bluuebunny/crossref_metadata_2025_split huggingface dataset:
Compartment Syndrome of the Foot – Implications for Military Surgeons
Authors: Middleton Simon , Clasper J 
Published: March 2013

IntroductionCompartment syndrome of the foot is a rare complication of injury to the foot. Treatment by decompression of the compartments is debatable. The debate surrounding decompression stems from the rarity of the condition, the lack of consensus regarding the anatomy of the foot compartments and whether to accept the inevitable contractures by not decompressing. The aim of this paper is two fold; firstly to sample current military orthopaedic experience and secondly establish if there exists a consensus of opinion in how and if to perform fasciotomy of the foot thereby providing guidance to other clinicians.MethodA questionnaire was sent to 10 DMS orthopaedic consultants to identify their experience with foot compartment syndrome and performing foot fasciotomies.ResultsFive had performed a foot fasciotomy (average 2, range 1-6) over an average of 6.2 years as consultant and an average of 7.3 months deployed. Most commonly two dorsal and a medial incision were used to decompress the foot. One surgeon advocated not decompressing the foot and accepting the subsequent contractures,ConclusionDMS clinicians need to remain vigilant to compartment syndrome of the foot and especially in cases of crush or blast injury or of multiple fractures. If diagnosed or even if an impending compartment syndrome is suspected then, in line with the current weight of expert opinion, the foot should be decompressed and the deployed orthopaedic surgeon should be capable of performing it. Evidence concerning their battlefield use is limited. Extensive UK military trials are ongoing and the results of which are expected to clarify questions regarding complication rate and efficacy.
Systemic Blood Pressure, Arterial Stiffness and Pulse Waveform Analysis at Altitude
Authors: Rhodes HL , Chesterman K , Chan CW , Collins P , Kewley E , Pattinson KTS , Myers S , Imray CHE , Wright A D 
Published: March 2013

ObjectivesSystemic arterial pressure rises on acute exposure to high altitude and changes in blood pressure (BP) and endothelial function may be important in the pathogenesis of clinical syndromes occurring at high altitude.MethodsArterial BP, stiffness (SI) and tone (RI) were studied over 11 days in 17 subjects (three having mild hypertension) ascending to 3,450m and 4,770m using a non-invasive, finger photoplethysmography technique.ResultsAt 3,450m BP rose from mean 131/75 mmHg (SD 23/12) to 145/86 (23/12) and was maintained at this level (p< 0.001). SI did not change significantly from 8.5 m/sec (2.5) to 9.7 (3.2). RI fell during the first day at 3,450m from 74.4% (7.9) to 70.5% (13.8) (NS p>0.05) and to 69.9% (12.0) (p< 0.02) at 4,770m but then reverted to baseline. Changes in SI and RI did not relate to changes in blood pressure. Changes in both arterial stiffness and tone were similar in those who developed AMS compared with those who did not. Baseline SI tended to be higher in the three subjects with hypertension 11.1m/sec(SD 2.7)) compared with the normotensives 8.3 m/sec (SD 2.7) (NS) and baseline RI lower 74.7% (7.0) compared with the normotensives 76.5% (8.5) (NS). Changes in SI and RI at altitude in the hypertensive subjects were similar to the non-hypertensive subjects.ConclusionsWe conclude that acute exposure temporarily affected endothelial function as measured by a change in vascular tone but this did not predict the development of AMS. The rise in arterial BP was not related to changes in arterial stiffness or tone.
Improvements in Compliance with Medical Force Protection Measures by Simplification of the Anti-Malarial Chemoprophylaxis Regime
Authors: Sellers Emma , Ross DA , Green AD 
Published: March 2013

ObjectivesMedical Force Protection (MFP) is important in keeping service personnel “fit to fight.” It is particularly important for overseas deployment, where personnel are exposed to a range of infectious diseases. We report a full audit cycle assessing compliance with medical force protection measures, on an exercise in Belize.MethodsAn anonymous questionnaire was administered to personnel four weeks after returning from an Infantry Overseas Training Exercise (OTX) in Belize in two successive years (OTX 1& 2).ResultsCompliance with physical MFP measures (mosquito nets, insecticide soak of kit and personal insect repellent usage) was excellent on both exercises. Antimalarial chemoprophylaxis compliance with a regime of weekly chloroquine and daily proguanil was poor (30%) during OTX 1. Revision of the regime to weekly chloroquine alone following review of anti-malarial policies increased compliance on OTX 2 to 67%.ConclusionSimplification of dosage regimes, consistency of information provided between different medical briefs and emphasis of the threat from malaria in Belize significantly improved compliance with antimalarial chemoprophylaxis.
A Three-Year Review of Emergency Department Admissions - Op HERRICK 4 to 9
Authors: Stalker Andrew , Ollerton J , Everington S , Russell R , Walker C , White S 
Published: March 2013

ObjectivesThis paper describes the key themes in presentations to the Emergency Department (ED) of the UK Field Hospital throughout the three-year period of April 2006 to April 2009 (Op HERRICK 4-9).MethodsElectronic ED attendance records held in the Operational Emergency Department Attendance Register (OpEDAR) were analysed with validation by Defence Analytical Services Agency and commentary by ADMEM clinical staff.ResultsThis paper discusses absolute numbers of emergency department attendances of which there were 11,158 recorded over the study period. It does not compare them to personnel at risk or operational tempo. Of these attendances, 59.7% (n=6,666) were UK military. Explosive injuries (15.2%, n=1,699), particularly Improvised Explosive Devices, increased throughout the period as did gunshot wounds (7.3%, n=809). Battle injuries represented 23.3% (n=2,602) attendances and had a fatality rate of 10.9%. 38.8% (n=4,327) of attendances were non-battle injuries and had a fatality rate of 0.4%. There were no fatalities in the 34.1% (n=3,800) attendances for disease. 315 fatalities were recorded (this figure relates to all attendances – not just UK personnel) with 90.2% (n=284) due to battle injuries. 59.4% (n=187) were due to explosives and 28.9% (n=91) due to gunshot wounds.ConclusionsOver the period, the hospital’s workload was characterised by an increase in explosive and gunshot injuries. In this role, the hospital met its obligation of responding to traumatic battle injury in support of fighting power and morale. Equally, the hospital faced a high proportion of attendances for non-battle injury and illness, and by patients from the local population. Extrapolation of data enables accurate medical planning and pre-deployment training and facilitates preparation for current operations.
Outcomes from Penetrating Ballistic Cervical Injury
Authors: Breeze J , Masterson L , Banfield G 
Published: March 2013

AimsBallistic cervical injury has become a significant source of both morbidity and mortality for the deployed UK soldier.The aim of this paper was to document a case series of ballistic cervical wounds to describe the pattern of these injuries and relate them to outcome.MethodsThe records of all UK service personnel sustaining wounds to the neck in Iraq or Afghanistan between 01 August 2004 and 01 January 2008 were analysed following identification by the Joint Theatre Trauma Registry. Blunt or thermal injuries were excluded.ResultsThe records of 75/76 service personnel sustaining penetrating cervical injury during this period were available for analysis. 56/75 (75%) were due to explosive fragmentation and the remainder due to gunshot wounds (GSW). 33/75 (44%) of soldiers sustained vascular injury, 32/75 (43%) injury to the spine or spinal cord, 29/75 (39%) injury to the larynx or trachea and 11/75 (15%) injury to the pharynx or oesophagus. 14/75 (19%) patients in this series underwent surgery in a hospital facility for treatment of potentially life threatening cervical injuries, with a survival rate after surgery of 12/14 (86%). The overall mortality from this series of battlefield penetrating neck injury was 63%.ConclusionsPenetrating cervical ballistic injury is a significant source of injury to deployed UK service personnel, predominantly due to neurovascular damage. Neck collars if worn would likely prevent many of the injuries in this case series but such protection is uncomfortable and may interfere with common military tasks. Newer methods of protecting the neck should be investigated that will be acceptable to the deployed UK soldier.
To Refer or Not to Refer: A Qualitative Study of Reasons for Referral From Role 1
Authors: Driver Jamie , Nelson TG , Simpson R , Wall C 
Published: March 2013

Objectives:There are currently over 9000 British soldiers serving in Afghanistan. The Defence Medical Services provide primary health care to soldiers at forward locations using Regimental Medical Officers (RMOs) and General Duties Medical Officers (GDMOs). If required, GDMOs can refer patients to senior colleagues. Currently, little is known about the reasons for referrals by GDMOs. This study aims to identify the main factors affecting why GDMOs refer from forward locations.Methods:Nine GDMOs, who deployed on Operation HERRICK 13, were invited to join the study. They maintained a log of their referrals for two 14 day periods, one in each half of their tour. In addition, a semi-structured interview was performed with each GDMO in order to elicit the common themes surrounding referrals.Results:The mean referral rate was 0.9 referrals/GDMO/week. The main reasons for referral were dental problems, musculoskeletal injuries, abdominal pain of unknown cause, and ano-genital problems. Factors that influenced referrals included availability of forwardly projected services (dentist and physiotherapist), manpower availability at the locations, the availability of flights (affected by weather, enemy action, and schedule of routine flights), and the timing of the tour in relation to leave.Conclusions:Referrals from GDMOs were due to doctor inexperience in the treatment of a particular condition, lack of access to investigations and the potential for deterioration in a location without adequate support. The referral decision process was affected by the patient’s importance with regards to the mission, the weather and access to safe transportation. The introduction of clinical guidelines for common conditions in conjunction with minor alterations to GDMO training could help reduce referrals from Role 1, preserving manpower, reducing costs, and minimising risk to evacuation aircraft.
Military Nephrology: A Review of Cases 1985-2011
Authors: World MJ 
Published: March 2013

Objective:Evidence of the prevalence of renal pathology in military populations is rare, probably as a result of a traditionally cautious military medical attitude that limits applicants with evidence of renal disease joining the Armed Forces and the continued service of military personnel who develop this later. The aim of this paper is to provide the first comprehensive review of renal diseases in a British military population.Methods:An archive of out-patient consultations, discharge summaries and renal biopsies between 1985 and 2011 was reviewed. Cases were classified according to diagnosis providing a frequency distribution over this 26-year period. Serum creatinine concentration and demographic data permitted retrospective calculation of estimated glomerular filtration rate (eGFR) at presentation and follow-up. Calculation of an annualised rate of deterioration of eGFR (ml/min/1.73m2/y) was undertaken when there were at least four follow-up values. In those cases where there was a statistically significant negative correlation with time, the probability of deterioration of renal function according to diagnosis was calculated. Where numbers of patients with a given diagnosis were sufficient for statistical purposes, correlations were also attempted between initial eGFR and both initial mean arterial pressure (MAP) and initial proteinuria.Results:The most frequent condition was IgA nephropathy, present in 115/346 (33%) of cases. Follow-up data permitted analysis of change in eGFR in 50 of these and 11 (22%) deteriorated. In this condition, there were statistically significant negative correlations between initial eGFR and MAP (r= -0.35, p=0.0008) and proteinuria (r= -0.4, p=0.0006). Other conditions showing deterioration despite therapeutic interventions included adult polycystic kidney disease (15/22=68%) and membranous nephropathy (4/7=57%). Altogether, 8/13 (61%) conditions included cases where eGFR deteriorated and this was present in 40/161 (25%) individual cases.Conclusions:Cases of renal disease are discovered de novo in serving military personnel and, despite interventions to maintain renal function, a significant proportion deteriorate supporting the traditionally restrictive policy concerning applicants with evidence of renal disease.
Smoking prevalence amongst UK Armed Forces recruits: changes in behaviour after 3 years follow-up and factors affecting smoking behaviour
Authors: Bray Isabelle , Richardson P , Harrison K 
Published: March 2013

ObjectivesThe purpose of this study was to investigate smoking prevalence of Tri-Service recruits, and changes in smoking behaviour at 3-year follow-up, by trade group and gender. Associations with educational attainment and deprivation were also assessed.MethodsAnalysis of a survey into the health behaviours of 10 531 recruits in 1998/1999. A follow-up 3 years later measured changes in behaviour. Correlation and multiple regression was used to investigate the relationship between smoking prevalence in each trade group and both educational attainment and deprivation, using Index of Multiple Deprivation 2004 (IMD 2004) scores.ResultsArmy recruits exhibited a significantly higher smoking prevalence (45%) than Royal Navy recruits (34%) and Royal Air Force (RAF) recruits (31%). There were marked differences between smoking levels amongst officer cadets (12%, 20% and 10% in the Navy, Army and RAF, respectively) and other rank trade groups (24–56%), with the exception of the Marines (13%). At follow up, smoking had generally increased, and in some parts of the infantry had risen to 66%. There was a clear correlation between smoking at enlistment and both educational attainment (correlation coefficient=0.7, p<0.005) and deprivation score (correlation coefficient=0.8, p<0.005).ConclusionsThere were clear differences between Services, rank and trade groups in smoking prevalence at recruitment. Smoking levels increased in the 3 years after recruitment to the Armed Forces. Deprivation was more important than educational attainment in determining the smoking status of recruits.
Round Afghanistan with a fridge
Authors: Wild Gareth , Anderson D , Lund P 
Published: March 2013

IntroductionThis paper covers the contemporary deployment of blood products in the pre–hospital environment during extended field operations in Afghanistan. The equipment used was standard–issue to the British Armed Forces but used in a novel manner. The aim of this paper was to establish the reliability of the RCB42P blood bank and the concept of blood storage in the field during protracted vehicle-borne patrols.MethodTempIT tag data was collected for five patrols and analysed. Ambient temperatures varied immensely from minus 5°C to plus 50°C. Mitigation measures were introduced to reduce the exposure of the blood bank to radiated and ambient heat.ResultsThe blood bank is affected by radiated heat from the engine compartment on long journeys coupled with high ambient temperatures. However, this can be minimised by simple mitigation measures using insulation and passive cooling.ConclusionsThe RCB42P blood bank is a robust unit capable of enduring a considerable amount of physical abuse and extremes of temperature. It is suitable for the storage of blood products on protracted vehicle-borne patrols in high ambient temperatures if the mitigation measures outlined are employed.
Dynamic pressure testing for chronic exertional compartment syndrome in the UK military population
Authors: Dharm-Datta Shreshth , Minden D F , Rosell P A , Hill P F , Mistlin A , Etherington J 
Published: March 2013

ObjectivesChronic exertional compartment syndrome is one of the main causes of exertional leg pain. Diagnosis is based on the history and intracompartmental muscle pressure testing during exercise prior to consideration of fasciotomy for treatment. We present the data gathered at Defence Medical Rehabilitation Centre Headley Court during the first year of a revised protocol on dynamic pressure testing from May 2007.MethodsThe exercise protocol involved exercising patients using a representative military task: the Combat Fitness Test with a 15 kg Bergen on a treadmill, set at 6.5 km/h with zero incline up to 15 min and if completed, a further 5 min at 7.5 km/h. Subjects informed us when the exertional leg pain was 7/10 on a visual analogue scale and were instructed to carry on till failure (pain 10/10) or till the test finished. Mean pressure during this time period (7/10 to 10/10) was calculated by computer.ResultsOver 1 year, we performed 151 intracompartmental pressure studies in 76 patients. 120 were successful in 68 patients, with 31 technical failures. All studies were performed in the anterior or deep posterior muscle compartments as these were the symptomatic compartments; no patients had symptoms in the lateral or superficial posterior compartments and these were not tested. There was only one complication with a posterior tibial artery puncture. In 119 compartment studies, the mean pressure was 97.8 mm Hg (SD 31.7). These data are normally distributed (Shapiro Wilk test, W=0.98 p=0.125).ConclusionsOur data based on this exercise protocol are comparable with the few studies that record dynamic pressure during running-based exercise. There is no accepted diagnostic pressure or exercise protocol. Due to the uncertainty of diagnostic criteria, it is necessary to perform a study measuring dynamic pressures in normal asymptomatic subjects.
ONLINE SCHEDULING AND PLACEMENT OF HARDWARE MODULES ON PARTIALLY DYNAMIC ARCHITECTURES
Authors: OUNI BOURAOUI , MTIBAA ABDELLATIF 
Published: March 2013

New FPGA families can be reconfigured partially, meaning that only a certain portion of the chip area is reprogrammed. Partial reconfiguration makes possible to exchange function blocks on the FPGA and adapt it to a changing environment. It is used to have only a subset of necessary applications running on chip at each time, and replacing them by those needed. One of the challenging problems is the scheduling and the placement of modules on reconfigurable resources, this problem is called temporal placement. Several modules placement techniques have been introduced in the literature to solve the temporal placement problem. In this paper, we examine the temporal placement, showing how it can be decomposed into a number of distinct but not independent subtasks. Furthermore, in this paper, we have classified the temporal placement algorithms into the following classes: (1) Algorithms without design optimization (2) Routing cost optimization algorithms (3) Reconfiguration time optimization algorithms (4) Modules interfering optimization algorithms (5) Device resources optimization algorithms After that, experiments are conducted in order to evaluate the complexity and performances in term of traditional design metrics, like latency, area, etc., of each algorithm.
Sequential specification of time-aware stream processing applications
Authors: Geuns Stefan J. , Hausmans Joost P. H. M. , Bekooij Marco J. G. 
Published: March 2013

Automatic parallelization of Nested Loop Programs (NLPs) is an attractive method to create embedded real-time stream processing applications for multi-core systems. However, the description and parallelization of applications with a time dependent functional behavior has not been considered in NLPs. In such a description, semantic information about time dependent behavior must be made available for the compiler, such that an optimized time independent implementation can be generated automatically.
This article introduces language constructs with temporal semantics to NLPs. Using these language constructs, time dependent applications can be specified and a corresponding data-driven implementation can be generated for use on a multi-core system. Despite that these time-aware language constructs can be data-dependent, the application remains functionally deterministic. Pipelining is exploited to increase the throughput of an application. The media access control (MAC) protocol of an IEEE 802.11p WLAN transceiver is used to illustrate the relevance and applicability of the introduced concepts.
Analysis of Over 10,000 Cases Finds No Association between Previously Reported Candidate Polymorphisms and Ovarian Cancer Outcome
Authors: White Kristin L. , Vierkant Robert A. , Fogarty Zachary C. , Charbonneau Bridget , Block Matthew S. , Pharoah Paul D.P. , Chenevix-Trench Georgia ,   for AOCS/ACS group;, Rossing Mary Anne , Cramer Daniel W. , Pearce Celeste Leigh , Schildkraut Joellen M. , Menon Usha , Kjaer Susanne Kruger , Levine Douglas A. , Gronwald Jacek , Culver Hoda Anton , Whittemore Alice S. , Karlan Beth Y. , Lambrechts Diether , Wentzensen Nicolas , Kupryjanczyk Jolanta , Chang-Claude Jenny , Bandera Elisa V. , Hogdall Estrid , Heitz Florian , Kaye Stanley B. , Fasching Peter A. , Campbell Ian , Goodman Marc T. , Pejovic Tanja , Bean Yukie , Lurie Galina , Eccles Diana , Hein Alexander , Beckmann Matthias W. , Ekici Arif B. , Paul James , Brown Robert , Flanagan James M. , Harter Philipp , du Bois Andreas , Schwaab Ira , Hogdall Claus K. , Lundvall Lene , Olson Sara H. , Orlow Irene , Paddock Lisa E. , Rudolph Anja , Eilber Ursula , Dansonka-Mieszkowska Agnieszka , Rzepecka Iwona K. , Ziolkowska-Seta Izabela , Brinton Louise , Yang Hannah , Garcia-Closas Montserrat , Despierre Evelyn , Lambrechts Sandrina , Vergote Ignace , Walsh Christine , Lester Jenny , Sieh Weiva , McGuire Valerie , Rothstein Joseph H. , Ziogas Argyrios , Lubiński Jan , Cybulski Cezary , Menkiszak Janusz , Jensen Allan , Gayther Simon A. , Ramus Susan J. , Gentry-Maharaj Aleksandra , Berchuck Andrew , Wu Anna H. , Pike Malcolm C. , Van DenBerg David , Terry Kathryn L. , Vitonis Allison F. , Doherty Jennifer A. , Johnatty Sharon E. , deFazio Anna , Song Honglin , Tyrer Jonathan , Sellers Thomas A. , Phelan Catherine M. , Kalli Kimberly R. , Cunningham Julie M. , Fridley Brooke L. , Goode Ellen L. 
Published: March 2013

Abstract
Background: Ovarian cancer is a leading cause of cancer-related death among women. In an effort to understand contributors to disease outcome, we evaluated single-nucleotide polymorphisms (SNP) previously associated with ovarian cancer recurrence or survival, specifically in angiogenesis, inflammation, mitosis, and drug disposition genes.
Methods: Twenty-seven SNPs in VHL, HGF, IL18, PRKACB, ABCB1, CYP2C8, ERCC2, and ERCC1 previously associated with ovarian cancer outcome were genotyped in 10,084 invasive cases from 28 studies from the Ovarian Cancer Association Consortium with over 37,000-observed person-years and 4,478 deaths. Cox proportional hazards models were used to examine the association between candidate SNPs and ovarian cancer recurrence or survival with and without adjustment for key covariates.
Results: We observed no association between genotype and ovarian cancer recurrence or survival for any of the SNPs examined.
Conclusions: These results refute prior associations between these SNPs and ovarian cancer outcome and underscore the importance of maximally powered genetic association studies.
Impact: These variants should not be used in prognostic models. Alternate approaches to uncovering inherited prognostic factors, if they exist, are needed. Cancer Epidemiol Biomarkers Prev; 22(5); 987–. ©2013 AACR.