bluuebunny/crossref_metadata_2025_split huggingface dataset:
Clinical activity at the UK military level 2 hospital in Bentiu, South Sudan during Op TRENTON from June to September 2017
Authors: Bailey Mark S , Gurney I , Lentaigne J , Biswas J S , Hill N E 
Published: April 2019

IntroductionDiseases and non-battle injuries (DNBIs) are common on UK military deployments, but the collection and analysis of clinically useful data on these remain a challenge. Standard medical returns do not provide adequate clinical information, and clinician-led approaches have been laudable, but not integrated nor standardised nor used long-term. Op TRENTON is a novel UK military humanitarian operation in support of the United Nations Mission in South Sudan, which included the deployment of UK military level 1 and level 2 medical treatment facilities at Bentiu to provide healthcare for UK and United Nations (UN) personnel.MethodsA service evaluation of patient consultations and admissions at the UK military level 2 hospital was performed using two data sets collected by the emergency department (ED) and medicine (MED) teams.ResultsOver a three-month (13-week) period, 286 cases were seen, of which 51% were UK troops, 29% were UN civilians and 20% were UN troops. The ED team saw 175 cases (61%) and provided definitive care for 113 (40%), whereas the MED team saw and provided definitive care for 128 cases (45%). Overall, there were 75% with diseases and 25% with non-battle injuries. The most common diagnoses seen by the ED team were musculoskeletal injuries (17%), unidentified non-malarial undifferentiated febrile illness (UNMUFI) (17%), malaria (13%), chemical pneumonitis (13%) and wounds (8%). The most common diagnoses seen by the MED team were acute gastroenteritis (AGE) (56%), UNMUFI (12%) and malaria (9%). AGE was due to viruses (31%), diarrhoeagenicEscherichia coli(32%), other bacteria (6%) and protozoa (12%).ConclusionData collection on DNBIs during the initial phase of this deployment was clinically useful and integrated between different departments. However, a standardised, long-term solution that is embedded into deployed healthcare is required. The clinical activity recorded here should be used for planning, training, service development and targeted research.
Comparative evaluation of the efficacy of using monocular, binocular and panoramic night vision goggles in successful venous access in darkness
Authors: Bilge Sedat , Aydin A , Yakut U 
Published: April 2019

IntroductionThe use of night vision goggles (NVGs) by medical staff operating in active combat areas may present a tactical advantage in maintaining unit concealment. This study seeks to assess the degree to which NVG use improves speed and ease of intravenous access in comparison to no NVG use, and which NVG system (monocular, binocular or panoramic) provides the best conditions for the clinician.MethodsCannulation was carried out using both eyes open (BEO) and one eye open (OEO) in well-lit conditions to establish a baseline measurement. The same procedure was then performed with a variety of NVGs, with and without infrared (IR) light sources in a dark room, and the degree of difficulty, time to procedural completion and success rate were compared.ResultsNVG use improved procedure speed in comparison to the BEO method in the dark. Among the NVG methods trialled, binocular NVG (BNVG) methods outperformed panoramic NVG (PNVG) and monocular NVG in terms of success rate.ConclusionsUse of BNVG resulted with a better success rate in our study. We would like to emphasise that although combatant units prefer PNVGs for the wider temporal vision they provide, it must be kept in mind that this may pose a disadvantage in peripheral vascular access procedures while providing first aid to the casualty at close distances.
Evolution of military medicine literature: a scientometric study of global publications on military medicine between 1978 and 2017
Authors: Şenel Engin 
Published: April 2019

ObjectivesScientometrics is a popular statistical discipline providing data relevant to publication patterns and trends in a certain academic field. There are no scientometric analyses of publications produced in military medicine literature. The present study aims to perform a holistic analysis of military medicine literature.MethodsAll data of this study were collected from theWeb of Science Core Collection. All indexed documents between 1978 and 2017 were included. Countries, authors, institutions, citations and keywords relevant to the military medicine literature were comprehensively analysed. An infomap revealing global productivity and infographics of scientometric networks were generated.ResultsA total of 48 240 published items were found, 82.29% of which were original articles. USA, covering 56.66% of all literature dominated the military medicine field followed by the UK, China, Canada and Israel. We found that 18 of 20 most productive institutions in the world were from USA and the US Department of Defense was the most contributing institution in the literature with 9664 documents. The most used keywords over a 40-year period were ‘military’, ‘veterans’, ‘posttraumatic stress disorder’ and ‘military personnel’. A scientometric network of keywords showed a complicated ‘starburst pattern’.ConclusionAll most contributing countries except Turkey, China and Israel were developed nations. Only one institution (Tel Aviv University) from developing countries was noted in the list of 20 most productive institutions. The researchers from developing and the least developed countries should be encouraged and supported to carry out novel studies on military medicine.
Repatriation for diseases or non-battle injuries (DNBI): long-term impact on quality of life
Authors: Huizinga Eelco , Idenburg F J , van Dongen T T C F , Hoencamp R 
Published: April 2019

IntroductionThroughout history, diseases and non-battle injuries (DNBI) have threatened deployed forces more than battlefield injuries. During the Dutch involvement in Afghanistan, the amount of DNBI that needed medical evacuation out of theatre (60%) exceeded the number of battle injuries (40%). The aim of this study is to explore the long-term quality of life (QoL) of Dutch service members that acquired a DNBI, warranting repatriation during their deployment to Afghanistan between 2003 and 2014.MethodsObservational cross-sectional cohort study in a selected group of Dutch service members who deployed to Afghanistan 2003–2014 and were repatriated due to DNBI. Using the 36-item Short Form, EuroQol-6D, Symptom Checklist 90 and Post Deployment Reintegration Scale questionnaires, their outcomes were compared with a control group of deployed service members who did not sustain injuries or illnesses.ResultsGroups were comparable in age, rank, number of deployments and social status. There were significant differences found in terms of physical functioning, pain and health perspective. No differences were seen in emotional or psychological outcomes.ConclusionThe amount of military service members who contract a DNBI is significant and imposes a burden on the capacity of the medical support, readiness of deployed units and sustainability of ongoing operations. However, regarding QoL, being forced to leave their units and to be repatriated to their home country due to a DNBI seems to have no significant impact on reported psychological symptoms of distress and reintegration experiences. Future research should focus on more in-depth registration of illnesses and not combat related diseases and injuries and even longer-term outcomes.
Assessing the utility of ultrasound in the role 2 hospital setting
Authors: Sellon Edward , Durdle S , Bailey D 
Published: April 2019

IntroductionThe usefulness of departmental diagnostic ultrasound in the role 2 setting has not been previously evaluated. This is because role 2 hospital manning does not traditionally include a diagnostic radiologist. This study aims to evaluate the usefulness of this added capability in the deployed role 2 hospital setting.MethodsProspective data were collected using a questionnaire alongside each scan request during the Op TRENTON 3 operational period. This included details of clinical indication and presumptive diagnosis. Scans were acquired and reported as part of routine care. The postscan clinical diagnosis and effect on management plan were determined by the treating clinician and recorded on the questionnaire. Point-of-care and focused assessment with sonography in trauma scans were excluded, as were ultrasound-guided interventional procedures.Results41 diagnostic departmental scans were included over the six-month period. 68% (28/41) of the scans increased clinical confidence in the management plan, while 29% (12/41) led to an alteration in the management plan. Only one examination (3%) was deemed to have had no clinical impact. Overall, the musculoskeletal scans had the greatest impact on patient management.ConclusionsConstraints of manoeuvrability at role 2 currently preclude the availability of body CT and shift the demand for diagnostic soft tissue imaging to ultrasound. This capability is only possible with the deployment of suitably trained individuals. This study highlights the utility of this capability at role 2. Musculoskeletal ultrasound skills were of particular value, and training should be encouraged among physiotherapists and radiographers in lieu of, where necessary, a suitably trained deployable radiologist.
How leadership training saves money ‘service line leadership’ at Nottingham University Hospitals
Authors: Orme Duncan , Campbell Colin 
Published: April 2019

New findingsThe evidence presented demonstrates that this leadership programme improved financial performance through increased participant confidence, leading to improved individual and team performance. Observations confirm that margins were maximised by clinicians when provided with granular understanding of costs and training in leadership. Limitations of the study and methodology are discussed.Background/aimThe ‘Service Line Leadership’ programme was developed at Nottingham University Hospitals National Health Service Trust to support financial recovery, through leadership skills and improved understanding of cost. Over 3 years, the programme attracted 425 participants (69 consultants). This retrospective study quantifies the impact of the programme and how it influenced leaders.MethodsThe five measures used were: (1) evaluation of the financial return on investment, (2) analysis of the mean differences between 360° psychometric assessment scores before and after the programme, (3) a survey utilising a focused interview and a follow-up questionnaire, (4) a post-programme questionnaire examining skills acquired and (5) a workshop evaluation using a net promoter score.ResultsSavings of £3.3 million were identified through the delivery of 11 separate initiatives. Quality improvements were observed. Participants were found to have changed their leadership behaviours through improved communication of trust, leading to empowerment, confidence to challenge perceptions and being mindful of others. New techniques were acquired giving rise to increased confidence in personal leadership.ConclusionThe return on investment based on projects of leaders employing the techniques from the programme, demonstrated a positive impact on the business model of the hospital.
Predictive value of platelet reactivity unit (PRU) value for thrombotic and hemorrhagic events during flow diversion procedures: a meta-analysis
Authors: Ajadi Ebunoluwa , Kabir Shaowli , Cook Aaron , Grupke Stephen , Alhajeri Abdulnasser , Fraser Justin F 
Published: April 2019

Background and purposePlatelet function testing prior to flow diversion procedures, although initially heavily debated, has seen a substantial increase in its adoption to assess the risk of operative and perioperative thrombotic and hemorrhagic events. This meta-analysis was conducted to assess platelet function testing, particularly the VerifyNow Platelet Reactivity Unit (PRU) assay, for a relationship between the reported assay PRU value and thrombotic and hemorrhagic events.Materials and methodsThe currently available literature (2013–2018) was surveyed with PubMed and Google Scholar searches. Included studies were those for which there were at least 30 cases during the study period, for which VerifyNow platelet reactivity unit values were obtained prior to the procedures and for which intraoperative and perioperative adverse events were noted. PRU value cut-offs ranging from >200 to >240 comprised the hyporesponse group while values ranging from <60 to <70 comprised the hyper-response group. The data were subject to statistical analysis to assess the relationship between PRU values and thrombotic and hemorrhagic events. The collected data were subsequently statistically analyzed to assess for publication bias.ResultsThe searches yielded 27 studies, of which 12 met the inclusion criteria for the meta-analysis. The meta-analysis included data from 1464 reported Pipeline cases. The study included 273 men and 1177 women with a mean age across the analyzed procedures of 58 years (range 25–85). After loading with antiplatelet medications, preprocedural platelet hyper-responsiveness was associated with a greater incidence of hemorrhagic events with an increased absolute risk of 12%, but showed no relationship with thrombotic events. Preprocedural platelet hyporesponsiveness was associated with a greater incidence of thrombotic events with an absolute risk of 15%, but showed no relationship with hemorrhagic events.ConclusionsVerifyNow PRU values that correspond to platelet hyporesponse or hyper-response to dual antiplatelet therapy are associated with a higher risk of thrombotic and hemorrhagic events, respectively. Thus, the PRU value may offer some predictive value for these events.
Novel clinical scores for occupational asthma due to exposure to high-molecular-weight agents
Authors: Taghiakbari Mahsa , Pralong Jacques-André , Lemière Catherine , Moullec Gregory , Saha-Chaudhuri Paramita , Cartier André , Castano Roberto , Suarthana Eva 
Published: April 2019

ObjectiveSpecific inhalation challenge (SIC) as the reference diagnostic test for occupational asthma (OA) is not widely available worldwide. We aimed to develop non-SIC-based models for OA.MethodsOf 427 workers who were exposed to high-molecular-weight agents and referred to OA clinic at Montréal Sacré-Cœur Hospital between 1983 and 2016, we analysed 160 workers who completed non-specific bronchial hyper-responsiveness (NSBHR) tests and still worked 1 month before SIC. OA was defined as positive SIC. Logistic regression models were developed. The accuracy of the models was quantified using calibration and discrimination measures. Their internal validity was evaluated with bootstrapping procedures. The final models were translated into clinical scores and stratified into probability groups.ResultsThe final model, which included age ≤40 years, rhinoconjunctivitis, inhaled corticosteroid use, agent type, NSBHR, and work-specific sensitisation had a reasonable internal validity. The area under the receiver operating characteristics curve (AUC) was 0.91 (95% CI 0.86 to 0.95), statistically significantly higher than the combination of positive NSBHR and work-specific sensitisation (AUC=0.84). The top 70% of the clinical scores (ie, the high probability group) showed a significantly higher sensitivity (96.4%vs86.9%) and negative predictive value (93.6%vs84.1%) than the combination of positive NSBHR and work-specific sensitisation (p value <0.001).ConclusionsWe developed novel scores for OA induced by high-molecular-weight agents with excellent discrimination. It could be helpful for secondary-care physicians who have access to pulmonary function test and allergy testing in identifying subjects at a high risk of having OA and in deciding on appropriate referral to a tertiary centre.
High-sensitive cardiac troponin T as a predictor of efficacy and safety after pulmonary vein isolation using focal radiofrequency, multielectrode radiofrequency and cryoballoon ablation catheter
Authors: Zeljkovic Ivan , Knecht Sven , Pavlovic Nikola , Celikyrut Umut , Spies Florian , Burri Sarah , Mannhart Dominik , Peterhans Loris , Reichlin Tobias , Schaer Beat , Osswald Stefan , Sticherling Christian , Kuhne Michael 
Published: April 2019

IntroductionMyocardial injury markers such as high-sensitive cardiac troponin T (hs-cTnT) and creatine kinase MB (CK-MB) reflects the amount of myocardial injury with ablation. The aim of the study was to identify the value of myocardial injury markers to predict outcomes after pulmonary vein isolation (PVI) using three different ablation technologies.MethodsConsecutive patients undergoing PVI using a standard 3.5 mm irrigated-tip radiofrequency catheter (RF-group), an irrigated multielectrode radiofrequency catheter (IMEA-group) and a second-generation cryoballoon (CB-group) were analysed. Blood samples to measure injury markers were taken before and 18–24 hours after the ablation. Procedural complications were collected and standardised follow-up was performed. Logistic regression was used to identify predictors of recurrence and complications.Results96 patients (RF group: n=40, IMEA-group: n=17, CB-group: n=39) undergoing PVI only were analysed (82% male, age 59±10 years). After a follow-up of 12 months, atrial fibrillation (AF) recurred in 45% in the RF-group, 29% in the IMEA-group and 36% in the CB-group (p=0.492). Symptomatic pericarditis was observed in 20% of patients in the RF-group, 15% in the IMEA-group and 5% in the CB-group (p=0.131). None of the injury markers was predictive of AF recurrence or PV reconnection after a single procedure. However, hs-cTnT was identified as a predictor of symptomatic pericarditis (OR: 1.003 [1.001 to 1.005], p=0.015).ConclusionHs-cTnT and CK-MB were significantly elevated after PVI, irrespective of the ablation technology used. None of the myocardial injury markers were predictive for AF recurrence or PV reconnection, but hs-cTnT release predicts the occurrence of symptomatic pericarditis after PVI.
Cardiorespiratory fitness in patients with rheumatoid arthritis is associated with the patient global assessment but not with objective measurements of disease activity
Authors: Liff Marthe Halsan , Hoff Mari , Fremo Thomas , Wisløff Ulrik , Thomas Ranjeny , Videm Vibeke 
Published: April 2019

ObjectivePatients with rheumatoid arthritis (RA) suffer from more cardiovascular disease (CVD), and develop cardiovascular risk factors at an earlier age than the general population. Cardiorespiratory fitness (CRF) is an important predictor of cardiovascular health. There are few data regarding CRF of RA patients, measured as peak oxygen uptake (VO2peak) by the gold standard method; cardiopulmonary exercise testing. We compared CRF in RA patients to those from a healthy population, and investigated if risk factors for CVD and RA-specific variables including subjective and objective disease activity measures were associated with CRF in RA patients.MethodsVO2peaktests of RA patients (n=93) were compared to those of an age-matched and gender-matched healthy population (n=4631) from the Nord-Trøndelag Health Study. Predictors of VO2peakwere found using Lasso (least absolute shrinkage and selection operator) regression, followed by standardised multiple linear regression.ResultsWomen with RA ≥40 years and men with RA aged 40–49 years or 60–69 years had up to 20% lower CRF than the healthy population in the same age groups. By relative importance, body mass index (standardised coefficient=−0.25, p<0.001), physical activity level (coefficient=0.21, p<0.001), patient global assessment (PGA; coefficient=−0.14, p=0.006), systolic blood pressure (coefficient=−0.12, p=0.016), resting heart rate (coefficient=−0.11, p=0.032) and smoking (coefficient=−0.10, p=0.046) were significant predictors of CRF (R2=0.82, gender-adjusted and age-adjusted).ConclusionCRF in RA patients was lower than in a healthy population. CRF was associated with common risk factors for CVD and the PGA score. Focusing on fitness in RA patients may improve cardiovascular health.
Heated tobacco products use in Chinese adults in Hong Kong: a population-based cross-sectional study
Authors: Wu Yongda Socrates , Wang Man Ping , Ho Sai Yin , LI Ho Cheung William , Cheung Yee Tak Derek , Tabuchi Takahiro , Kwong Antonio CS , Lai Vienna , Lam Tai Hing 
Published: April 2019

IntroductionWe investigated heated tobacco products (HTPs) use and associated factors in Chinese adults in Hong Kong where HTPs are not formally marketed yet, and cigarette smoking prevalence was the lowest in the developed world.MethodsA population-based landline telephone survey in 2017 interviewed 5131 (45.2% male; 26.7% aged ≥60) adults to collect information on awareness, intention to use, ever use of HTPs, cigarette smoking status and sociodemographic characteristics. Descriptive statistics were weighted by the age, sex and smoking status of the Hong Kong adult population. Sociodemographics were mutually adjusted in logistic regression to yield adjusted ORs (AORs) for awareness of HTPs, controlling for smoking status.ResultsOverall, 11.3% (95% CI 10.0% to 12.7%) were aware of HTPs and 1.0 % (0.8%–1.2%) had ever used it. Awareness was associated with aged 40–49 years (AOR 1.37, 95% CI 1.01 to 1.87) or 30–39 years (2.03, 1.41–2.91) (vs ≥60 years), born in Hong Kong (1.37, 1.11–1.68) and higher monthly household income (p for trend 0.001). Ever HTP users had higher educational attainment and monthly household income, and more were aged 30–39 and economically active (all p<0.003). In never HTP users, intention to use HTPs (7.3%, 4.9%–10.8%) were more prevalent in respondents with similar characteristics (all p<0.008). More current (vs never) smokers were aware of HTPs, intent to use HTPs and had ever used HTPs (all p<0.001).ConclusionHigher socioeconomic status was associated with HTP use and intention to use. Public health education on HTPs is needed especially for this high-risk group.
Experiment study of water based photovoltaic-thermal (PV/T) collector
Authors: Razali Nur Farhana Mohd , Fudholi Ahmad , Ruslan Mohd Hafidz , Sopian Kamaruzzaman 
Published: April 2019

<span lang="EN-US">Solar radiation can be converted to the electrical energy and thermal energy by photovoltaic panel and solar collector. In this experiment, PV/T collector was designed, fabricated and tested its performance. The experiment conducted on PV/T collector with water flow at mass flow rate 0.012 kg/s to 0.0255 kg/s. The water flow with the stainless stell absorber help the PV/T collector in increasing the convection of thermal heat transfer. The power output increase with increase of radiation. The efficiency of PVT varies with different intensity of radiation which stated in this experiment for 750 W/m<sup>2</sup> and 900 W/m<sup>2</sup>. The analysis of energy and exergy are excuted and results show energy output for water based PV/T collector are 346 W for solar radiation 700 W/m<sup>2</sup> and 457 W for solar radiation 900 W/m<sup>2</sup>. Meanwhile the total exergy output compared to the PV panel without stainless stell absorber, which the exergy increased by 22.48% for 700 W/m<sup>2</sup> and 20.87% for 900 W/m<sup>2</sup>.</span>