bluuebunny/crossref_metadata_2025_split huggingface dataset:
Assessment and outcome of 496 penetrating gastrointestinal warfare injuries
Authors: Saghafinia M , Nafissi N , Motamedi MHK , Motamedi MHK , Hashemzade M , Hayati Z , Panahi F 
Published: March 2013

AimThe abdominal viscera are among the most vulnerable organs of the body to penetrating trauma. Proper management of such trauma in war victims at the first-line hospital where these victims are first seen is of paramount importance. We reviewed medical records of war victims suffering small bowel and colorectal injuries treated at first, second and third-line hospitals during the Iraq-Iran War (1980-88) to assess surgical outcomes.MethodsThe medical records of 496 Iranian war victims suffering penetrating gastrointestinal (GI) injuries treated at first, second and third-line (tertiary) hospitals, a total of 19 centres, were reviewed. Laparotomy had been performed at the 1st line hospitals for all patients who had an acute abdomen, whose wounds violated the peritoneum or whose abdominal radiographs showed air or shrapnel in the abdominal cavity. Stable patients were transferred from first-line to second-line or from second line to tertiary hospitals postoperatively. The treatments, complications and patient outcomes were documented and analyzed.ResultsThere were 496 patients; 145, 220 and 131 victims underwent laparotomy for GI injuries at first, second and third-line hospitals respectively. The small intestine and colon respectively were the most prevalent abdominal organs damaged. Those first treated for GI injuries at front-line hospitals (145 victims) had more serious conditions and could not be transferred prior to surgery and presented a higher prevalence of complications and mortality. Overall mortality from GI surgery was 3.6% (18 patients). Eleven patients (7.5%) whose first GI operation was performed at frontline hospitals and 7 patients (3.2%) who underwent their first surgical operation at second-line hospitals died. The most common reason for these deaths was complications relating to the gastrointestinal operation such as anastomotic leak. Six missed injuries were seen at the frontline and one at second line hospitals. There were no deaths at the 3rd line hospitals.ConclusionPenetrating abdominal injuries were common in Iranian victims of war often causing multiple organ injuries. The colon and small intestine were the more commonly injured organs and carried the most postoperative complications. Mortality at 1st line hospitals was more than double that of 2nd line hospitals; the complication rate was also greater as was the number of missed injuries. Adherence to the standard surgical protocols, prompt evaluation, proper triage and management are factors which may lower patient morbidity and complications.
The Clients’ Perspective – Do military uniform and rank impact on the therapeutic relationship between military mental health clients and clinicians
Authors: Wilson MM , McAllister PD 
Published: March 2013

ObjectiveTo measure the perception of military mental health clients of the impact of wearing military uniform on the therapeutic relationship between client and clinician and to ascertain if uniform and rank is perceived as a barrier.MethodA brief questionnaire was distributed to Departments of Community Mental Health to be disseminated to theirmental health clients to measure their responses.Results282 responses from mental health clients were collected over a 30 day period regarding the impact that military uniform makes to the therapeutic relationship with the clinician. 63%(n=178) regarded uniform as negatively influencing their relationship with the clinician, 37% (n=104) responded that it did not. 39% (n=111) believed rank to be a barrier, whereas 61% (n=171) did not believe it affected the relationship.ConclusionThe majority of military mental health clients regard the wearing of uniform as negative to the therapeutic relationship and a significant minority have similar feelings about rank. Military mental health practitioners should consider the impact of these results on the therapeutic relationship with military patients.
UK Role 4 Military Infectious Diseases at Birmingham Heartlands Hospital in 2005-9
Authors: Glennie JS , Bailey Mark S 
Published: March 2013

ObjectivesInfectious diseases affecting British troops are mostly due to gastrointestinal and respiratory illnesses, but these are usually minor in severity, easy to manage and short in duration. To assess the importance of infections that are more severe, difficult to manage or longer in duration, it is necessary to look at military cases that are evacuated or otherwise referred to the UK Role 4 (definitive care) medical facility for infectious diseases.MethodsCase notes from military infectious disease patients seen at Birmingham Heartlands Hospital in 2005-2009 were reviewed to extract data on demographics, origin of infection, diagnostic categories, exact diagnoses, type and duration of care, time off duty, quality of care and costs incurred.ResultsOver a 4-year period, 138 cases were referred, 131 (95%) were male and 98 (71%) were from the Army. The origin of infection was Afghanistan in 52 (38%) and Belize in 19 (14%). From 131 patients (95%) that attended, 59 (45%) had dermatological illnesses and 38 (29%) had undifferentiated febrile illnesses. Diagnoses included 35 (27%) with cutaneous leishmaniasis and 21 (16%) with “Helmand Fever” due to sandfly fever, acute Qfever or rickettsial infection. For 51 in-patients, the median (range) length of stay was 3 (1-17) days and time off duty was 20 (5-127) days. For 80 out-patients, the median (range) number of attendances was 1 (1-23) and time off duty was 22 (1-228) days. All cases were seen promptly (within 7 days for in-patients and 28 days for out-patients), but only 59 (45%) had appropriate letters sent to the referring medical officer and none had FMed 85 notifications of infectious disease submitted. Aeromedical evacuation costs could not be calculated, but UK hospital care cost ∼ £ 78 000 per year.ConclusionsDermatological infections and undifferentiated febrile illnesses that require management at a UK Role 4 facility are important causes of disease non-battle injury. Prospective collection of this data in the future will be a valuable asset.
The Effectiveness of an Informal Teaching Programme for Junior Doctors Identifying Pleural Effusions Using Ultrasound at the Bedside
Authors: Moy Ross J , Chapman AL , Bapusamy A 
Published: March 2013

ObjectivesThe use of bedside ultrasound to localise pleural effusions has gained in popularity in recent years. We investigated whether or not junior doctors could accurately identify thoracic anatomical structures and localise pleural effusions using bedside ultrasound.MethodsJunior doctors were instructed by a consultant chest physician in the theory and practice of using ultrasound to localise pleural effusions, and then instructed in the method of inserting a Seldinger chest drain. Juniors were instructed to record a scan picture, including labelling of relevant structures. We then conducted a review of 52 images, noting indications, complications and the grade of doctor performing the scan. A consultant radiologist reviewed the scan pictures to confirm that the anatomy was correctly identified.ResultsFifty out of 52 images (96%) were of diagnostic quality, with the anatomy correctly identified. The complication rate from chest drain insertion was 3.85%.ConclusionsWith instruction, junior doctors can competently utilise basic chest ultrasound, obtain useful images, identify relevant thoracic anatomy and insert chest drains by the Seldinger technique with a low rate of complications. We suggest thoracic ultrasound should be more widely taught to junior doctors.
Furosemide in the Treatment of Phosgene Induced Acute Lung Injury
Authors: Grainge C , Smith Adam , Jugg BJ , Fairhall SJ , Mann T , Perrott R , Jenner J , Millar T , Rice P 
Published: March 2013

MethodUsing previously validated methods, 16 anaesthetised large white pigs were exposed to phosgene (target inhaled dose 0.3 mg kg-1), established on mechanical ventilation and randomised to treatment with either nebulised furosemide (4 ml of 10 mg.ml-1solution) or saline control. Treatments were given at 1, 3, 5, 7, 9, 12, 16 and 20 hours post phosgene exposure; the animals were monitored to 24 hours following phosgene exposure.ResultsFurosemide treatment had no effect on survival, and had a deleterious effect on PaO2: FiO2ratio between 19 and 24 hours. All other measures investigated were unaffected by treatment.ConclusionNebulised furosemide treatment following phosgene induced acute lung injury does not improve survival and worsens PaO2: FiO2ratio. Nebulised furosemide should be avoided following phosgene exposure.
Management of Intestinal Injury in Deployed UK Hospitals
Authors: Fries Cdr Anton , Penn-Barwell J , Tai NRM , Hodgetts TJ , Midwinter MJ , Bowley DM 
Published: March 2013

IntroductionDefinitive laparotomy (DL), with completion of all surgical tasks at first laparotomy has traditionally been the basis of surgical care of severe abdominal trauma. Damage control surgery (DCS) with a goal of physiological normalisation achieved with termination of operation before completion of anatomical reconstruction, has recently found favour in management of civilian trauma. This study aims to characterise the contemporary UK military surgeon’s approach to abdominal injury.Patients and methodsA retrospective analysis was performed on British service personnel who underwent a laparotomy for intestinal injury at UK forward hospitals from November 2003 to March 2008 as identified from the Joint Theatre Trauma Registry. Patient demographics, mechanism and pattern of injury and clinical outcomes were recorded. Surgical procedures at first and subsequent laparotomy were evaluated by an expert panel.Results22 patients with intestinal injury underwent laparotomy and survived to be repatriated; all patients subsequently survived to hospital discharge. Mechanism of injury was GSW in seven and blast in 13. At primary laparotomy, as defined by the operating surgeon, 15/22 underwent DL and 7/22 underwent DCS. Mean Injury Severity Score (ISS) was 19 for DL patients compared to 29 for DCS patients (p=0.021). Of the 15 patients undergoing DL nine had primary repair (suture or resection / anastomosis), one of which subsequently leaked. Unplanned re-look was required in 4/15 of the DL cases.ConclusionThis review examines the activity of British military surgeons over a time period where damage control laparotomy has been introduced into regular practice. It is performed at a ratio of approximately 1:2 to DL and appears to be reserved, in accordance with military surgical doctrine, for the more severely injured patients. There is a high rate of unplanned relook procedures for DL suggesting DCS may still be underused by military surgeons. Optimal methods of selection and implementation of DCS after battle injury to the abdomen remain unclear.
The Influence of Perceptions and Beliefs of Civilian Physiotherapist Working for the Ministry of Defence in their Management of Back Pain: An Exploratory Study using Mixed Methods
Authors: Bond SJ , Soundy A 
Published: March 2013

BackgroundThere is a high prevalence of Lower Back Pain (LBP) within military populations. Physiotherapeutic management has a primary role for patient care, but there is a need to establish the most effective management. Civilian physiotherapists provide the majority of clinical provision throughout the Defence Medical Rehabilitation Programme for British Armed Forces personnel. To date no study has been carried out looking at their perceptions and beliefs with regards to management of non-specific LBP and the potential impact this had on the delivery of rehabilitation across Defence.MethodsThis mixed methods exploratory study aimed to explore the potential complexities surrounding the decision making process with regards to management of non-specific LBP using semi-structured interviews with 14 MOD civilian physiotherapists. All interviews were transcribed verbatim. The transcribed data was then subjected to a categorical content analysis.ResultsThe analysis of the interview data revealed four interrelated themes that influence civilian physiotherapists in their management of back pain in military personnel: the military environment, integration of military procedures, physiotherapist treatment approach and communication.DiscussionThis paper highlights the value civilian physiotherapists place on experience when managing non-specific LBP. This experience however was gained through ‘patient mileage’ rather than integration of best evidence into practice. Several problems were identified in patient management including specific types of patients and their expectations and the importance of the right communication between Health Care Professionals, but also with patients.
Spinal Fractures in Current Military Deployments
Authors: Eardley Will , Bonner TJ , Gibb IE , Clasper JC 
Published: March 2013

ObjectiveTo describe spinal fracture patterns presenting to deployed medical facilities during recent military operations.MethodsRetrospective analysis of the United Kingdom Centre for Defence Imaging Computed Tomography database, 2005- 2009. Fractures are classified, mechanism noted and associated injuries recorded. Statistical analysis is by Fisher’s Exact test.Results128 fractures in 57 casualties are analysed. Ballistic (79%) and non-ballistic mechanisms contribute to vertebral fracture at all regions of the spinal column in patients treated at deployed medical facilities. There is a high incidence of lumbar spine fractures, which are more likely to be due to explosion than gunshot wounding (p<0.05). Two thirds of thoracolumbar spine fractures caused by explosive devices are unstable and are mainly burst-fractures in configuration. 60% of spinal fracture patients had concomitant injuries. There is a strong relationship between spinal fractures caused by explosions and lower limb fractures.ConclusionInjuries to the spine caused by explosive devices account for greater numbers, greater associated morbidity and increasing complexity than other means of spinal injury managed in contemporary warfare. With the predominance of explosive injury in current conflict, this work provides the first detail of an evolving injury mechanism with implications for injury mitigation research.
The Skeleton Coast Diet Plan: Body Mass and Body Fat Changes on an Arduous Expedition
Authors: Nicol Alastair , Donoghue O 
Published: March 2013

ObjectivesNo one has ever walked the 500 Km Skeleton Coast of Namibia totally unsupported. Fourteen explorers overcame this by carrying, along with all their other equipment, hand-held pumps to desalinate sea water on a daily basis to produce sufficient potable water. This paper highlights the changes in body mass, waist circumference and body fat in the group on this unique 20 day expedition.MethodsEight males (mean (SD)) 42.3 (9.7) years, height 1.741 (0.043) m, weight 78.7 (8.6) kg, body mass index (BMI) 24.8 (2.0) kg/m2) and six females (mean (SD) 40.0 (5.3) years, height 1.628 (0.043) m, weight 63.2 (5.5) kg, BMI 23.8 (1.8) kg/m2) undertook the expedition. Average pack weight at the start of the expedition for the men was 32.5 kg, and 26.5 kg for the women. On most days, the team walked for 8 – 10 hours on varying terrain then pumped water for a further 4 hours. Measurements taken included height, body mass, waist circumference and skin-fold thickness at four regions of the body, and were taken before, during and at the end of the expedition. The approximate daily calorific intake for each team member was 2400 – 3000 kcal.ResultsSignificant decreases in mean body mass (p<0.001, d=0.50) and mean BMI (p<0.001, d=0.67) were observed after the 20 day trek compared to baseline values. Mean waist circumference decreased during the expedition (p<0.001, d=0.67). There were significant reductions in all measures of skinfold thicknesses and overall percentage body fat at Day 13 (p<0.001, d=1.19) and Day 21 (p<0.001, d=1.98) in comparison to baseline values.ConclusionsAll participants lost significant amounts of both body mass and body fat, with body fat reducing by over 30%.
A Survey of Experience of Parenteral Analgesia at Role 1
Authors: Davey Colette , Mieville KE , Simpson R , Aldington D 
Published: March 2013

Objectives:To assess the confidence of deploying Role 1 Medical Officers (MOs)in the use of parenteral analgesia, to collate opinion as to whether analgesia training for Role 1 MOs is fit for purpose and to explore options for future analgesic approaches at Role 1.Methods:A survey distributed to Role 1 doctors prior to deployment to Afghanistan.Results:Areas of expressed concern included the use of ketamine and a lack of experience of intraosseous drug administration. Qualitative data collected included anecdotal experiences with analgesia administration which provides evidence to support a change in training.Conclusions:Doctors have the capability to provide good analgesic care but lack the confidence and experience to do it effectively. Improved analgesia training is required for deploying Role 1 MOs.
Characteristics and Visual Outcomes of Eye Trauma in the Chinese Armed Services
Authors: Xiao J , Zhang Maonian , Jiang C , Zhang Y , Qiu H , Chaloulias C , Suleman H 
Published: March 2013

Objectives:To outline the characteristics and outcomes of eye injuries in the Chinese People’s Liberation Army.Methods:A retrospective review of military inpatient eye injuries, in one military region, population 250,000 soldiers, between January 2006 and December 2010.Results:There were 709 eye injury patients (759 eyes) during the 5-year period with an incidence of inpatient eye injuries of 57 per 100,000 person-years. The mean age of patients was 24 years, the vast majority male. The majority of eye injuries occurred during recreational time (62%), with the commonest causing being violence (46%). The immediate post-injury vision acuity of 48% of eyes was >6/12; 93% of cases had mechanical ocular injuries and 7% had non-mechanical ocular injuries. 71% of patients were sent to an evacuation hospital within 24 hours and 75% had surgery within 24 hours of injury. The majority of cases (97%) were hospitalized for one visit. On discharge, there was a statistically significant improvement in visual outcomes with 85% of eyes achieving >6/12.Conclusions:Eye injuries secondary to violence were a frequent occurrence amongst young male PLA members, particularly during recreational time. Most injuries were not sight-threatening, with the majority of patients achieving an excellent visual outcome.
A comparison of two 3-week resistance training programmes commonly used in short-term military rehabilitation
Authors: Kristensen Jakob , Burgess S 
Published: March 2013

IntroductionResistance training is an important component of rehabilitation due to its ability to increase muscular strength and enhance functional ability. The aim of this study was to assess the effects of two different resistance-training programmes currently used in military rehabilitation.Method27 male rehabilitation patients, serving with the Armed Forces and suffering from a range of lower limb musculoskeletal injuries were divided into two matched groups. Group 1 (n=14) performed the Daily Adjusted Progressive Resistance Exercise (DAPRE), whereas Group 2 (n=13) performed the Functional Strength Training (FST). An 8 repetition maximum (8RM) deadlift and countermovement vertical jump (CMVJ) test were used as Functional Assessment Tests (FATs) and as measures of changes in strength and power, respectively. Both were conducted on admission and at discharge.ResultsLower limb strength and power increased significantly in both the DAPRE (p≤0.001/p≤0.001) and the FST (p≤0.001/0.001) groups. There was no significant difference between groups for either strength (p≥0.05) or power (p≥0.05).ConclusionsShort-term resistance training during rehabilitation can lead to gains in strength and power despite differences in programme design. However we conclude that three weeks of resistance training is insufficient duration to see significant differences between different training protocols.
Parallel programming patterns for multi-processor SoC
Authors: Paulin Pierre G. , Özcan Ali Erdem , Gagné Vincent , Lavigueur Bruno , Benny Olivier 
Published: March 2013

Efficient, scalable and productive parallel programming is a major challenge for exploiting the future multi-processor SoC platforms. This article presents the
MultiFlex
programming environment which has been developed to address this challenge. It is targeted for use on
Platform 2012
, a scalable multi-processor fabric. The MultiFlex environment supports high-level simulation, iterative platform mapping, and includes tools for programming model aware debug, trace, visualization and analysis.

This article focuses on the two classes of programming abstractions supported in MultiFlex. The first is a set of Parallel Programming Patterns (PPP) which offer a rich set of programming abstractions for implementing efficient data- and task-level parallel applications. The second is a Reactive Task Management (RTM) abstraction, which offers a lightweight C-based API to support dynamic dispatching of small grain tasks on tightly coupled parallel processing resources.
The use of the MultiFlex native programming model is illustrated through the capture and mapping of two representative video applications. The first is a high-quality rescaling (HQR) application on a multi-processor platform. We present the details of the optimization process which was required for mapping the HQR application, for which the reference code requires 350 GIPS (giga instructions per second), onto a 16 processor cluster. Our results show that the parallel implementation using the PPP model offers almost linear acceleration with respect to the number of processing elements.
The second application is a high-definition VC-1 decoder. For this application, we illustrate two different parallel programming model variants, one using PPPs, the other based on RTM. These two versions are mapped onto two variants of a homogeneous version of the Platform 2012 multi-core fabric.
On the Fluctuating Buoyancy Fluxes Simulated in a OGCM
Authors: Li Hongmei , Storch Jin-Song von 
Published: March 2013

Abstract
Subgrid-scale fluctuations with zero means have generally been neglected in ocean modeling, despite their potential role in affecting the oceanic state following Hasselmann's seminal paper on stochastic climate models and series of studies conducted thereafter. When representing effects of these fluctuations in a stochastic parameterization, knowledge of basic properties of these fluctuations is essential. Here, the authors quantify these properties using hourly output of a simulation performed with a global OGCM. This study found that fluctuating buoyancy fluxes are strong in the sense that their strengths are up to one order of magnitude larger than the magnitudes of the respective mean eddy fluxes and that the fluctuations originate not only from mesoscale eddies and tropical instability waves but also from near-inertial waves, especially in the low- and midlatitude oceans. It is this wave contribution that makes the basic properties of fluctuations distinctly different from those expected from mesoscale eddies. The geographical distribution of fluctuation intensity differs from that of mesoscale eddy activity and is strongest in the low- and midlatitude oceans complemented by additional and secondary maxima in the Gulf Stream, the Kuroshio, and the Southern Ocean. The seasonality in most of the low- and midlatitude oceans, characterized by stronger fluctuations in winter than in summer, is just the opposite of that of mesoscale eddies. In the tropical oceans, the correlation length scales reach 500 km in the zonal direction but only about 30–40 km in the meridional direction, reflecting near-inertial waves with nearly zonally oriented wavecrests. Overall, these results provide an important basis for stochastically describing the effects of subgrid-scale fluctuations.