bluuebunny/crossref_metadata_2025_split huggingface dataset:
Evaluation of the Military Functional Assessment Program for Return-to-Duty Decision Making: A Longitudinal Study
Authors: Kelley Amanda M , Showers Mark 
Published: March 2019

Abstract
Following concussion, return-to-duty decisions are made by medical providers and leaders using informal assessment, review of symptom resolution, and clinical assessments. In an effort to provide military-specific tasks for use in the decision making regarding return-to-duty, a battery developed from the set of basic soldier skills, the Military Functional Assessment Program (MFAP), was evaluated for construct validity using clinical assessment outcomes as well as the relationships between MFAP performance and indicators of long-term performance and satisfaction. A total of 48 participants were enrolled in the study providing baseline and post-treatment clinical assessment, and MFAP performance data. Twenty participants provided follow-up data at 6-month post-MFAP. Correlational analyses suggest significant relationships between MFAP performance ratings and clinical measures of vestibular and cognitive functions and psychological well-being. These findings are consistent with those from previous research on construct validity of the MFAP tasks. Performance on one MFAP task related to perceptions of performance and overall MFAP ratings related to satisfaction reported at 6 months. These findings provide preliminary, however limited, support for these tasks being indicative of the motivation and mental state of the program participant.
Evaluation of Three Postal Invitational Strategies to Increase Survey Response Rates in a Combat-Injured U.S. Military Population: Findings From the Wounded Warrior Recovery Project
Authors: Sack Daniel I , Woodruff Susan I , McCabe Cameron T , Galarneau Michael R , Han Peggy P 
Published: March 2019

Abstract
The survival rate of those injured in combat in overseas contingency operations is higher than in previous conflicts. There is a need to assess the long-term psychosocial and quality of life outcomes of those injured in combat, yet surveying this population presents inherent challenges. As part of a large-scale, longitudinal examination of patient-reported outcomes of service members injured on deployment, the present manuscript evaluated the effectiveness of three postal strategies on response rates: (1) mailing a study prenotification postcard, (2) mailing the survey invitation in a larger envelope, and (3) including a small cash preincentive ($2). Evaluation of these strategies yielded mixed results in this population. Neither the prenotification postcard nor inclusion of a $2 cash preincentive significantly increased response rates. However, use of a larger envelope to mail the survey invitation significantly increased the response rate by 53.1%. Researchers interested in collecting patient-reported outcomes among military populations, including those with combat-related injuries, may find that increasing the visibility of recruitment materials is more effective for improving response rates than attempting to cognitively prime or offer prospective participants preincentives.
Identifying Predictors of Pressurized Submarine Escape Training (PSET) Attrition
Authors: Hughes Linda M , Clarke John 
Published: March 2019

Abstract
Pressurized Submarine Escape Training (PSET) physically prepares submariners to safely escape a submarine at depth. Failure to complete PSET is not a submarine service disqualification. Serious medical incidents are rare, but the safety record tradeoff has been low throughput. From 2009 to 2015, only 34% of students screened completed PSET. Students may be medically screened out of the training altogether (disqualified), or dropout during the physical training (attrite). Training records from 12,122 U.S. Navy students were used to identify factors contributing to training disqualification and attrition. Multivariate logistic regression model predictors included demographic and screening items. Association to PSET disqualification included cold/congestion/cough (ORadj 12.34), limited duty status (ORadj 4.29), Physical Readiness Test failure (ORadj 3.37), pneumonia or bronchitis in last 2 years (ORadj 3.17) and nervousness or anxiety in tight spaces (ORadj 2.37). Basic Enlisted Submarine School students were more likely to be disqualified and attrite than other submariner groups, and black/African American (ORadj 1.53) students were more likely to attrite than white students. Only cold/congestion/cough (ORadj 1.52), trouble swimming (ORadj 1.53), and screening during cold/flu season (ORadj 1.28), were associated with training attrition. Recommendations to modify screening requirements are listed in conclusions.
3D Tibia Reconstruction Using 2D Computed Tomography Images
Authors: Iyoho Anthony E , Young Jonathan M , Volman Vladislav , Shelley David A , Ng Laurel J , Wang Henry 
Published: March 2019

Abstract

OBJECTIVE
Skeletal stress fracture of the lower limbs remains a significant problem for the military. The objective of this study was to develop a subject-specific 3D reconstruction of the tibia using only a few CT images for the prediction of peak stresses and locations.

METHODS
Full bilateral tibial CT scans were recorded for 63 healthy college male participants. A 3D finite element (FE) model of the tibia for each subject was generated from standard CT cross-section data (i.e., 4%, 14%, 38%, and 66% of the tibial length) via a transformation matrix. The final reconstructed FE models were used to calculate peak stress and location on the tibia due to a simulated walking load (3,700 N), and compared to the raw models.

RESULTS
The density-weighted, spatially-normalized errors between the raw and reconstructed CT models were small. The mean percent difference between the raw and reconstructed models for peak stress (0.62%) and location (−0.88%) was negligible.

CONCLUSIONS
Subject-specific tibia models can provide even great insights into the mechanisms of stress fracture injury, which are common in military and athletic settings. Rapid development of 3D tibia models allows for the future work of determining peak stress-related injury correlates to stress fracture outcomes.
Reduced Complications of Supraclavicular Approach in Simulated Central Venous Access: Applicability to Military Medicine
Authors: Sappenfield Joshua , Grek Sasha , Cooper Lou Ann , Lizdas David E , Lampotang Samsun 
Published: March 2019

Abstract
In a study with 76 anesthesia providers on a mixed reality simulator, central venous access via the supraclavicular approach to the subclavian vein, without ultrasonography required less attempts compared to the infraclavicular approach. Participants had shorter times to venous access and larger improvements in confidence. Results from this simulation-based study indicate that the supraclavicular approach may deserve consideration as an alternative approach for central venous access in deployed military environments. The use of ultrasonography during the supraclavicular approach to the subclavian vein is also described which may improve its safety profile. This technique could be more appropriate in scenarios when central venous access is preferred over intraosseous access for patients being transported to another location for further care.
Mechanical and Finite Element Analysis of an Innovative Orthopedic Implant Designed to Increase the Weight Carrying Ability of the Femur and Reduce Frictional Forces on an Amputee’s Stump
Authors: Chillale Tejas P , Kim Nam Ho , Smith Larry N 
Published: March 2019

Abstract
This study was designed to test the hypothesis that: “A properly designed implant that harnesses the principle of the incompressibility of fluids can improve the weight carrying ability of an amputee’s residual femur and reduce the frictional forces at the stump external socket interface.” The hypothesis was tested both mechanically on an Amputee Simulation Device (ASD) and through Finite Element Analysis (FEA) modeling software. With the implant attached to the femur, the FEA and ASD demonstrated that the femur carried 90% and 93% respectively of the force of walking. Without the implant, the FEA model and ASD femur carried only 35% and 77%, respectively, of the force of walking. Statistical calculations reveal three (3) degrees of separation (99% probability of non-random significant difference) between with and without implant data points. FEA modeling demonstrates that the normal contact forces and shear forces are pushed the distal weight-bearing area of the amputee stump, relieving the lateral stump of frictional forces. The ASD mechanical and FEA modeling data validate each other with both systems supporting the hypotheses with confidence intervals of three degrees of separation between with implant and without implant models.
Is Vitamin D Level at Melanoma Diagnosis Associated With Stage Of Tumor? An Observational Study of Melanoma Patients Living in a High Ultraviolet Radiation Environment
Authors: Kimlin Michael G , Youl Pip , Baade Peter , Rye Sheree , Brodie Alison 
Published: March 2019

Abstract

Objectives
This study will assess the relationship between vitamin D concentration at melanoma diagnosis and melanoma tumor characteristics, in individuals in a high ultraviolet radiation (UVR) environment.

Methods
We aim to recruit 600 recently diagnosed melanoma patients from Queensland, Australia, a high UVR location with one of the world’s highest melanoma incidence rates. Patients are recruited through general practitioner, skin cancer specialist, dermatological and hospital-based practices. As close as possible to diagnosis, participants provide a blood sample for vitamin D analysis and have their sun exposure/sun protection behavior, melanoma risk factors and dietary vitamin D intake assessed by questionnaire and phone interview. Details of tumor pathology, including tumor level, thickness, and ulceration, are abstracted from cancer registry records. Here, we describe the study methods and present preliminary findings from early participants.

Results
As of December 2017, we have recruited 128 participants (48% male, mean age 60.2 years, mean Breslow thickness 0.63 mm).

Conclusions
When complete, this study will give insights into the association between vitamin D at diagnosis and melanoma tumor characteristics whilst adjusting for recent sun exposure and sun protection use. This study may impact military sun exposure and nutrition policies as vitamin D may play a role in melanomagenesis.
Formative Assessment of Performance in Diagnostic Ultrasound Using Simulation and Quantitative and Objective Metrics
Authors: Sheehan Florence H , McConnaughey Shannon , Freeman Rosario , Zierler R Eugene 
Published: March 2019

Abstract

Background
We developed simulator-based tools for assessing provider competence in transthoracic echocardiography (TTE) and vascular duplex scanning.

Methods
Psychomotor (technical) skill in TTE image acquisition was calculated from the deviation angle of an acquired image from the anatomically correct view. We applied this metric for formative assessment to give feedback to learners and evaluate curricula.
Psychomotor skill in vascular ultrasound was measured in terms of dexterity and image plane location; cognitive skill was assessed from measurements of blood flow velocity, parameter settings, and diagnosis. The validity of the vascular simulator was assessed from the accuracy with which experts can measure peak systolic blood flow velocity (PSV).

Results
In the TTE simulator, the skill metric enabled immediate feedback, formative assessment of curriculum efficacy, and comparison of curriculum outcomes. The vascular duplex ultrasound simulator also provided feedback, and experts’ measurements of PSV deviated from actual PSV in the model by &lt;10%.

Conclusions
Skill in acquiring diagnostic ultrasound images of organs and vessels can be measured using simulation in an objective, quantitative, and standardized manner. Current applications are provision of feedback to learners to enable training without direct faculty oversight and formative assessment of curricula. Simulator-based metrics could also be applied for summative assessment.
Characteristics of Iraqi Patients Treated During Operation Inherent Resolve by a Forward Surgical Team
Authors: Hahn Christina , Staudt Amanda M , Brockmeyer Joel , Mann-Salinas Elizabeth A , Gurney Jennifer M 
Published: March 2019

Abstract

Introduction
The combat experience during the re-entry stages of Operation Inherent Resolve was distinct from other recent operations, but there is no published literature regarding these “initial entry operations” experiences among forward surgical teams (FSTs) deployed to Role 2 facilities A descriptive analysis of patients treated by FSTs may provide valuable information for Role 2 surgical teams preparing to deploy in support of initial entry operations. The purpose of this analysis was to describe injury mechanism, wounding patterns and interventions performed by a small FST in the re-entry phase in Iraq.

Materials and Methods
From July 17, 2015 to January 31, 2016, a split surgical team with two surgeons and an ER physician documented care for all patients treated by their FST located in Iraq. Given their austere environment, FSTs have limited holding capacity, blood supply, and ability to triage and perform advanced procedures. Patients, who arrived to the Role 2 in asystole, were ineligible for the study. The patient population was Iraqi Security Forces as well as Iraqi civilians. No follow-up data were obtained. Using descriptive statistics, we described the basic demographics, health status, blood utilization, injury severity, and injury pattern of the patient population.

Results
The final study population included 300 Iraqi casualties. The majority of patients (96%) were discharged alive. Many patients were 16 years or older (96%), male (96%), Iraqi soldiers (86%), and injured during battle (96%). Over one-third of patients (35%) had a form of metabolic acidosis, 7% were hypothermic, and 18% were in shock at admission. The median amount of blood products used was 6 (interquartile ranges (IQR) = 2–12) units, while the median red blood cells:fresh frozen plasma ratio was 1.2:1. Six or more units of blood were given to 67 (22%) patients. The top three diagnoses were laceration (n = 197, 21%), penetrating injury (n = 185, 19%), and fracture (n = 174, 18%). A high number of injuries occurred in the extremities/pelvis and buttocks (n = 360, 38%) and in the abdomen and pelvic contents (n = 145, 15%). Over a quarter of patients (26%) had critical injuries (i.e., military injury severity score ≥25).

Conclusions
Given the Role 2 configuration, these results demonstrate FSTs must be capable of managing critically ill patients with markedly limited resources. This management will include general operations in both adult and pediatric patients, resuscitation with a limited blood supply, and patient assessment with minimal to no diagnostic tools. This analysis can inform resident training, pre-deployment training, as well as sustainment training for surgeons after residency.
A Comparative in vivo Study of Semi-constrained and Unconstrained Cervical Artificial Disc Prostheses
Authors: Choi Hoon , Baisden Jamie L , Yoganandan Narayan 
Published: March 2019

Abstract

Purpose
The objective of this study is to directly compare different types of cervical artificial disc implants using an in vivo model capable of simulating the axial load on a neck that is similar to the human neck.

Methods
Cervical arthroplasty was performed at C3-4 in 14 healthy female adult Alpine goats. The goats were divided into three groups. Group A received Bryan (unconstrained one-piece design); Group B received ProDisc-C (semi-constrained two-piece design); and Group C received Mobi-C (unconstrained three-piece design) artificial discs. The goats were monitored in a veterinary unit for 6 months with radiography at regular intervals.

Results
Each goat tolerated cervical arthroplasty well and had satisfactory placement of their implant per intra-operative radiography. Implants monitored in Group A demonstrated no migration. One out of five implants in Group B experienced anterior migration at 3 months. In Group C, anterior migration and disintegration occurred in all four implants, with migration occurring during the first postoperative week in three implants and after 5 weeks in the fourth.

Conclusions
Unconstrained multi-piece artificial cervical discs may be prone to anterior migration and extrusion out of the disc space. This outcome deserves attention in individuals with a hypermobile neck and/or an occupation involving the use of a head-supported mass, such as helmets.
Maximizing the Resilience of Healthcare Workers in Multi-hazard Events: Lessons from the 2014–2015 Ebola Response in Africa
Authors: Schreiber Merritt , Cates David S , Formanski Stephen , King Michael 
Published: March 2019

Abstract
There is increasing knowledge that health care workers (HCWs) can experience a variety of emotional impacts when responding to disasters and terrorism events. The Anticipate, Plan and Deter (APD) Responder Risk and Resilience Model was developed to provide a new, evidence-informed method for understanding and managing psychological impacts among HCWs. APD includes pre-deployment development of an individualized resilience plan and an in-theater, real-time self-triage system, which together allow HCWs to assess and manage the full range of psychological risk and resilience for themselves and their families. The inclusion of objective mental health risk factors to prompt activation of a coping plan, in connection with unit leadership real-time situational awareness, enables the first known evidence-driven “targeted action” plan to address responder risk early before Post Traumatic Stress Disorder and impairment become established. This paper describes pilot work using the self-triage system component in Alameda County’s Urban Shield and the Philippines’ Typhoon Haiyan, and then reports a case example of the full APD model implementation in West Africa’s Ebola epidemic.
Quantification of Mild Traumatic Brain Injury via Cortical Metrics: Analytical Methods
Authors: Favorov Oleg V , Francisco Eric , Holden Jameson , Kursun Olcay , Zai Laila , Tommerdahl Mark 
Published: March 2019

Abstract
Mild traumatic brain injuries are difficult to diagnose or assess with commonly used diagnostic methods. However, the functional state of cerebral cortical networks can be rapidly and effectively probed by measuring tactile-based sensory percepts (called cortical metrics), which are designed to exercise various components of cortical machinery. In this study, such cortical metrics were obtained from 52 college students before and after they experienced sports-related concussions by delivering vibrotactile stimuli to the index and middle fingertips. Performance on four of the sensory test protocols is described: reaction time, amplitude discrimination, temporal order judgment, and duration discrimination. The collected test performance data were analyzed using methods of uni- and multivariate statistics, receiver operated characteristic (ROC) curves, and discriminant analysis. While individual cortical metrics vary extensively in their ability to discriminate between control and concussed subjects, their combined discriminative performance greatly exceeds that of any individual metric, achieving cross-validated 93.0% sensitivity, 92.3% specificity, 93.0% positive predictive value, and 92.3% negative predictive value. The cortical metrics vector can be used to track an individual’s recovery from concussion. The study thus establishes that cortical metrics can be used effectively as a quantitative indicator of central nervous system health status.
Early Complement and Fibrinolytic Activation in a Rat Model of Blast-Induced Multi-Organ Damage
Authors: Yang Zhangsheng , Aderemi Olawale A , Zhao Qingwei , Edsall Peter R , Simovic Milomir O , Lund Brian J , Espinoza Mark D , Woodson Amber M , Li Yansong , Cancio Leopoldo C 
Published: March 2019

AbstractObjectiveBlast injury is associated with multi-organ failure (MOF), causing significant morbidity and mortality in trauma patients. However, the pathogenesis of blast-induced MOF still remains obscure. In this study, we evaluate the pathophysiological changes related to blast-induced MOF in a clinically relevant rat model of blast injury.MethodsA moderate blast overpressure was applied to induce injury in anesthetized rats. Pathological changes were evaluated by H&E staining. Complement activation, plasminogen, and myeloperoxidase levels were analyzed by complement hemolytic assay (CH50) and/or ELISA in blood samples.ResultsAnalysis of lung, brain, and liver tissue at 24 hour after blast overpressure revealed severe injuries. The level of complement components C3 and C1q decreased in parallel with the reduction of CH50 level in injured animals at 1, 3, and 6 hours after blast. Consumption of plasminogen was also detected as early as 1 hour post-injury. Myeloperoxidase levels were elevated within 1 hour of blast injury.ConclusionOur data reveal that blast injury triggers the complement and fibrinolytic systems, which likely contribute to blast-induced MOF. Conceivably, therapies that target these systems early may improve clinical outcomes in blast patients.
Prehospital Use of Ketamine: Effectiveness in Critically Ill and Injured Patients
Authors: Zietlow John , Berns Kathy , Jenkins Donald , Zietlow Scott 
Published: March 2019

AbstractBackgroundThe military use of ketamine is well established. The benefits of prehospital civilian use have not been extensively reported.MethodsA retrospective review was performed of patients with prehospital ketamine use in Mayo One’s air and critical care ground transport.ResultsThe medical records were reviewed from 2014 to 2016 to assess the efficacy of Ketamine. During this time frame, 158 (167 instances) patients were treated with ketamine for analgesia (38%), sedation (44%), or procedural (18%) use. The patient population had a mean age of 49 (range: 1–100), with 105 (67%) male patients. Indications included trauma (69%), which was further broken down into blunt (57%), penetrating (4%), and miscellaneous (8%), and medical illness (31%). The mean ketamine dose was 52.6 mg (range: 5–200 mg) via intravenous route. Ketamine was utilized in 61% of patients after other medications were ineffective. Overall success rate was 98%. Mean pain scale before and after ketamine use was 9/10 and 3/10, respectively. Ketamine use increased yearly from 21 (13%) in 2014, 56 (36%) in 2015, and 81 (51%) in 2016.ConclusionPrehospital ketamine use is effective alone or in conjunction with other medications for analgesia, sedation, and procedural use in trauma and critically ill patients with minimal hemodynamic and respiratory consequences.
Precise optical timing of PSR J1023+0038, the first millisecond pulsar detected with Aqueye+ in Asiago
Authors: Zampieri Luca , Burtovoi Aleksandr , Fiori Michele , Naletto Giampiero , Spolon Alessia , Barbieri Cesare , Papitto Alessandro , Ambrosino Filippo 
Published: March 2019

Abstract
We report the first detection of an optical millisecond pulsar with the fast photon counter Aqueye+ in Asiago. This is an independent confirmation of the detection of millisecond pulsations from PSR J1023+0038 obtained with SiFAP at the Telescopio Nazionale Galileo. We observed the transitional millisecond pulsar PSR J1023+0038 with Aqueye+ mounted at the Copernicus telescope in 2018 January. Highly significant pulsations were detected. The rotational period is in agreement with the value extrapolated from the X-ray ephemeris, while the time of passage at the ascending node is shifted by 11.55 ± 0.08 s from the value predicted using the orbital period from the X-rays. An independent optical timing solution is derived over a baseline of a few days that has an accuracy of ∼0.007 in pulse phase (∼12 μs in time). This level of precision is needed to derive an accurate coherent timing solution for the pulsar and to search for possible phase shifts between the optical and X-ray pulses using future simultaneous X-ray and optical observations.