bluuebunny/crossref_metadata_2025_split huggingface dataset:
Regional Strain Response of an Anatomically Accurate Human Finite Element Head Model Under Frontal Versus Lateral Loading
Authors: Rooks Tyler F , Chancey Valeta Carol , Baisden Jamie L , Yoganandan Narayan 
Published: November 2023

ABSTRACT

Introduction
Because brain regions are responsible for specific functions, regional damage may cause specific, predictable symptoms. However, the existing brain injury criteria focus on whole brain response. This study developed and validated a detailed human brain computational model with sufficient fidelity to include regional components and demonstrate its feasibility to obtain region-specific brain strains under selected loading.

Methods
Model development used the Simulated Injury Monitor (SIMon) model as a baseline. Each SIMon solid element was split into 8, with each shell element split into 4. Anatomical regions were identified from FreeSurfer fsaverage neuroimaging template. Material properties were obtained from literature. The model was validated against experimental intracranial pressure, brain–skull displacement, and brain strain data. Model simulations used data from laboratory experiments with a rigid arm pendulum striking a helmeted head–neck system. Data from impact tests (6 m/s) at 2 helmet sites (front and left) were used.

Results
Model validation showed good agreement with intracranial pressure response, fair to good agreement with brain–skull displacement, and good agreement for brain strain. CORrelation Analysis scores were between 0.72 and 0.93 for both maximum principal strain (MPS) and shear strain. For frontal impacts, regional MPS was between 0.14 and 0.36 (average of left and right hemispheres). For lateral impacts, MPS was between 0.20 and 0.48 (left hemisphere) and between 0.22 and 0.51 (right hemisphere). For frontal impacts, regional cumulative strain damage measure (CSDM20) was between 0.01 and 0.87. For lateral impacts, CSDM20 was between 0.36 and 0.99 (left hemisphere) and between 0.09 and 0.93 (right hemisphere).

Conclusions
Recognizing that neural functions are related to anatomical structures and most model-based injury metrics focus on whole brain response, this study developed an anatomically accurate human brain model to capture regional responses. Model validation was comparable with current models. The model provided sufficient anatomical detail to describe brain regional responses under different impact conditions.
The Association Between Glasgow Coma Scale Scores and PTSD in Military Trauma Casualties: Does Mental Status Following Injury Play a Role in PTSD Development?
Authors: Bulis Shir , Talmy Tomer , Radomislensky Irina , Gelman Daniel , Bushinsky Shir , Nachum Dikla , Tomer Gaia , Tsur Avishai M , Paulman Omer , Gendler Sami , Almog Ofer , Benov Avi 
Published: November 2023

ABSTRACT

Background
Posttraumatic stress disorder (PTSD) is prevalent among military personnel and may arise following a wide range of traumatic exposures. Consciousness level following traumatic injury may play a role in the development of PTSD, but its effects have been primarily investigated in the context of traumatic brain injury.

Methods
Registry-based study surveying three databases documenting care from point of injury to long-term rehabilitation of traumatic injuries among military personnel. The study population was divided according to Glasgow Coma Scale (GCS) scores upon emergency department admission (GCS scores 15, 13 and 14, 9–12, and 3–8), with PTSD diagnoses being determined according to disability claim records. Multivariable logistic regression was utilized to determine the association between GCS score at admission and PTSD.

Results
Overall, 3,376 military personnel hospitalized following traumatic injuries between 1997 and 2020 were included. The majority were male (92.3%), with a median age of 20 (interquartile range 19–22) at the injury time. Of these, 569 (16.9%) were diagnosed with PTSD according to disability claims, with a median follow-up time of 10.9 years. PTSD diagnosis was most prevalent (30.3% of patients), with a GCS score of 13 and 14. In the adjusted multivariable model, a GCS score of 13 and 14 was associated with significantly higher odds of PTSD diagnosis when compared to a GCS score of 15 (odds ratio 2.19, 95% CI, 1.21–3.88). The associations of other GCS groupings with PTSD diagnosis were nonsignificant.

Conclusions
Minimally impaired consciousness following traumatic injuries is associated with increased odds of PTSD. The role of patient awareness, analgesia, and sedation following an injury in developing PTSD warrants further investigation and could guide early diagnosis and preventive interventions.
Utilization of the En Route Aeromedical Patient Movement Form by Critical Care Air Transport Teams
Authors: Valdez-Delgado Krystal K , Medellin Kimberly L , Arana Allyson A , Hare Jonathan , Maddry Joseph K , Ng Patrick C , Mann-Salinas Elizabeth A , Davis William T 
Published: November 2023

ABSTRACT

Introduction
Understanding usage patterns of current paper-based documentation can inform the development of electronic documentation forms for en route care. The primary objective was to analyze the frequency of use of each field within the 3899 L Patient Movement Record documented by en route Critical Care Air Transport Teams. Secondary objectives were to identify rarely utilized form fields and to analyze the proportion of verifiable major events documented within the 3899 L form.

Materials and methods
We performed a retrospective review of 3899 L patient movement records for patients transported via Critical Care Air Transport Teams from January 2019 to December 2019. Scanned 3899 L forms were manually transcribed into a Microsoft Access database for evaluation and analysis. Proportions were calculated for completed fields. Major vital sign event frequency was compared for checkbox fields versus the vital sign flow sheet for each patient. We performed descriptive analyses for the proportion of charts with completed documentation in each evaluated field and the proportion of flow sheet events documented in major event fields.

Results
We analyzed 130 records. Fourteen of 18 (77.8%) demographic fields had a 75% or greater completion ratio. Sections with the largest proportion of rarely or never utilized fields (&lt;1.5% completed) were procedures (77.8% of fields) and major events (63.9% of fields). Major event checkboxes had low sensitivity for documented events in the flow sheet: Change in heart rate greater than 20% (1 of 28 patients); increase in the fraction of inspired oxygen requirement of greater than 10% (6 of 23 patients); decrease in mean arterial pressure of greater than 20% (1 in 12 patients); and temperature less than 35.6°C (1 in 13 patients).

Conclusions
Many of the current 3899 L fields are highly utilized, but some 3899 L sections contain high proportions of rarely utilized fields. Major event checkboxes did not consistently capture events documented within the in-flight vital sign flow sheet.
Impact of the COVID-19 Pandemic on Indicators of Psychological Health and Suicidal Ideation Within an Active Duty U.S. Military Population
Authors: Baker Justin C , Bhola Simran , Tabares Jeffrey V , Beckman Derek , Martin Christiana , Khazem Lauren R , Bryan AnnaBelle O , Bryan Craig J 
Published: November 2023

ABSTRACT

Introduction
The COVID-19 pandemic has had a significant impact on the psychological health of individuals. The pandemic has contributed to increased anxiety, elevated rates of depression, and worsening suicidal ideation among civilians. Reported rates of burnout are also elevated as employees and employers adapted to ever-changing work environments, finding it increasingly difficult to maintain a work-life balance. The objective of this study is to determine how the COVID-19 pandemic impacted the psychological health and rates of suicidal ideation of active duty military personnel in the USA.

Materials and Methods
A total of 2055 military personnel and military-adjacent employees stationed at a U.S. Air Force base completed a self-report survey that was administered six times from January 2020 to December 2021. Validated scales assessed measures of psychological health and suicidal ideation. General Estimating Equations were used to examine how indicators of time and psychological health predicted suicidal ideation in a military population.

Results
Life satisfaction, happiness, feeling life is worthwhile, depression severity, and suicidal ideation did not statistically change across the six time points. Worry (P &lt; .01) and depression (P &lt; .001) did decrease significantly, while burnout (P = .01) significantly increased across these time points. Feeling life is worthwhile significantly predicted reduced suicidal ideation (B = -.19; SE = 0.05), while depression (B = 0.11; SE = 0.03), depression severity (B = 0.24; SE = 0.05), worry (B = 0.06; SE = 0.02), and burnout (B = 0.15; SE = 0.07) predicted increased suicidal ideation.

Conclusions
The rates of depression and worry decreased throughout the pandemic for those in the study while rates of suicidal ideation remained constant, demonstrating the potential resilience of military personnel and military-adjacent employees in response to the COVID-19 pandemic. However, burnout increased and significantly predicted elevated rates of suicidal ideation, highlighting the importance of focusing on reducing workplace stressors for military personnel.
Adaptive Human-Robotic Interaction for Robotic-assisted Surgical Settings
Authors: Yang Jing , Layadi Iris Charlene , Wachs Juan P , Yu Denny 
Published: November 2023

ABSTRACT

Introduction
Increased complexity in robotic-assisted surgical system interfaces introduces problems with human–robot collaboration that result in excessive mental workload (MWL), adversely impacting a surgeon’s task performance and increasing error probability. Real-time monitoring of the operator’s MWL will aid in identifying when and how interventions can be best provided to moderate MWL. In this study, an MWL-based adaptive automation system is constructed and evaluated for its effectiveness during robotic-assisted surgery.

Materials and Methods
This study recruited 10 participants first to perform surgical tasks under different cognitive workload levels. Physiological signals were obtained and employed to build a real-time system for cognitive workload monitoring. To evaluate the effectiveness of the proposed system, 15 participants were recruited to perform the surgical task with and without the proposed system. The participants’ task performance and perceived workload were collected and compared.

Results
The proposed neural network model achieved an accuracy of 77.9% in cognitive workload classification. In addition, better task performance and lower perceived workload were observed when participants completed the experimental task under the task condition supplemented with adaptive aiding using the proposed system.

Conclusions
The proposed MWL monitoring system successfully diminished the perceived workload of participants and increased their task performance under high-stress conditions via interventions by a semi-autonomous suction tool. The preliminary results from the comparative study show the potential impact of automated adaptive aiding systems in enhancing surgical task performance via cognitive workload-triggered interventions in robotic-assisted surgery.
The Military Health System: Minimizing Disparities in Breast Cancer Treatment
Authors: Liggett Jedson R , Norris Emily A , Rush Toni M , Sicignano Nicholas M , Oxner Christopher 
Published: November 2023

ABSTRACT

Background
The Military Health System (MHS) is a universal health care system, in which health care disparities are theoretically minimized. This study aimed to identify disparities and assess their impact on the initiation of timely treatment for breast cancer within a universally insured population.

Methods
A retrospective cohort study was performed to evaluate the treatment of female breast cancer patients ≥18 years of age within the MHS from January 1, 2014, to December 31, 2018. Incident breast cancer was defined as ≥2 breast cancer diagnoses without a prior diagnosis of breast cancer during the three continuous years before index diagnosis. Time from index diagnosis to initial treatment was calculated and dichotomized as receiving treatment within a clinically acceptable time course. Poisson regression was used to estimate relative risk (RR) with 95% CIs.

Results
Among the 30,761 female breast cancer patients identified in the MHS, only 6% of patients had a prolonged time to initial treatment. Time to initial treatment decreased during the study period from a mean (SD) of 63.2 (152.0) days in 2014 to 37.1 (28.8) days in 2018 (P &lt; 0.0001). Age, region, and military characteristics remained significantly associated with receiving timely treatment even after the adjustment of confounders. Patients 70-79 years old were twice as likely as 18-39 years olds to receive timely treatment (RR: 2.0100, 95% CI, 1.52-2.6563, P &lt; 0.0001). Senior officers and their dependents were more likely to receive timely initial treatment compared to junior enlisted patients and their dependents (RR: 1.5956, 95% CI, 1.2119-2.1005, P = 0.004).

Conclusions
There have been significant improvements in the timely initiation of breast cancer treatment within the MHS. However, demographic and socioeconomic disparities can be identified that affect the timely initiation of therapy.
Protocol for the Implementation of Psychologically Informed Physical Therapy to Prevent Chronification in Service Members With Musculoskeletal Disorders
Authors: Campello Marco , Ziemke Gregg , Hair Leslie C , Oh Cheongeun , Mowery Hope , Hope Timothy , Weiser Sherri 
Published: November 2023

ABSTRACT

Introduction
Musculoskeletal disorders (MSDs) are a primary cause of separation and long-term disability in active duty service members (ADSMs). Psychologically informed physical therapy (PiPT) is designed to identify and address modifiable psychological risk factors early in an MSD episode and has been proven effective in preventing chronicity in civilian populations. We developed a course to train military physical therapy (PT) personnel in PiPT for treating ADSM with MSD. This study tests the feasibility and effectiveness of our training.

Objective
Establish the feasibility of implementing PiPT and its effectiveness in the U.S. military.

Specific Aims

Materials and Methods
An observational, prospective, comparative cohort study will test implementation and effectiveness. First, we will observe clinical outcomes in a cohort of ADSM with MSD receiving usual PT care at a military outpatient PT clinic. Next, we will train all PT staff in PiPT. Finally, PiPT will be implemented in a second cohort of ADSM. Data will be collected from each cohort at pre-treatment, fourth PT visit, 6 months post enrollment, and 12 months post enrollment. The primary outcomes are pain interference and psychological risk for chronicity.

Results and Conclusions
Data collection is ongoing. Findings will identify the factors associated with PiPT outcomes in ADSM, inform the implementation of PiPT across health care settings, and allow us to document the prevalence of risk factors for chronicity in ADSM. Findings can help to prevent chronification from MSD, thereby reducing lost man-hours and enhancing military readiness, contribute to the development of a highly skilled workforce for the provision of health services to ADSM, and enhance the efficiency of health care delivery through optimal allocation of PT resources, resulting in significant cost savings for the military.
Prevalence and Risk Factors of Self-reported Dizziness in Post-9/11 Service Members and Veterans
Authors: Sonstroem Anneka , Thapa Samrita , Pigott Kaylee , Henry James A , Schultz James , Esquivel Carlos , Carlson Kathleen F , Hullar Timothy E , Reavis Kelly M 
Published: November 2023

Abstract

Introduction
Dizziness is prevalent in the general population, but little is known about its prevalence in the U.S. military population. Dizziness is commonly associated with blast exposure and traumatic brain injury (TBI), but the potential independent contributions of blast and TBI have yet to be evaluated. This study’s goal was to estimate the prevalence of dizziness among post-9/11 service members and Veterans and to examine independent and joint associations between military TBI history, blast exposure, and self-reported dizziness.

Materials and Methods
The study sample consisted of service members (n = 424) and recently separated (&lt; ∼2.5 years) Veterans (n = 492) enrolled in the Noise Outcomes in Service members Epidemiology (NOISE) Study. We examined associations between self-reported history of probable TBI and blast exposure and recent dizziness using logistic regression. Models were stratified by service member versus Veteran status and adjusted to account for potentially confounding demographic and military characteristics.

Results
Overall, 22% of service members and 31% of Veterans self-reported dizziness. Compared to those with neither TBI nor blast exposure history, both service members and Veterans with TBI (with or without blast) were three to four times more likely to self-report dizziness. Those with blast exposure but no TBI history were not more likely to self-report dizziness. There was no evidence of an interaction effect between blast exposure and a history of TBI on the occurrence of dizziness.

Conclusion
Self-reported dizziness was prevalent in this sample of service members and Veterans. Probable TBI history, with or without blast exposure, was associated with dizziness, but blast exposure without TBI history was not. This suggests that treatment guidelines for TBI-related dizziness may not need to be tailored to the injury mechanism. However, future efforts should be directed toward the understanding of the pathophysiology of TBI on self-reported dizziness, which is fundamental to the design of treatment strategies.
Measurement of Head Kinematics Using Instrumented Mouthguards During Introductory Boxing Courses in U.S. Military Academy Cadets
Authors: Fetchko Travis J , Hart Gerald J , Aderman Michael J , Ross Jeremy D , Malvasi Steven R , Roach Megan H , Cameron Kenneth L , Rooks Tyler F 
Published: November 2023

ABSTRACT

Introduction
Use of wearable impact sensor devices to quantitatively measure head impact exposure remains largely unstudied in military-style martial arts training and combat sports, particularly at the beginner levels. The baseline frequency and severity of head impact exposure during introductory military-style martial arts trainings, such as combatives training, is valuable information for developing future programs of instruction and exposure monitoring programs. The purpose of this study was to describe head impact exposures experienced during introductory combatives training (a boxing course) at U.S. Military Academy.

Methods
This study used instrumented mouthguards to measure head impact exposure in U.S. Military Academy cadets during a compulsory boxing course. Summary exposures from a preliminary dataset are presented.

Results
Twenty-two male subjects (19.9 ± 1.1 years, 86.6 ± 11.7 kg) participated in 205 analyzed player-bouts (full contact sparring sessions) with 809 video verified impacts (average 3.9 impacts per player-bout). The mean peak linear acceleration was 16.5 ±7.1 G, with a maximum of 70.8 G. There was a right-skewed distribution, with 640/809 (79.1%) events falling between 10 and 20 G. The mean peak angular acceleration was 1.52 ± 0.96 krad/s2, with a maximum of 8.85 krad/s2.

Conclusions
Compared to other high-risk sports at Service Academies, head impacts from beginner boxing were of similar magnitude to those reported for Service Academy football and slightly lower than those reported for Service Academy rugby. Based on these preliminary data, the risk profile for introductory military-style martial arts training, such as boxing or combatives, may be similar to other contact sports like football and rugby, but further research is required to confirm these findings and understand the effects of the exposures in a shorter duration.
Robust Multi-View Fracture Detection in the Presence of Other Abnormalities Using HAMIL-Net
Authors: Lu Xing , Chang Eric Y , Du Jiang , Yan An , McAuley Julian , Gentili Amilcare , Hsu Chun-Nan 
Published: November 2023

ABSTRACT

Introduction
Foot and ankle fractures are the most common military health problem. Automated diagnosis can save time and personnel. It is crucial to distinguish fractures not only from normal healthy cases, but also robust against the presence of other orthopedic pathologies. Artificial intelligence (AI) deep learning has been shown to be promising. Previously, we have developed HAMIL-Net to automatically detect orthopedic injuries for upper extremity injuries. In this research, we investigated the performance of HAMIL-Net for detecting foot and ankle fractures in the presence of other abnormalities.

Materials and Methods
HAMIL-Net is a novel deep neural network consisting of a hierarchical attention layer followed by a multiple-instance learning layer. The design allowed it to deal with imaging studies with multiple views. We used 148K musculoskeletal imaging studies for 51K Veterans at VA San Diego in the past 20 years to create datasets for this research. We annotated each study by a semi-automated pipeline leveraging radiology reports written by board-certified radiologists and extracting findings with a natural language processing tool and manually validated the annotations.

Results
HAMIL-Net can be trained with study-level, multiple-view examples, and detect foot and ankle fractures with a 0.87 area under the receiver operational curve, but the performance dropped when tested by cases including other abnormalities. By integrating a fracture specialized model with one that detecting a broad range of abnormalities, HAMIL-Net’s accuracy of detecting any abnormality improved from 0.53 to 0.77 and F-score from 0.46 to 0.86. We also reported HAMIL-Net’s performance under different study types including for young (age 18–35) patients.

Conclusions
Automated fracture detection is promising but to be deployed in clinical use, presence of other abnormalities must be considered to deliver its full benefit. Our results with HAMIL-Net showed that considering other abnormalities improved fracture detection and allowed for incidental findings of other musculoskeletal abnormalities pertinent or superimposed on fractures.