bluuebunny/crossref_metadata_2025_split huggingface dataset:
What is the Ideal Pre-Hospital Analgesic? – A Questionnaire Study
Authors: Smith JE , Russell R , Mahoney PF , Hodgetts T J 
Published: March 2013

AimTo determine clinical opinion of effectiveness of current battlefield analgesia and the realistic options to improve future analgesia in hostile environments.MethodsStructured electronic questionnaire distributed to selected individuals in UK and on operations.Population122 UK Defence Medical Services and US Medical Corps doctors, nurses and combat medical technicians involved in the early management of severe trauma on deployment.Results54 (44%) agreed and 63 (52%) disagreed that intramuscular morphine had the ideal analgesic properties for the military pre-hospital environment. Over half of those with operational experience reported multiple instances of intramuscular morphine providing inadequate analgesia. 86 (70%) desired a more potent analgesic than morphine in the first hour following injury. 101 (83%) identified simplicity and reliability of use by a soldier as of high importance. 99 (81%) identified rapid onset of action of high importance. With regard to an acceptable route of drug self-administration, 88 (72%) supported a nasal spray; 78 (64%) supported a sustained release buccal tablet (adhesive to the gum); 61 (50%) supported a disposable inhaler of volatile gas (although 91%had no experience of the currently available drug in this formulation); and 55 (45%) supported a skin patch.ConclusionIntramuscular morphine does not meet the needs of the majority of clinical stakeholders. Alternative routes of self-administration are acceptable, but support for available commercial solutions is clouded by incomplete awareness. Anaesthetists and emergency physicians desire a multimodal approach to battlefield analgesia within the evacuation chain.
The Additional Value of a Pneumatic Leg Brace in the Treatment of Recruits with Medial Tibial Stress Syndrome; a Randomized Study
Authors: Moen Maarten Hendrik , Bongers T , Bakker EWP , Weir A , Zimmermann WO , van der Werve M , Backx FJG 
Published: March 2013

ObjectiveTo study the additional effect of a pneumatic leg brace with standard rehabilitation for the treatment of medial tibial stress syndrome (MTSS) in recruits.MethodsIn a single blinded randomized study, 15 recruits (age 17-22) followed a rehabilitation programme consisting of leg exercises and a graded running programme. Recruits performed daily exercises and ran three times a week. The running programme consisted of 6 consecutive phases. One group was, after randomization, additionally provided with a pneumatic leg brace. Follow-up was provided every other week. Days to completing the running programme was the primary outcome measure, the Sports Activity Rating Scale (SARS) score and satisfaction with the treatment were secondary outcome measures.ResultsIn total 14 recruits completed the rehabilitation programme. No differences were found in the number of days until phase six of the running schedule was finished between the brace and the control group (Brace 58.8 ± 27.7 (mean ± SD) vs Non-Brace 57.9 ± 26.2 (mean ± SD,p= 0.57). Also no differences were found in the SARS scores between the groups. Overall satisfaction with the treatment was 6.4 ± 1.1 (mean ± SD) on a 1-10 scale for the brace group and 7.1 ± 0.7 (mean ± SD) for the control group (p = 0.06). Comfort of the brace was assessed as 4.8 ± 1.3 (mean ± SD) on a 1-10 scale.ConclusionsNo additional large effect of the pneumatic leg brace could be found in recruits and wearing of the brace was not feasible, since the wearing comfort was low.
Undifferentiated Febrile Illnesses Amongst British Troops in Helmand, Afghanistan
Authors: Bailey Mark S , Trinick TR , Dunbar JA , Hatch R , Osborne JC , Brooks TJ , Green AD 
Published: March 2013

ObjectivesUndifferentiated febrile illnesses have been a threat to British expeditionary forces ever since the Crusades. The infections responsible were identified during the Colonial Era, both World Wars and smaller conflicts since, but nearly all remain a significant threat today. Undiagnosed febrile illnesses have occurred amongst British troops in Helmand, Afghanistan since 2006 and so a fever study was performed to identify them.MethodsFrom May to October 2008, all undifferentiated fever cases seen at the British field hospital in Helmand, Afghanistan were assessed using a standard protocol. Demographic details, clinical features and laboratory results were recorded and paired serum samples were sent for testing at the UK Special Pathogens Reference Unit (SPRU).ResultsOver 6 months, there were 26 cases of “Helmand Fever” assessed and 23 diagnoses were made of which 12 (52%) were sandfly fever, 6 (26%) were acute Q fever and 5 (22%) were rickettsial infections. Four cases had co-infections and 7 cases were not diagnosed (mostly due to inadequate samples). The clinical features and laboratory results available at the British field hospital did not allow these diseases to be distinguished from each other. The exact type of rickettsial infection could not be identified at SPRU.ConclusionsThese cases probably represent the “tip of an iceberg” for British and Allied forces. More resources for diagnostic facilities and follow-up of patients are required to improve the management and surveillance of “Helmand Fever” cases; until then doxycycline 100 mg twice daily for 2 weeks should be given to all troops who present with an undifferentiated febrile illness in Helmand, Afghanistan. Patients with acute Q fever should be followed-up for at least 2 years to exclude chronic Q fever. Prevention of these diseases requires a better understanding of their epidemiology, but prophylaxis with doxycycline and possibly Q fever vaccine should be considered.
A Kinematic and Kinetic Analysis of Drop Landings in Military Boots
Authors: Oliver Gretchen D. , Stone AJ , Booker JM , Plummer HA 
Published: March 2013

ObjectiveThe purpose of this study was to examine knee valgus in drop landings during three different footwear conditions and to examine the ground reaction forces exhibited during the drop landing in the three different footwear conditions.MethodsSixteen male and female Reserve Officer Training Corps (ROTC) university undergraduate cadets (21±3 yrs, 79±12 kg, and 172±10 cm) volunteered to participate in the study. Kinematic data were collected while participants performed drop landings in three conditions: bare feet, tennis shoes, and issued military boots.ResultsSignificant differences among footwear for ground reaction forces (bare feet: 1646 ±359%, tennis shoe: 1880±379%, boot: 1833±438%; p < 0.05) were found, while there was no significant difference in knee valgus among footwear.ConclusionsThough footwear conditions did not affect knee valgus, they did affect ground reaction forces. Participants in this study had yet to receive any military training on how to land properly from a specified height. Further research should be completed to analyze the kinematics and kinetics of the lower extremity during different landing strategies implemented by trained military personnel in order to better understand injury mechanisms of drop landings in this population. It is likely that injury prevention landing techniques would be beneficial if these were employed by the military and not just in the sporting community.
The Pattern of Paediatric Trauma on Operations
Authors: Woods KL , Russell RJ , Bree S , Mahoney PF , McNicholas J 
Published: March 2013

ObjectivesRecent military campaigns in Iraq and Afghanistan have resulted in the treatment of children in British Medical facilities. In order to determine how care for children may develop in the future, it is necessary to understand the current situation. The aim of this article is to examine the pattern of paediatric trauma on recent operations in Iraq and Afghanistan.MethodsData was requested from the Joint Theatre Trauma Registry, held at the Royal Centre for Defence Medicine in Birmingham, on all trauma calls for patients aged under 16 between the dates 21/3/03 and 31/8/09. Data included age, gender, theatre of operation, injury mechanism and type, trauma scores and destination of the child.Results176 children were identified with 16.5% from Iraq and 83.5% from Afghanistan. The overall survival rate was 88.6% with survival rates in Iraq of 89.7% and in Afghanistan of 88.4%. Males accounted for 66.5% of admissions and the commonest age group was age 6-8 years. In 59.1% of total admissions the mechanism of injury was related to explosives. This differed between theatres with explosive injury causing 27.6 % of admissions in Iraq and 63.5% in Afghanistan. Injury Severity Scores (ISS) showed equal numbers of minor and severe injuries with fewer moderately injured patients. The median ISS of all data was nine. The median ISS from Iraq was 16 and the median ISS from Afghanistan was nine.ConclusionsThe treatment of children in British medical facilities whilst deployed on operations is likely to continue. An assessment of the injury patterns of paediatric patients on current deployments allows development of training and an understanding of logistic requirements. Data collection will also need to be adapted to meet the needs of paediatric patients. These remain issues that are being addressed by the Defence Medical Services.
Putting Role 1 First: The Role 1 Capability Review
Authors: Hodgetts TJ , Findlay S 
Published: March 2013

Aim:To quantify the risk for delivering care at Role 1 in the Land Environment (point of wounding to hospital care) on current operations and set the conditions for systematic change to enhance future capability.Population:UK, US and Danish Army Role 1 Subject Matter Experts (SMEs)Methods:(1) Questionnaire study of UK SMEs to determine capability gaps; (2) Questionnaire study of US and Danish SMEs to benchmark UK capability; (3) Semi-structured interviews of UK SMEs; (4) In-theatre evaluation of deployed Role 1.Results:Thirty two SMEs completed the questionnaire (68% response rate), comprising 25 medical officers (20 in clinical appointments; five in command and staff appointments), six nurses and one medical support officer. Results of the entire review were collated as a cross-Defence Lines of Development analysis, separating the specific experience of 1 Medical Regiment’s Hybrid Foundation Training (HFT), Mission Specific Training (MST) and deployment cycle from the analysis gained from questionnaire studies, SME consultation and documentary evidence.Recommendations and Conclusions:The review generated 77 recommendations and 38 sub-recommendations. The top six messages of the review were (1) To balance the expressed desire to increase the ratio of trained Team Medics with the reality of generating credible instructors with clinical experience; (2) To recognise that inadequate experience for Combat Medical Technicians in Primary Healthcare in the Firm Base undermines their operational preparedness; (3) To recognise that Current Regimental Aid Post (RAP) at contingency without power lacks the rudimentary infrastructure of a modern Medical Treatment Facility; (4) To recognise that inappropriate deployment of personnel with chronic disease or acutely limiting conditions is a consistent trend for 20 years that highlights continuing system weaknesses in applying protective medical grading; (5) To accept that General Practitioner manning requires re-evaluating as an Operational Pinch Point, reviewing all options to maintain operational effectiveness including, but not focusing on, incentives; and (6) To recognise that a best practice template for Role 1 Healthcare Governance has been created that must endure.
Factors Affecting Front Line Casualty Care in Afghanistan
Authors: Batham D , A Finnegan , Kiernan M , Wall C , Simpson RG 
Published: March 2013

Objective:Limited research has been undertaken to assess the effectiveness of pre-hospital care given at the point of wounding, nor how battlefield conditions affect the implementation of Battlefield Advanced Trauma Life Support (BATLS). This study examines the quality of care given at Role 1 and the psychological impact on clinical personnel of the application of current pre-hospital trauma management guidelines.Method:Data was collected through 17 digitally recorded semi-structured interviews with healthcare clinicians deployed in Role 1 medical facilities on OP HERRICK 14 following major medical incidents. Interview transcripts were subjected to content analysis based on a modified grounded theory approach.Results:Triage was found to be done poorly with individuals treating patients as they were found rather than by identifying clinical priorities. Pain management was not always achieved. Fluid replacement was hampered with difficulty in obtaining parenteral access. Subsequently fluids were sometimes given in excess of protocols. Clinical documentation was not always completed even after a patient had been evacuated. Some interesting elements were noted, such as post incident reports being used as a reflective process which may be self-developmental and help clinicians deal psychologically with the incident. Clinical personnel carry out their duties, irrespective of personal injury or threats to their safety. However their performance may be tapered under such stress. Human factors training prior to deployment may help to ensure adherence to BATLS protocols despite the complexities of the battle space.Conclusions:The data identified a number of factors that affected clinicians ability to provide a high standard of casualty care. The general perception of this research cohort was that despite all the obstacles, the level of trauma care was of a high nature. However, the study provides pointers to a number of areas for future exploration where patient care was not BATLS protocol compliant.
Cold Injuries in Contemporary Conflict
Authors: Mitchell J , Simpson R , Whitaker John 
Published: March 2013

Objectives:To describe the cases of cold injury sustained during the most recent winter operational tour of Afghanistan, Op HERRICK 15.Methods:Retrospective review of all notified British military cases of cold injury sustained between 1 Oct 11 and 30 Mar 12 recorded by UK Medical Group Environmental Health Team.Results:14 patients with 13 Non-freezing Cold Injuries (NFCI) and two hypothermic injuries were identified. Five patients were of African ethnic decent. Eight out of 13 NFCI patients had probably suffered a previous injury, injuries were sustained from December until February and 9/13 NFCI patients had periods of static duties implicated in the injury mechanism. Eight patients were able to remain in operational theatre on restricted duties whilst 6/14 were evacuated home after sustaining their injuries.Conclusions:Although awareness and equipment have improved, cold injuries remain an important cause of Disease and Non Battle Injury on current operations within the British Military. Cases of cold injury are probably under reported and often stem from situations where risk would seem predicable. It is hoped this article will assist in enabling greater understanding of contemporary operational cold injuries and continuing the development of preventative strategies.
Experiences of Combat Medical Technician Continuous Professional Development on Operations
Authors: Randall-Carrick J 
Published: March 2013

Whilst on operations, British military medical staff strive to provide high quality medical care to deployed soldiers. The application of UK Health Care Governance principles, particularly Clinical Professional Development (CPD), is especially challenging on operations. This article highlights some of the difficulties faced and the solutions generated to facilitate good CPD of Combat Medical Technicians (CMTs) deployed to Afghanistan on Operation HERRICK 13.The article describes the opportunities for CMTs to develop their skills in the assessment and management of trauma and primary health complaints. It also describes the difficulties in capturing this development especially when the supervision of CMTs was limited, with variable communication modalities and within the current limitations of the CMT portfolio.Solutions described include the use of individual reflective practice, face-to-face supervision and assessment by Medical Officers, Significant Event Reports, the mandatory After Action Review Process, and the development of formal standardised CMT CPD. This included refresher training after return from leave, Senior Medical Officer (SMO) weekly lectures and the SMO weekly report. Finally, the future of CMT CPD is raised and it is hoped that this article will stimulate debate into how to approach these challenges and refine these processes further.
Measuring the Visual Complexities of Web Pages
Authors: Wu Ou , Hu Weiming , Shi Lei 
Published: March 2013

Visual complexities (VisComs) of Web pages significantly affect user experience, and automatic evaluation can facilitate a large number of Web-based applications. The construction of a model for measuring the VisComs of Web pages requires the extraction of typical features and learning based on labeled Web pages. However, as far as the authors are aware, little headway has been made on measuring VisCom in Web mining and machine learning. The present article provides a new approach combining Web mining techniques and machine learning algorithms for measuring the VisComs of Web pages. The structure of a Web page is first analyzed, and the layout is then extracted. Using a Web page as a semistructured image, three classes of features are extracted to construct a feature vector. The feature vector is fed into a learned measuring function to calculate the VisCom of the page.
In the proposed approach of the present study, the type of the measuring function and its learning depend on the quantification strategy for VisCom. Aside from using a category and a score to represent VisCom as existing work, this study presents a new strategy utilizing a distribution to quantify the VisCom of a Web page. Empirical evaluation suggests the effectiveness of the proposed approach in terms of both features and learning algorithms.
A Comprehensive Study of Techniques for URL-Based Web Page Language Classification
Authors: Baykan Eda , Henzinger Monika , Weber Ingmar 
Published: March 2013

Given only the URL of a Web page, can we identify its language? In this article we examine this question. URL-based language classification is useful when the content of the Web page is not available or downloading the content is a waste of bandwidth and time.
We built URL-based language classifiers for English, German, French, Spanish, and Italian by applying a variety of algorithms and features. As algorithms we used machine learning algorithms which are widely applied for text classification and state-of-art algorithms for language identification of text. As features we used words, various sized n-grams, and custom-made features (our novel feature set). We compared our approaches with two baseline methods, namely classification by country code top-level domains and classification by IP addresses of the hosting Web servers.
We trained and tested our classifiers in a 10-fold cross-validation setup on a dataset obtained from the Open Directory Project and from querying a commercial search engine. We obtained the lowest F1-measure for English (94) and the highest F1-measure for German (98) with the best performing classifiers.
We also evaluated the performance of our methods: (i) on a set of Web pages written in Adobe Flash and (ii) as part of a language-focused crawler. In the first case, the content of the Web page is hard to extract and in the second page downloading pages of the “wrong” language constitutes a waste of bandwidth. In both settings the best classifiers have a high accuracy with an F1-measure between 95 (for English) and 98 (for Italian) for the Adobe Flash pages and a precision between 90 (for Italian) and 97 (for French) for the language-focused crawler.
Cache persistence analysis
Authors: Cullmann Christoph 
Published: March 2013

To compute a worst-case execution time (WCET) estimate for a program, the architectural effects of the underlying hardware must be modeled. For modern processors this results in the need for a cache and pipeline analysis.
The timing-relevant result of the cache analysis is the categorization of the accesses to cached memory. Categorizations that are obtainable by the well-known must and may cache analysis [Ferdinand 1997] are always-hit, always-miss and not-classified. The cache persistence analysis tries to provide additional information for the not-classified case to limit the number of misses.
There exists a cache persistence analysis by Ferdinand and Wilhelm based on abstract interpretation computing these classifications. In this article, we present a correctness issue with this analysis. To fix this issue, we propose two new abstract interpretation based persistence analyses and show their safety. One is based on the known may analysis and a second one on the concept of conflict counting.

For
fully timing compositional architectures
[Wilhelm et al. 2009] the persistence information is straightforward to use. We will apply the concepts of persistence analysis for the first time to state-of-the-art architectures that exhibit both timing anomalies and domino effects. Such architectures do not allow the analyzer to quantify the costs of a single cache hit or miss in isolation. To make the usage of the persistence information feasible, we integrate the presented novel persistence analyses together with a novel path analysis approach into the industrially used WCET analyzer aiT.
Comparative Safety and Effectiveness of Metformin in Patients With Diabetes Mellitus and Heart Failure
Authors: Eurich Dean T. , Weir Daniala L. , Majumdar Sumit R. , Tsuyuki Ross T. , Johnson Jeffrey A. , Tjosvold Lisa , Vanderloo Saskia E. , McAlister Finlay A. 
Published: March 2013

Background—
There is an ongoing controversy regarding the safety and effectiveness of metformin in the setting of heart failure (HF). Therefore, we undertook a systematic review of the trial and nontrial evidence for metformin in patients with diabetes mellitus and HF.

Methods and Results—

We conducted a comprehensive search for controlled studies, evaluating the association between metformin and morbidity and mortality in people with diabetes mellitus and HF. Two reviewers independently identified citations, extracted data, and evaluated quality. Risk estimates were abstracted and pooled where appropriate. As measures of overall safety, we examined all-cause mortality and all-cause hospitalizations. Nine cohort studies were included; no randomized controlled trials were identified. Most (5 of 9) studies were published in 2010 and were of good quality. Metformin was associated with reduced mortality compared with controls (mostly sulfonylurea therapy): 23% versus 37% (pooled adjusted risk estimates: 0.80; 0.74–0.87;
I
2
=15%;
P
<0.001). No increased risk was observed for metformin in those with reduced left ventricular ejection fraction (mortality pooled adjusted risk estimate: 0.91; 0.72–1.14;
I
2
=0%;
P
=0.34), nor in those with HF and chronic kidney disease (pooled adjusted risk estimate: 0.81; 0.64–1.02;
P
=0.08). Metformin was associated with a small reduction in all-cause hospitalizations (pooled adjusted risk estimate: 0.93; 0.89–0.98;
I
2
=0%;
P
=0.01). Metformin was not associated with increased risk of lactic acidosis.

Conclusions—
The totality of evidence indicates that metformin is at least as safe as other glucose-lowering treatments in patients with diabetes mellitus and HF and even in those with reduced left ventricular ejection fraction or concomitant chronic kidney disease. Until trial data become available, metformin should be considered the treatment of choice for patients with diabetes mellitus and HF.