bluuebunny/crossref_metadata_2025_split huggingface dataset:
Perceptions and Response to Conservative Treatment of Low Back Pain in Soldiers During Initial Entry Training: A Convergence Mixed Methods Study
Authors: Schoonover Cortney M , Turner Stephen L , Woods Yvette , Smith-Forbes Enrique , Rhon Daniel I 
Published: March 2019

Abstract
Low back pain (LBP) is a common condition suffered by military personnel. Psychosocial factors play a role in LBP prognosis and can be addressed with self-management tools. This study’s purpose was to (1) describe clinical changes in psychosocial factors of LBP following a self-management intervention and (2) explore the LBP experience of military trainees. Ten participants in Initial Entry Training (IET) were included in this mixed methods study. A self-management intervention of exercises and psychosocial education was provided. Quantitative instruments assessing psychosocial factors were delivered at baseline and 6 weeks. Qualitative data were gathered after treatment and analyzed using a phenomenological approach. Low levels of psychosocial risk factors were reported. Patient satisfaction (COPM-Satisfaction subscale) was the only outcome that achieved statistical significance at 6 weeks (p = 0.037). Three themes emerged from the qualitative results: the influence of the military culture on recovery from LBP, the LBP experience of a trainee, and promoting the self-management of LBP. While this cohort of IET soldiers exhibited low levels of psychosocial risk factors, qualitative reports indicate that LBP has a negative impact on participation in training, academics, and interpersonal relationships. The constraints of military training make seeking care and applying treatment strategies challenging.
IV DripAssist: An Innovative Way to Monitor Intravenous Infusions Away From an Outlet?
Authors: Couperus Kyle , Kmiecik Karl , Kang Christopher 
Published: March 2019

Abstract
Intravenous (IV) administration of fluids and medications are a significant part of patient treatment. In austere environments, typical methods of counting drops from gravity drips or infusion pumps both have limitations such as accuracy, weight, and need for power. The DripAssist device calculates drip rates by counting drops in IV tubing drip chambers and may provide a useful patient safety monitor adjunct. The protocol was IRB approved, prospective, and designed as a pilot study involving 28 Madigan Army Medical Center Emergency Department personnel. After a brief didactic introduction to the device for clinical staff with no prior experience using the device, participants were timed setting three normal saline infusions at rates of 250 mL/h, 125 mL/h and 83 mL/h with 15gtt/mL tubing. Participants filled out a survey on perceived ease of use and utility of the device compared to pumps and manual counting. Most participants felt the DripAssist device was easy to understand and set up, but nurses and physician assistants were more likely than medics to perceive a benefit versus IV pumps or gravity drips. The DripAssist device may offer a safe, low-weight, functional tool which could improve care in a variety of resource-limited environments. However, additional studies using the device during actual field exercises would be beneficial.
Evaluation of the Commercial, Off-the-Shelf (COTS) King-Devick Eye Tracking System
Authors: Onge Paul St , Temme Leonard A , McAtee Aaron , O’Brien Kevin J , Byrd Brigid K 
Published: March 2019

Abstract
Concussion biomarkers are important guides for diagnosis and return-to-duty decisions. Recent literature describes the King-Devick (KD) test as a sensitive sports-related concussion screener. This test involves timing an individual reading aloud 120 digits printed on three test cards. The test is commonly considered to evaluate the effects of concussion and other factors on reading-related eye movements (EMs). However, the extent to which the KD test reflects EMs remains a matter of conjecture since the test reports only reading speed and number of errors. An off-the-shelf, computerized KD with eye tracking system recently became commercially available. Two early model KD with eye tracking systems were purchased in 2015 and evaluated before deploying them for research. The evaluation consisted of two studies; one with 20 volunteers assessing the comparability of the two systems and the other with 5 volunteers to quantify the systems’ stability and repeatability over 5 successive days. The results showed that several of the systems’ reported EM response parameters lacked face validity; consequently, the systems could not be used for scientific research. This conclusion emphasizes the importance of systematic test and evaluation of new equipment before it is used for research.
A Reusable Perfused Human Cadaver Model for Surgical Training: An Initial Proof of Concept Study
Authors: Held Jenny M , McLendon Robert B , McEvoy Christian S , Polk Travis M 
Published: March 2019

Abstract

Objectives
Today’s surgical trainees have less exposure to open vascular and trauma procedures. Lightly embalmed cadavers may allow a reusable model that maximizes resources and allows for repeat surgical training over time.

Methods
This was a three-phased study that was conducted over several months. Segments of soft-embalmed cadaver vessels were harvested and perfused with tap water. To test durability, vessels were clamped, then an incision was made and repaired with 5-0 polypropylene. Tolerance to suturing and clamping was graded. In a second phase, both an arterial-synthetic graft and an arterial-venous anastomosis were performed and tested at 90 mmHg perfusion. In the final phase, lower extremity regional perfusion was performed and vascular control of a simulated injury was achieved.

Results
Seven arteries and six veins from four cadavers were explanted. All vessels accommodated suture repair over 6 weeks. There was minor leaking at all previous clamp sites. In the anastomotic phase, vessels tolerated grafting, clamping, and perfusion without tearing or leaking. Regional perfusion provided a life-like training scenario.

Conclusions
Explanted vessels of soft-embalmed cadavers show adequate durability over time with realistic vascular surgery handling characteristics. This shows promise as initial proof of concept for a reusable perfused cadaver model. Further study with serial regional and whole-body perfusion is warranted.
Applications of Future Technologies to Detect Skill Decay and Improve Procedural Performance
Authors: Linde Amber S , Miller Geoffrey T 
Published: March 2019

Abstract
Medical simulation training has progressed in its use of incorporating various technologies to provide quality training interfaces from novices to experts. The purpose of this paper is to explore modeling, simulation and visualization training technology interfaces to improve precision learning, rigorous, objective assessment, and performance improvement feedback for clinical procedural skill training and sustainment. Technologies to include augmented reality (AR), haptic technology and computer vision will be defined and clarified. It is believed that by exploring the combination of using AR, haptics and computer vision technologies it is possible to develop a fully immersive learning system that can automate mentoring while detecting and measuring gross and fine motor skills. Such a system can be used to predict or delay the onset of skills decay (SD) by capturing rigorous, objective measures, and human performance metrics that can provide feedback to individual performers for skills improvement in real time.
Enhanced Survival in Mice Exposed to Ionizing Radiation by Combination of Gamma-Tocotrienol and Simvastatin
Authors: Pathak Rupak , Kumar Vidya Prasanna , Hauer-Jensen Martin , Ghosh Sanchita Purohit 
Published: March 2019

Abstract
Ionizing radiation exposure is a major concern for active military service members, as well as civilian population. Considering that the exposure is not predictable, it is imperative that strategies to counteract radiation damage must be discovered. Recent in vitro studies performed in our laboratory demonstrated that the vitamin E analog gamma-tocotrienol (GT3) in combination with cholesterol-lowering drugs (Statins), synergistically induced endothelial thrombomodulin, an anticoagulant with radio-protective efficacy. It was hypothesized that the combination of treatment with both GT3 along with Statins would provide better radiation protection in vivo than each drug individually. CD2F1 mice were injected subcutaneously with either vehicle or single dose of GT3 (200 mg/kg body weight) 24 hours before irradiation followed by oral or subcutaneous administration of various doses of simvastatin (25, 50, and 100 mg/kg body weight) before exposure to lethal doses (11.5 and 12 Gy) of Cobalt-60 (60Co) gamma-irradiation. The combined treatment group exhibited enhanced radiation lethality protection substantially, accelerated white blood cell recovery, and augmented restoration of bone marrow cellularity when compared to the animals treated with either drug exclusively. This information clearly suggests that combined treatment could be used as a safeguard for military personnel from exposure to harmful ionizing radiation.
Predictive Power of Head Impact Intensity Measures for Recognition Memory Performance
Authors: Leeds Daniel D , D’Lauro Christopher , Johnson Brian R 
Published: March 2019

Abstract
Subconcussive head injuries are connected to both short-term cognitive changes and long-term neurodegeneration. Further study is required to understand what types of subconcussive impacts might prove detrimental to cognition. We studied cadets at the US Air Force Academy engaged in boxing and physical development, measuring head impact motions during exercise with accelerometers. These head impact measures were compared with post-exercise memory performance. Investigators explored multiple techniques for characterizing the magnitude of head impacts. Boxers received more head impacts and achieved lower performance in post-exercise memory than non-boxers. For several measures of impact motion, impact intensity appeared to set an upper bound on post-exercise memory performance – stronger impacts led to lower expected memory performance. This trend was most significant when impact intensity was measured through a novel technique, applying principal component analysis to boxer motion. Principal component analysis measures also captured more distinct impact information than seven traditional impact measures also tested.
Natural History and Management of Incidentally Discovered Focal Brain Lesions Indeterminate for Tumor in Children
Authors: Zaazoue Mohamed A , Manley Peter E , Kapur Kush , Ullrich Nicole J , Silvera V Michelle , Goumnerova Liliana C 
Published: March 2019

Abstract

BACKGROUND
The incidental discovery of brain lesions in children has increased due to greater utilization of neuroimaging. Standardized surveillance and management guidelines following the discovery of such lesions remain nonexistent.

OBJECTIVE
To study the natural history and management of incidental brain lesions in children.

METHODS
A retrospective analysis of pediatric patients who were treated at our institution between 2000 and 2016 with incidentally detected brain lesions that were indeterminate for neoplasm on MRI.

RESULTS
We identified 445 patients with incidental brain abnormalities of whom 144 had lesions indeterminate for neoplasm. Average age at diagnosis was 11.2 (SD = 4.14) yr and average follow-up was 3.8 yr (range 1-13.2 yr). Lesions showed no progression in 112 patients (77.8%), whereas progression was detected in 31 patients (21.5%). Mean time to progression was 32.3 months (SD = 24.4). A change in management was made in 13/144 patients (9%), which included surgical resection (n = 11), biopsy (n = 1), and lumbar puncture (n = 1). Lesion size, location, multiplicity, new-onset symptoms, associated contrast enhancement, or edema were not predictive of radiologic progression. Larger lesions and those with contrast enhancement or edema were significantly more likely to undergo surgery (P < .001 each). Median geometric diameter of lesions that did not undergo surgery was 6.5 mm, whereas that of surgically resected lesions was 12.5 mm (P < .001).

CONCLUSION
Most incidental brain lesions indeterminate for neoplasm have an indolent, benign course. For asymptomatic patients with radiologically stable lesions, we recommend conservative management with MRI and clinical surveillance at 6, 12, 24, 36, and 60 mo after detection.
Non-severe eosinophilic granulomatosis with polyangiitis: long-term outcomes after remission-induction trial
Authors: Puéchal Xavier , Pagnoux Christian , Baron Gabriel , Lifermann François , Geffray Loïk , Quémeneur Thomas , Saraux Jean-Luc , Wislez Marie , Cottin Vincent , Ruivard Marc , Limal Nicolas , Aouba Achille , Bonnotte Bernard , Néel Antoine , Agard Christian , Cohen Pascal , Terrier Benjamin , Le Jeunne Claire , Mouthon Luc , Ravaud Philippe , Guillevin Loïc ,   French Vasculitis Study Group investigators, Holy Benahary , Florence Gény , Pascal Godmer , Cédric Landron , Jean Christophe Lega , Véronique Le Guern , Alfred Mahr , Arsène Mékinian , Denis Mulleman , Jean-Marc Naccache , Louis Olagne , Diallo Alpha Oumar , Sylvain Palat , Vincent Poindron , Alexis Régent , Virginie Rieu , Anne Marie Ruppert , Pascale Soria 
Published: March 2019

Abstract

Objective
In a previous controlled trial, 1-year adjunction of AZA to glucocorticoids (GC) for patients with non-severe, newly diagnosed eosinophilic granulomatosis with polyangiitis (EGPA) failed to lower remission failure, vasculitis relapse and isolated asthma/rhinosinus exacerbation rates, or cumulative GC use at month (M) 24. The aim of this study was to analyse longer-term outcomes to determine whether subsequent vasculitis relapse or isolated asthma/rhinosinus exacerbation (IARE) rates differed.

Methods
After M24, patients were followed prospectively, being treated based on physicians’ best judgment. Flares and reasons for increased GC dose or immunosuppressant use were recorded, and reviewed according to randomization group to distinguish vasculitis relapses from IAREs according to EGPA Task Force recommendations.

Results
Fifty EGPA trial participants were followed for a median (interquartile range) of 6.3 (5.4–7.6) years; two (4%) died 11 months post-inclusion. By M24, vasculitis had relapsed in 21/49 (43%) patients and 14/50 (28%) had IAREs. Another patient died 4.8 years post-inclusion (infection). Among nine patients with subsequent vasculitis relapses, three had a major relapse and three had their first relapse after M24; among 25 patients with later IAREs, 17 occurred after M24. At 5 years, respective vasculitis relapse and IARE rates were 48% (95% CI 34.0, 62.6) and 56% (95% CI 41.7, 70.8), with no between-arm differences (P = 0.32 and 0.13). No entry clinical or biological parameter was associated with these outcomes during follow-up.

Conclusion
These results confirmed that 1-year AZA and GC induction obtained good overall survival but no long-term benefit for non-severe EGPA patients. Vasculitis relapses, occurring mostly during the first 2 years, and IAREs, occurring throughout follow-up, require other preventive treatments.

Trial registration
ClinicalTrials.gov, https://clinicaltrials.gov, NCT00647166.
The influence of supplemental zinc and dietary fiber concentration on mineral retention of beef steers1
Authors: Carmichael Remy N , Genther-Schroeder Olivia N , Deters Erin L , Jackson Trey D , Messersmith Elizabeth M , VanValin Katherine R , Hansen Stephanie L 
Published: March 2019

Abstract
The objective was to determine if zinc (Zn) retention improved with supplemental Zn above recommended concentrations with increasing dietary fiber concentration. Angus steers (n = 32; 309 ± 4.2 kg body weight [BW]) with GeneMax gain scores of 3, 4, or 5 were utilized in a 2 × 2 factorial arrangement (8 steers per treatment). Steers were stagger started (four blocks of eight steers) and stratified by BW within growing diets to one of two Zn strategies (ZNTRT), no supplemental Zn (analyzed 36 mg Zn/kg dry matter [DM]; CON) or supranutritional Zn (CON + 60 mg Zn/kg DM as ZnSO4 + 60 mg Zn/kg DM as Zn–amino acid complex; SUPZN). Dietary fiber strategies (FIBER) were formulated to target two fiber supplementation rates representing high fiber (HF; ~35% neutral detergent fiber [NDF]) or low fiber (LF; ~25% NDF). Within block, steers received HF for 60 d; then pens were randomly assigned to LF or HF for finishing. Steers fed LF were transitioned for 15 d; on day 75, steers were moved to metabolism crates and adapted for 10 d, followed by 5 d of total fecal and urine collection. Retention of Zn, Mn, Fe, Cu, and N were calculated. The model for analysis of metabolism data included the fixed effects of ZNTRT, FIBER, block, and the interaction of ZNTRT × FIBER, with the three-way interaction of ZNTRT × FIBER × block as random. Steer was the experimental unit (n = 8 per treatment combination). Zinc did not affect initial 60-d performance (P ≥ 0.62). DM and organic matter digestibility were lesser (P = 0.02) and N digestibility tended to be lesser (P = 0.07) in CON vs. SUPZN. Intake and digestibility of NDF and acid detergent fiber were greater (P ≤ 0.01) in HF vs. LF. Digestibility and retention of N as a percentage of intake were greater (P ≤ 0.04) whereas N retention as grams per day tended to be greater in HF vs. LF (P = 0.06). Apparent absorption of Zn tended to be greater (P = 0.06) in CON vs. SUPZN. A ZNTRT × FIBER effect was identified for Zn retention (milligrams per day; P = 0.01) where within SUPZN Zn retention was greater in HF vs. LF (P &lt; 0.01). Apparent absorption and retention of Zn were greater (% of intake; P ≤ 0.02) in HF vs. LF. Apparent absorption of Cu, Fe, and Mn was unaffected by ZNTRT or FIBER (P ≥ 0.24). Increasing dietary Zn increased Zn retained regardless of changes in coefficient of absorption. In addition, dietary fiber content may impact trace mineral and N metabolism by steers, potentially due to increased release of these nutrients from feed as fiber digestibility increases. It appears dietary Zn concentrations and diet composition influence trace mineral absorption in beef steers.
A Pilot Study of Oxytocin in Low-Income Women With a Low Birth-Weight Infant
Authors: Garfield Lindsey , Holditch-Davis Diane , Carter C. Sue , McFarlin Barbara L. , Seng Julia S. , Giurgescu Carmen , White-Traut Rosemary 
Published: March 2019

Background:
Negative outcomes related to prematurity may lead to maternal distress. Mothers of premature/low birth-weight infants report increased posttraumatic stress (50%) and depressive symptoms (63%) compared with mothers of full-term infants. Low-income, minority mothers with greater posttraumatic stress and depression have an increased risk for premature/low birth-weight delivery compared with their white counterparts. Variations in the neuropeptide oxytocin are implicated in lactation, perinatal depression, and maternal behavior.

Purpose:
To examine the associations among posttraumatic stress, depressive symptoms, and oxytocin in a pilot sample of minority mothers with premature/low birth-weight infants in the neonatal intensive care unit (NICU).

Methods:
This study employed a descriptive, correlational pilot design of 8 minority, low-income mothers with premature/low birth-weight infants. Participants answered questionnaires pertaining to posttraumatic stress, depression, lactation, and demographics and oxytocin was measured. This is a substudy that added oxytocin values.

Results:
Four participants had elevated depressive symptoms and 5 supplied their own milk. Women who provided their own milk had lower depressive (t = 3.03, P = .023) and posttraumatic stress (t = 3.39, P = .015) symptoms compared with women not supplying their own milk. Women with elevated posttraumatic stress had higher levels of depressive symptoms (r
(8) = 0.8, P = .006) and lower levels of oxytocin (r
(8) = 0.77, P = .026).

Implications for Practice:
These results are congruent with previous literature on providing human milk and maternal mental health. In addition, we found a possible relationship between postpartum posttraumatic stress and oxytocin in minority women with premature/low birth-weight infants. NICU nurses should encourage lactation and assess mothers for posttraumatic stress and depressive symptoms.

Implications for Research:
Research is needed to identify the biologic milieu associated with posttraumatic stress and depression in at-risk mothers.
Surgical Outcomes of Prepectoral Versus Subpectoral Implant-based Breast Reconstruction in Young Women
Authors: Manrique Oscar J. , Banuelos Joseph , Abu-Ghname Amjed , Nguyen Minh-Doan , Tran Nho V. , Martinez-Jorge Jorys , Harless Christin , Sharaf Basel , Jakub James W. , Degnim Amy C. , Boughey Judy C. , Jacobson Steven R. 
Published: March 2019

Background:
Two-staged implant-based reconstruction (IBR) is the most common breast reconstructive modality. Recently, technological and surgical advances have encouraged surgeons to revisit prepectoral IBR. Data comparing prepectoral against subpectoral IBR in women under the age of 40 are lacking.

Methods:
Retrospective chart review of patients under the age of 40 years old, who underwent immediate 2-staged IBR at our institution, was performed. Patient’s demographics, clinical characteristics, operative details, and early surgical outcomes of prepectoral and subpectoral reconstruction were compared. Data with values of P < 0.05 were considered statistically significant.

Results:
Between 2012 and 2016, 100 patients (187 breasts) who underwent prepectoral and 69 patients (124 breasts) who underwent subpectoral IBR were included. Median follow-up was 17.9 and 17.5 months in the prepectoral and subpectoral groups, respectively. Total number of complications including both stages of reconstruction was 20 (10.7%) and 19 (15.3%) in the prepectoral and subpectoral groups, respectively (P = 0.227). Specific complications, including hematoma, seroma, skin flap necrosis, wound dehiscence, and breast infections, were not significantly different among groups. Ten (5.4%) devices, including implants and tissue expander, required explantation in the prepectoral group and 8 (6.5%) in the subpectoral group (P = 0.683). Explantation was most commonly due to infection (n = 14), and all of them occurred during the first stage (P < 0.001).

Conclusions:
Early complications and implant explantation rates are comparable among prepectoral and subpectoral breast reconstruction in women under 40 years old. Based on these results, we believe that prepectoral IBR is a safe, reliable, and promising reconstructive option.
Toward a More Definitive Goldilocks Mastectomy: Simultaneous Addition of the Lateral Intercostal Perforator Flap
Authors: Schwartz Jean-Claude D. 
Published: March 2019

Summary:
The Goldilocks mastectomy was originally described as a safe technique that allowed for a single-stage autologous reconstruction in the patient who either was a poor candidate or was not interested in traditional multistage postmastectomy reconstructive approaches. This technique involved a skin-sparing mastectomy through Wise incisions and utilized the residual cutaneous flaps to create a breast mound. The final result was often less than optimal with regards to volume as the surgeon was limited by the amount of residual skin and fat that remained after the mastectomy. The best results were obtained in women with ptosis and an elevated body mass index. Here, we improve on these results by combining the Goldilocks mastectomy and the lateral intercostal artery perforator (LICAP) flap to provide a more definitive, autologous, single-stage, reconstructive option after mastectomy. Fourteen consecutive women underwent simultaneous bilateral Goldilocks mastectomy with bilateral LICAP flap augmentation. All patients successfully completed their reconstruction and were healed by 10 weeks postoperatively. The combination of the Goldilocks mastectomy and LICAP flap provides reconstructive surgeons an opportunity to provide a greater proportion of women a more definitive, safe, single-stage autologous reconstructive option after mastectomy.