bluuebunny/crossref_metadata_2025_split huggingface dataset:
The Use of Exercise and Dietary Supplements Among British Soldiers in Afghanistan
Authors: Boos Christopher , Simms P , Morris F R , Fertout M 
Published: March 2013

Background and ObjectivesRecently published case reports, coupled with a large observational study of 1017 deployed servicemen to Iraq (January 2009), has highlighted the issue and potential concerns regarding the unregulated use of dietary and exercise supplements within the British military. Consequently, an exploratory pilot study was undertaken to assess whether the findings of the previous Iraq study were applicable to current deployed British servicemen in Afghanistan.MethodsThis was a voluntary questionnaire-based study targeted at individuals attending a health promotion fair in Camp Bastion, Afghanistan in June 2010.ResultsFrom 150 questionnaires handed out there were 87 completed questionnaires (58% return). The mean age was 28.0 (SD 7.1; range of 18-50 years) with 89.7% being male. From the total of 87 persons 46.0% were self-declared current smokers with 37.9% admitting to drinking > 6 caffeinated drinks per day. Forty nine persons (56.3%) admitted to a history of supplement use with 35 (40.2% compared with 32.0% in 2009 in Iraq) declaring current use. The average duration of supplement use among current users was 3.0 (2.0-9.0) months. The main sources of supplement supply were via local NAAFI purchase (57.1%), internet purchase (40.0%) and via their local chemist (2.9%). The main types of supplement used were proteins / amino acids (85.7%), creatine (34.3%), chromium (31.4%), stimulants (17.1%), hydroxycut (5.7 %), and testosterone boosters (1.2%) with no persons admitting to the use of ephedra or anabolic steroids.ConclusionsA significant proportion of the British servicemen employed on operations in Afghanistan who were sampled, admitted to current dietary and exercise supplement use whilst on deployment. The results of this small study suggest that their use on operations may be increasing. Smoking rates and caffeine consumption, on deployment, remain high in the British military. A larger detailed study with greater representation among soldiers deployed to forward operating bases would be helpful to fully appreciate the scale of supplement use.
Outbreak of Zoonotic Cutaneous Leishmaniasis with Local Dissemination in Balkh, Afghanistan
Authors: Bailey Mark S , Caddy AJ , McKinnon KA , Fogg LF , Roscoe M , Bailey JW , O’Dempsey TJ , Beeching NJ 
Published: March 2013

Objectives:In Afghanistan zoonotic cutaneous leishmaniasis (CL) due to Leishmania major has been less widely reported than anthroponotic CL due to L. tropica. However, an outbreak of zoonotic CL occurred amongst a group of British soldiers at a military camp near Mazar-e-Sharif in the Balkh province of northern Afghanistan in 2004.Methods:A study was performed to assess the epidemiology, clinical features, parasitology results, treatment outcomes and environmental health measures associated with this incident.Results:Twenty (17%) of 120 soldiers developed CL due to L. major and the risk of infection increased with the proximity of their accommodation to an area of recently cleared scrub, where many wild rodents were observed. Most cases had features of local dissemination, including secondary lesions from the pseudo-Koebner phenomenon, sporotrichoid lymphatic spread, lymphadenopathy and satellite papules or milia formation around healing lesions. Several cases responded poorly to fluconazole and low dose (10 mg/kg) sodium stibogluconate, which were considered suitable treatments at the time. Environmental health measures at the military camp were found to be deficient.Conclusions:Zoonotic CL due to L. major is a significant threat for foreign troops based in Balkh, Afghanistan and may present with unusually severe clinical features and be resistant to previously recommended treatments.
Dermatology on Operation HERRICK
Authors: Driver Jamie , Simpson R , Wall C , Nelson TG 
Published: March 2013

Objectives:To identify the dermatological conditions affecting British troops in Afghanistan, understand how they are treated and identify potential areas for improvement.Methods:Data was collected from the Defence Analytical Services and Advice agency and the Operational Emergency Department Attendance Register via the Disease and Non Battle Injury working group. Additional data was collected from J4 – Medical Permanent Joint Headquarters. Treatment information from Clinical Guidelines on Operations (CGOs), Medics’ protocols, and primary care module composition was reviewed.Results:Dermatological conditions accounted for 1 in 5 attendances to a Role 1 Medical Treatment Facility during the study period. They were consistently in the top five reasons for working days lost, and had a comparatively high hospital admission rate (0.3/1000 Population at Risk (PAR)/month) and a repatriation rate similar to other medical specialties such as respiratory and neurology (0.1/1000 PAR/month). Treatment appeared to be adequate based on declining return attendance numbers, although CGOs were found to lack dermatological protocols and medic protocols were eight years old and not specific to the current operational requirements.Conclusions:Although treatments are working for dermatological conditions, areas for optimisation of health care have been identified, such as updating medic protocols to include campaign specific information and latest guidelines in the CGOs. Pre-deployment dermatologist-devised treatment plans and tele-consults may also help keep soldiers with pre-existing skin complaints in theatre.
Behavioural activation for the treatment of depression in military personnel
Authors: Whybrow Dean 
Published: March 2013

IntroductionDepression is a common mental health problem in both civilian and military populations. Access to evidence based psychological therapies for treating common mental health problems such as depression may not be adequate at present. Behavioural Activation (BA) represents a National Institute for Clinical Excellence recommended, evidence-based treatment for depression. The aim of this review was to review the literature to determine how BA could work as a therapeutic approach for military personnel with depression.MethodFive specialty-specific electronic databases were searched using the key words ‘behavioural activation’, ‘activity scheduling’ and ‘depression’. Emerging themes were drawn out of the literature using a long table approach to thematic analysis.ResultsSeven themes were identified: Clinical Effectiveness, Cultural Competence, Co-morbidity, Cost Effectiveness, Alternatives to Face-to-Face Therapy, Training and Patient Experience.ConclusionsGroup based BA is a cost effective option that may build upon service personnel's cultural affinity to teamwork and peer support. Brief training workshops and supervision could be provided to military mental health nurses to deliver group based BA. However service delivery may also be enhanced by enabling some nurses to specialise as Cognitive Behavioural Psychotherapists. More research is needed to understand whether this pragmatic, two pronged approach to training would result in the sustained dissemination of evidence based practice.
Rigorous rental memory management for embedded systems
Authors: Jeong Jinkyu , Kim Hwanju , Hwang Jeaho , Lee Joonwon , Maeng Seungryoul 
Published: March 2013

Memory reservation in embedded systems is a prevalent approach to provide a physically contiguous memory region to its integrated devices, such as a camera device and a video decoder. Inefficiency of the memory reservation becomes a more significant problem in emerging embedded systems, such as smartphones and smart TVs. Many ways of using these systems increase the idle time of their integrated devices, and eventually decrease the utilization of their reserved memory.
In this article, we propose a scheme to minimize the memory inefficiency caused by the memory reservation. The memory space reserved for a device can be rented for other purposes when the device is not active. For this scheme to be viable, latencies associated with reallocating the memory space should be minimal. Volatile pages are good candidates for such page reallocation since they can be reclaimed immediately as they are needed by the original device. We also provide two optimization techniques, lazy-migration and adaptive-activation. The former increases the lowered utilization of the rental memory by our volatile page allocations, and the latter saves active pages in the rental memory during the reallocation.
We implemented our scheme on a smartphone development board with the Android Linux kernel. Our prototype has shown that the time for the return operation is less than 0.77 seconds in the tested cases. We believe that this time is acceptable to end-users in terms of transparency since the time can be hidden in application initialization time. The rental memory also brings throughput increases ranging from 2% to 200% based on the available memory and the applications' memory intensiveness.
Influence of Stratospheric Sudden Warming on AIRS Midtropospheric CO2
Authors: Jiang Xun , Wang Jingqian , Olsen Edward T. , Pagano Thomas , Chen Luke L. , Yung Yuk L. 
Published: March 2013

Abstract
Midtropospheric CO2 retrievals from the Atmospheric Infrared Sounder (AIRS) were used to explore the influence of stratospheric sudden warming (SSW) on CO2 in the middle to upper troposphere. To choose the SSW events that had strong coupling between the stratosphere and troposphere, the authors applied a principal component analysis to the NCEP/Department of Energy Global Reanalysis 2 (NCEP-2) geopotential height data at 17 pressure levels. Two events (April 2003 and March 2005) that have strong couplings between the stratosphere and troposphere were chosen to investigate the influence of SSW on AIRS midtropospheric CO2. The authors investigated the temporal and spatial variations of AIRS midtropospheric CO2 before and after the SSW events and found that the midtropospheric CO2 concentrations increased by 2–3 ppm within a few days after the SSW events. These results can be used to better understand how the chemical tracers respond to the large-scale dynamics in the high latitudes.
Climatology of High Cloud Dynamics Using Profiling ARM Doppler Radar Observations
Authors: Kalesse Heike , Kollias Pavlos 
Published: March 2013

AbstractIce cloud properties are influenced by cloud-scale vertical air motion. Dynamical properties of ice clouds can be determined via Doppler measurements from ground-based, profiling cloud radars. Here, the decomposition of the Doppler velocities into reflectivity-weighted particle velocity Vt and vertical air motion w is described. The methodology is applied to high clouds observations from 35-GHz profiling millimeter wavelength radars at the Atmospheric Radiation Measurement Program (ARM) Southern Great Plains (SGP) climate research facility in Oklahoma (January 1997–December 2010) and the ARM Tropical Western Pacific (TWP) site in Manus (July 1999–December 2010). The Doppler velocity measurements are used to detect gravity waves (GW), whose correlation with high cloud macrophysical properties is investigated. Cloud turbulence is studied in the absence and presence of GW. High clouds are less turbulent when GW are observed. Probability density functions of Vt, w, and high cloud macrophysical properties for the two cloud subsets (with and without GW) are presented. Air-density-corrected Vt for high clouds for which GW (no GW) were detected amounted to hourly means and standard deviations of 0.89 ± 0.52 m s−1 (0.8 ± 0.48 m s−1) and 1.03 ± 0.41 m s−1 (0.86 ± 0.49 m s−1) at SGP and Manus, respectively. The error of w at one standard deviation was estimated as 0.15 m s−1. Hourly means of w averaged around 0 m s−1 with standard deviations of ±0.27 (SGP) and ±0.29 m s−1 (Manus) for high clouds without GW and ±0.22 m s−1 (both sites) for high clouds with GW. The midlatitude site showed stronger seasonality in detected high cloud properties.
A Decomposition of Feedback Contributions to Polar Warming Amplification
Authors: Taylor Patrick C. , Cai Ming , Hu Aixue , Meehl Jerry , Washington Warren , Zhang Guang J. 
Published: March 2013

Abstract
Polar surface temperatures are expected to warm 2–3 times faster than the global-mean surface temperature: a phenomenon referred to as polar warming amplification. Therefore, understanding the individual process contributions to the polar warming is critical to understanding global climate sensitivity. The Coupled Feedback Response Analysis Method (CFRAM) is applied to decompose the annual- and zonal-mean vertical temperature response within a transient 1% yr−1 CO2 increase simulation of the NCAR Community Climate System Model, version 4 (CCSM4), into individual radiative and nonradiative climate feedback process contributions. The total transient annual-mean polar warming amplification (amplification factor) at the time of CO2 doubling is +2.12 (2.3) and +0.94 K (1.6) in the Northern and Southern Hemisphere, respectively. Surface albedo feedback is the largest contributor to the annual-mean polar warming amplification accounting for +1.82 and +1.04 K in the Northern and Southern Hemisphere, respectively. Net cloud feedback is found to be the second largest contributor to polar warming amplification (about +0.38 K in both hemispheres) and is driven by the enhanced downward longwave radiation to the surface resulting from increases in low polar water cloud. The external forcing and atmospheric dynamic transport also contribute positively to polar warming amplification: +0.29 and +0.32 K, respectively. Water vapor feedback contributes negatively to polar warming amplification because its induced surface warming is stronger in low latitudes. Ocean heat transport storage and surface turbulent flux feedbacks also contribute negatively to polar warming amplification. Ocean heat transport and storage terms play an important role in reducing the warming over the Southern Ocean and Northern Atlantic Ocean.
Sensitivity of MRI for Articular Cartilage Lesions of the Patellae
Authors: Mattila V. M. , Weckström M. , Leppänen V. , Kiuru M. , Pihlajamäki H. 
Published: March 2013

Background and Aims Reliable diagnosis of articular cartilage lesions of the patellae is often based on arthroscopy. However, unnecessary arthroscopies should be avoided. The aim of this study was to assess the sensitivity and applicability of MRI to diagnosing articular cartilage lesions of the patellae. Materials and Methods We identified 74 consecutive males (mean age 21 years, range 18–28) from the medical records of our institute with the sole diagnosis of articular cartilage lesions of the patellae based on arthroscopy. Magnetic resonance imaging was performed with 1.0 Tesla scanner a mean of 4 weeks before arthroscopy. Sensitivity of symptoms, and MRI for the diagnosis was calculated. Results Based on arthroscopy, 20 (27%) cases of cartilage lesions of the patellae were grade-I, 32 (43%) were grade-II, and 22 (30%) were grade-III. MRI revealed cartilage lesions of the patellae in 49 knees (66%), indicating that the sensitivity of MRI was 66% (95% CI: 53%–74%). MRI sensitivity increased with the severity of chondral lesions: all grade III to IV lesions were detected (sensitivity 100%, 95% CI: 85%–100%) by MRI. Grade of articular cartilage lesions of the patellae based on arthroscopy was not associated with clinical symptoms (p = 0.61). Conclusions The sensitivity of 1.0 Tesla MRI for detecting grade-I lesions was low and could not be used to confirm the diagnosis of articular cartilage lesions of the patellae. For the detection of more severe grade-II to III lesions, the MRI sensitivity was markedly higher. MRI may thus be considered an accurate diagnostic tool for identifying more severe cases of articular cartilage lesions of the patellae.
Early Results of Large Head Metal-on-Metal Hip Arthroplasties
Authors: Kostensalo I. , Seppänen M. , Mäkelä K. , Mokka J. , Virolainen P. , Hirviniemi J. 
Published: March 2013

Background and Aims Total hip arthroplasty significantly improves patient's life quality. However, total joint replacement is associated with possible complications, such as dislocations, infections, fractures and periprosthetic osteolysis. The goal of this study was to evaluate a large head metal-on-metal total hip arthroplasties and analyse short term complications related to them. Material and Methods Between 9/2005 and 6/2009, a total of 691 hip replacements were performed on 635 patients with the use of Magnum M2 large head cementless metal-on-metal prosthesis in Turku University Hospital. All patients had a scheduled follow-up at two to three months, and at one year. The results were evaluated using X-rays, Harris Hip Score (HHS), and evaluating post-operative complications and reasons for re-operations. Results During our follow-up the HHS median raised from its preoperative value of 59.8 to 86.4 two to three months after the operation, and to 93.9 one year after the operation. As a complication we had five infections requiring single open debridement (early infection) or a two stage revision. Seven patients had a periprosthetic femoral fracture that was operated and 11 patients were reoperated because of acetabular component malposition, fracture or early loosening. We did not observe any dislocations, n. ischiadicus damages, squeeking or complications related to high metal ion release (ALVAL-reactions (Aseptic Lymphocyte-dominated Vasculitis-Associated Lesion) or pseudotumours). Conclusions The metal-on-metal bearing pair allows large femoral head size, which decreases the risk for dislocation. It may also decrease the risk for osteolysis and aseptic loosening in a long run. Early complication rate related to the bearing surface is minimal. Metal-on-metal prosthesis is a good choice for young and active patients with good bone quality.
The Path from Art to Evidence in Treating Critical Limb Ischaemia — Reflections on 35 Years' Experience
Authors: Lepäntalo M. 
Published: March 2013

Despite numerous attempts, chronic critical limb ischaemia (CLI) has not been unequivocally defined as yet. Its epidemiology is poorly investigated and its prevalence probably higher than anticipated. It is accompanied by high mortality and morbidity irrespective of the way it is treated. Its management is very expensive. Additionally, the prevailing diabetes epidemic is increasing the need for revascularizations although there is a clear lack of evidence as to when to revascularize an ulcerated diabetic foot. The fast development of endovascular techniques blurs the vision as the window of opportunity for gathering proper evidence keeps narrowing. The notion of endovascular artistry prevails, but attempts to conduct proper studies with clear definitions, strict criteria and appropriate outcome measures in a standardised manner should continue – preferably using propensity scoring if randomised controlled trials are not possible. This review highlights some of the steps leading from art to evidence and illustrates the difficulties encountered along the path. In parallel with this overview, the progress of the treatment for CLI in Finland is described from the perspective of the work concluded at Helsinki University Central Hospital.
Angiosome Theory: Fact or Fiction?
Authors: Alexandrescu V. , Söderström M. , Venermo M. 
Published: March 2013

The angiosome concept delineates the human body into three-dimensional blocks of tissue fed by specific arterial and venous sources named “angiosomes.” Adjacent angiosomes are connected by a vast compensatory collateral web, or “choke vessels.” This concept may provide new information applicable to improving targeted revascularization of ischemic tissue lesions. A few dedicated studies available seem to favor this strategy, as encouraging ulcer healing and limb preservation are reported in connection with both bypass and endovascular techniques based on these principles. The theory on the angiosome model of revascularization (AMV) may help the clinician to better refine vessel selection, vascular access, and specific strategies in the revascularization of critically ischemic legs with tissue lesions. Specific applications of angiosome-guided revascularization were recently suggested for patients with diabetes or renal insufficiency, with ischemic tissue lesions of the lower limb, and extended large- and medium-size collateral network decay. For these cases, the concept may allow deliberate arterial reconstruction following individual wound topographies in specific ischemic areas, although deprived from “rescue-vessel” supply. The AMV theory may contribute to a shift in common reperfusion options. However, the data available is suggestive and does not provide strong evidence as factors such as case mix and the severity of ischemia are unsatisfactorily controlled. At present, the evidence is scarce as to the effect of the severity of the arterial disease. In all comparisons, the groups treated are likely to be dissimilar and mismatched. The angiosome concept is postulated to be valid especially in diabetics, whose ischemic lesions tend to heal worse than those of non-diabetics.
Synchronous Pulmonary Metastases from Renal Cell Carcinoma — A Whole Nation Study on Prevalence and Potential Resectability
Authors: Oddsson S. J. , Hardarson S. , Petursdottir V. , Jonsson E. , Sigurdsson M. I. , Einarsson G. V. , Pfannschmidt J. , Gudbjartsson T. 
Published: March 2013

Background: At the time of diagnosis, almost one third of patients with renal cell carcinoma (RCC) have metastasis. We studied the prevalence, survival, and potential resectability of synchronous pulmonary metastases (SPMs) in a well-defined cohort of RCCpatients. Material and Methods: Aretrospective whole nation study including RCC patients with SPM diagnosed 1970–2005 in Iceland. Imaging studies and histology were reviewed, the TNM system used for staging the primary tumors, and disease-specific survival estimated. Eligibility for SPM removal was evaluated using different criteria from the literature on surgical management of SPM, including solitary SPM and SPMs confined to one lung. Results: Altogether, 154 patients (16.9%) had SPMs. In 55 of these patients (35.7%) the lungs were the only site, with detailed information available in 46 cases. Of these 46 patients with SPMs, 15 were unilateral, and of those 11 were solitary. All of these 11 patients were in good physical condition and were deemed eligible for surgical resection; however, only one of them was operated with metastasectomy. Disease-specific survival at five years for patients with solitary SPM was 27.2%, as compared to 12.7%, 7.1%, and 12.0% for patients with unilateral SPMs, all patients with SPMs, and patients with extrapulmonal metastases, respectively (p = 0.33). Conclusion: At the time of diagnosis, 16.9% of RCCpatients had SPM. In one in three of these SPM patients metastases were confined to the lungs, while one in five had solitary pulmonary metastases. Although the benefit of pulmonary metastasectomy in RCC is still debated and criteria for resection are not well defined, it appears that many RCC patients with SP Mare potentially eligible for pulmonary metastasectomy.