaboration, which recently announced measurements of the pp-chain solar neutrinos, are optimistic that they will be able to measure the flux ΦCNO of the neutrinos emitted by the relatively weak CNO cycle. Since C, N, and O constitute the majority of the heavy elements, that measurement will permit a crucial determination of the heavy-element abundance Zc in the Sun’s energy-generating core, thereby shedding important light on the problem. To accomplish that determination, a robust relation between Zc and ΦCNO will be required. That relation is $Z_{\rm c}= 0.400\, \Phi _{\rm CNO}$, where ΦCNO is in units of 1010 cm−2 s−1.
Pain Intensity, Pressure Pain Hypersensitivity, Central Sensitization, and Pain Catastrophizing Related to Vascular Alterations in Raynaud’s Phenomenon: A Preliminary Case–Control Study
Authors: Tapia-Haro Rosa María , Guisado-Barrilao Rafael , García-Ríos María del Carmen , Raya-Álvarez Enrique , Pérez-Mármol José Manuel , Aguilar-Ferrándiz María Encarnación 
Published: March 2019

Abstract

Objective
To evaluate pain intensity, widespread pressure pain, central sensitization (CS), and catastrophizing between subjects with primary and secondary Raynaud’s phenomenon (RP) and healthy controls and to compare the relationships between vascular impairment and pain perception.

Methods
A preliminary case–control study was performed with a total sample of 57 participants (37 with RP). Sociodemographic data, clinical/vascular data, and pain variables (pain intensity, pressure pain sensitivity, pain magnitude and threshold, CS, and catastrophizing) were registered. Results were analyzed by analysis of covariance and Pearson correlation.

Results
Participants with RP had a lower basal temperature (more vasoconstriction) in their hands (P ≤ 0.012), higher pain intensity (P ≤ 0.001), higher electrical pain magnitude (P &lt; 0.001), and lower pressure pain (P ≤ 0.05) and electrical pain (P &lt; 0.001) thresholds in comparison with healthy controls. Secondary RP participants showed a significantly higher level of CS compared with controls and primary RP participants (P = 0.001). Catastrophizing was higher in the primary and secondary RP (P ≤ 0.001) groups than in controls. No correlations were observed between severity of vasoconstriction and pain variables.

Conclusions
RP participants showed bilateral hypersensitivity to pressure pain. However, the severity of vascular alterations seems not to be related to central pain experiences. Additional mechanisms such as catastrophizing may influence pain in RP; nevertheless, central sensitization only appears to be involved in the secondary form of RP.
External Validity in a Stochastic World: Evidence from Low-Income Countries
Authors: Rosenzweig Mark R , Udry Christopher 
Published: March 2019

Abstract
We examine empirically the generalizability of internally valid micro-estimates of causal effects in a fixed population over time when that population is subject to aggregate shocks. Using panel data, we show that the returns to investments in agriculture in India and Ghana, small and medium non-farm enterprises in Sri Lanka, and schooling in Indonesia fluctuate significantly across time periods. We show how the returns to these investments interact with specific, measurable, and economically relevant aggregate shocks, focusing on rainfall and price fluctuations. We also obtain lower-bound estimates of confidence intervals of the returns based on estimates of the parameters of the distributions of rainfall shocks in our two agricultural samples. We find that even these lower-bound confidence intervals are substantially wider than those based solely on sampling error that are commonly provided in studies, most of which are based on single-year samples. We also find that cross-sectional variation in rainfall cannot be confidently used to replicate within-population rainfall variability. Based on our findings, we discuss methods for incorporating information on external shocks into evaluations of the returns to policy.
Radiation Treatment for Ewing Sarcoma Family of Tumors in Adult Patients
Authors: Kharod Shivam M. , Spiguel Andre R. , Lagmay Joanne P. , Jones Charles , Morris Christopher G. , Gibbs Charles Parker , Zlotecki Robert A. 
Published: March 2019

Purpose/Objectives:
To report prognostic factors and long-term outcomes in adults with Ewing sarcoma treated with definitive radiotherapy.

Materials and Methods:
We reviewed patients 18 years old and above with nonmetastatic Ewing sarcoma treated with radiotherapy +/− chemotherapy or surgery. Outcomes were stratified by age (30 and above vs. younger than 30 y), soft tissue extension, tumor size (≥8.5 vs. <8.5 cm), tumor location, resection (yes vs. no), and treatment era (1970–1992 vs. 1993–2012). Toxicities were scored using the RTOG criteria.

Results:
Fifty-five patients (21 women) were treated with radiotherapy. Average age at diagnosis: 26.7 years (38 patients below 30 vs. 17 patients 30 y and above). A total of 43 had soft tissue extension (78%). Median tumor size: 8.5 cm. Most tumors were in the pelvis (40%), followed by the lower (27%) and upper (24%) extremities. All but 1 patient received chemotherapy; 13 underwent resection. Median dose: 55 Gy. Median follow-up: 3.6 years; 17.5 years for living patients. The 5-year overall (OS) and cause-specific survival (CSS) rates were both 46%. OS and CSS rates were unaffected by age (P=0.97), tumor size (P=0.12), or tumor location (P=0.99). Soft tissue extension portended a significantly poorer prognosis for 5-year OS and CSS: 37% vs. 82% (with and without, respectively; P=0.04). Patients who underwent resection had improved 5-year OS and CSS: 77% vs. 37%, respectively (P=0.01). Patients treated after 1993 had improved 5-year OS: 58% vs. 37% (P=0.0264).

Conclusions:
Adult patients with Ewing sarcoma experience similar treatment outcomes regardless of age at diagnosis. Soft tissue extension represents a poor prognostic factor. Aggressive trimodality therapy achieved the highest OS and CSS.
Immediate Soft-Tissue Reconstruction for Chronic Infected Tibia Nonunions Treated with an Ilizarov Frame
Authors: Jubbal Kevin T. , Zavlin Dmitry , Doval Andres F. , Cherney Steven M. , Brinker Mark R. , Dinh Tue A. , Echo Anthony 
Published: March 2019

Summary:
There are multiple options available for the management of large tibial defects. The Ilizarov frame is one of the most widely used techniques due to the physiological bone growth and the symmetrical distribution of axial forces permitting adequate bone distribution. However, disadvantages still remain including obtaining additional soft-tissue access for defect coverage. We present our experience with soft-tissue reconstruction for chronic infected tibial nonunions using free tissue transfers simultaneously with Ilizarov device placement. A retrospective review was performed from 2014 to 2016 of patients presenting with a chronically infected tibia nonunion and treated by our senior orthopedic and plastic surgeons. Demographic data, comorbidities, intraoperative details and postoperative outcomes were collected. A total of 6 patients were identified with a mean age of 46.2 ± 11.6 years. Complete flap survival and resolved active infection were achieved in 5 of our patients, 4 demonstrated body union on imaging, and all of them reached complete ambulance. Flap revisions with allografting for partial flap loss were performed in 1 patient. Preoperative planning is critical for immediate lower extremity reconstruction in the setting of an Ilizarov frame. From our institutional experience, free tissue transfer can safely be placed after frame placement.
Dose Reconstruction Using Electron Paramagnetic Resonance Dosimetry on Tooth Enamel From Wild Boar Living in the Fukushima Exclusion Zone
Authors: Harshman Amber , Johnson Thomas 
Published: March 2019

Abstract
The goal of the study was to establish characteristics of Japanese wild boar tooth enamel in the dose region of 0.25–2.0 Gy and to reconstruct external absorbed doses to wild boar native to the Fukushima exclusion zone using electron paramagnetic resonance dosimetry. The significance of Japanese wild boar in their ecosystem and their position within the trophic hierarchy make the wild boar a species of particular importance and therefore, the focus of this study. Dose response linearity and variability of enamel originating from various wild boar were investigated. Radiation dose response of Japanese wild boar tooth enamel in the range of 0.25–2.0 Gy was found to be linear, and the average variation in dose response between teeth originating from the same boar specimen was nearly 30%. No statistically significant difference in dose response was found based on sex of the boar or in permanent molar teeth of boar of differing ages. Electron paramagnetic resonance absorbed doses to boar tooth enamel were successfully reconstructed using the calibration curve method and converted into estimates of absorbed dose to soft tissue with large associated confidence intervals. The critical level dose value for the calibration curve was 1.0 Gy and the detection limit dose was 1.8 Gy, suggesting that this method would be more beneficial for boar with lifetime absorbed doses greater than 1.0 Gy. The method of reconstructing external absorbed doses using electron paramagnetic resonance dosimetry with tooth enamel from Japanese wild boar as dosimeters has proven to be a viable method which can be used to reconstruct absorbed doses to wildlife in accident-stricken areas in the absence of alternative dosimetry.
Development of the Environmental Radiation Survey Program and Its Application to In Situ Gamma-Ray Spectrometry
Authors: Ji Young-Yong , Jang Mee , Lee Wanno 
Published: March 2019

Abstract
An environmental radiation survey using a gamma-ray spectrometer is used to rapidly detect radioactive contamination over a wide area of ground that was released from nuclear events. For the successful application of a gamma-ray spectrometer to the calculation of the radioactivity concentration in the ground and the dose rate at 1 m above the ground, it is necessary to build a calibration procedure to obtain the counting efficiency at the in situ measurement, which means in situ calibration factor to report the calculation results from the measured net count rate according to the diverse detection geometries. This study is focused on the development of a program to calculate the in situ calibration factor and report the survey results in the environmental radiation surveys using three kinds of gamma-ray spectrometers, which have been widely used in the field of in situ measurements: a coaxial HPGe detector, cylindrical NaI(Tl), and rectangular NaI(Tl). The program is based on the results of diverse theoretical calculations of the unscattered photon fluence at the detector height, detector responses of three detectors, and their angular corrections. The developed program was successfully applied to the estimation of the radioactivity concentration of nuclides in the ground and the dose rate at 1 m height above the ground induced from them.
Intercomparison of Commercially Available Active Radon Measurement Devices in a Discovered Radon Chamber
Authors: Carmona Marco A. , Kearfott Kimberlee J. 
Published: March 2019

Abstract
An unventilated 70 m3 underground space, with 2.1 m high ceilings and an inner set of concrete walls to damp vibrations, was discovered to have relatively stable radon levels of ~1,080 Bq m−3 over a 1-y period. The addition of radium sources was not required to achieve high and somewhat variable radon levels, as these arise naturally in the space. Several active radon monitoring devices designed for homeowners, radon screeners, radon mitigation professionals, and researchers were tested in the space. These devices were variable in both cost and intended user sophistication. Data were collected at specific time intervals that varied for each device. A cellphone was deployed with an available camera application to periodically capture photographs of the displays of devices not enabled for automatic temporal recording. Attempts were made to alter the radon concentration using fans, radium-laden objects, and radon impermeable sheets. Statistical methods were employed to compare the device's performance under the minor radon transients produced by the addition of 226Ra sources during the test period. The evaluation of the overall accuracy, noise, and response to transients revealed highly affordable devices that may be useful for future research applications. While unsuitable for precise calibrations at stable radon levels, the space was determined to be adequate as a radon chamber for general research purposes.
Small Benign Storiform Fibrous Tumor (Fibrous Histiocytoma) of the Conjunctival Substantia Propria in a Child: Review and Clarification of Biologic Behavior
Authors: Tieger Marisa G. , Jakobiec Frederick A. , Ma Lina , Wolkow Natalie 
Published: March 2019

Purpose:
A case of a small benign storiform fibrous tumor of the conjunctival substantia propria is described to clarify the category of fibrous histiocytoma. In addition, a comparison of the various spindle cell tumors of the conjunctival substantia propria is explored.

Methods:
The patient underwent a complete tumor excision, and the specimen was analyzed by histopathologic and immunohistochemical investigations.

Results:
A cellular mass, composed solely of spindle cells in a storiform pattern without a component of histiocytic cells, was found beneath an undisturbed nonkeratinizing squamous epithelium and was separated from the epithelium by a grenz zone of uninvolved collagen. The lesion was sharply demarcated but not encapsulated. The Masson trichrome stain revealed scant deposition of intercellular collagen. The reticulin stain displayed numerous and delicate wiry fibers between the tumor cells and encircling capillaries. The Alcian blue stain demonstrated faint positivity in the interstitium. Immunohistochemistry revealed positivity for vimentin, factor XIIIa, smooth muscle actin, CD10, and CD45. Negative stains were obtained for CD34, CD56, S100, desmin, and Ki67.

Conclusions:
The broad term of fibrous histiocytoma should be reserved for deep fibroblastic spindle cell tumors (e.g., those of the orbit) that display an aggressive behavior. More benign superficial spindle cell tumors of the dermis are now preferentially characterized as dermatofibromas. It is suggested that equally benign epibulbar tumors should no longer be designated as fibrous histiocytomas but rather as benign storiform fibrous tumors. Tumors completely composed of polygonal histiocytoid (epithelioid) cells that are CD34+ should be excluded from the benign storiform fibrous tumor category. Positive smooth muscle actin and factor XIIIa staining in conjunction with negative staining for CD34 and desmin in the current spindled tumor cells are findings consistent with those of cutaneous dermatofibromas. Both the epibulbar and dermal spindle cell lesions have displayed an indolent and nonaggressive behavior. Microscopically they contain a high proportion of dendrocytic stellate cells that are either factor XIIIa+ or XIIIa−. Given the anatomic differences between the dermis and conjunctiva, the term dermatofibroma is inappropriate for the current tumor; instead the term benign storiform fibrous tumor has been proposed for superficial tumors of the conjunctiva.