bluuebunny/crossref_metadata_2025_split huggingface dataset:
A Novel Paradigm to Develop Regional Thoracoabdominal Criteria for Behind Armor Blunt Trauma Based on Original Data
Authors: Yoganandan Narayan , Shah Alok , Somberg Lewis , Baisden Jamie , Stemper Brain D , Bass Cameron , Salzar Robert S , Chancey Valeta Carol , McEntire Joseph 
Published: November 2023

ABSTRACT

Introduction
For behind armor blunt trauma (BABT), recent prominent BABT standards for chest plate define a maximum deformation distance of 44 mm in clay. It was developed for soft body armor applications with limited animal, gelatin, and clay tests. The legacy criterion does not account for differing regional thoracoabdominal tolerances to behind armor-induced injury. This study examines the rationale and approaches used in the legacy BABT clay criterion and presents a novel paradigm to develop thoracoabdominal regional injury risk curves.

Materials and Methods
A review of the original military and law enforcement studies using animals, surrogates, and body armor materials was conducted, and a reanalysis of data was performed. A multiparameter model analysis describes survival–lethality responses using impactor/projectile (mass, diameter, and impact velocity) and specimen (weight and tissue thickness) variables. Binary regression risk curves with ±95% confidence intervals (CIs) and peak deformations from simulant tests are presented.

Results
Injury risk curves from 74 goat thorax tests showed that peak deflections of 44.7 mm (±95% CI: 17.6 to 55.4 mm) and 49.9 mm (±95% CI: 24.7 to 60.4 mm) were associated with the 10% and 15% probability of lethal outcomes. 20% gelatin and Roma Plastilina #1 clay were stiffer than goat. The clay was stiffer than 20% gelatin. Penetration diameters showed greater variations (on a test-by-test basis, difference 36-53%) than penetration depths (0-12%) across a range of projectiles and velocities.

Conclusions
While the original authors stressed limitations and the importance of additional tests for refining the 44 mm recommendation, they were not pursued. As live swine tests are effective in developing injury criteria and the responses of different areas of the thoracoabdominal regions are different because of anatomy, structure, and function, a new set of swine and human cadaver tests are necessary to develop scaling relationships. Live swine tests are needed to develop incapacitation/lethal injury risk functions; using scaling relationships, human injury criteria can be developed.
The Design and Application of a Health Behavioral Change (HBC) Roadmap
Authors: Schulz Theresa , Hammill Tanisha , Zapata Tracy , Betancourt Jose , Edwards-Stewart Amanda 
Published: November 2023

ABSTRACT

Introduction
To assist in addressing medical readiness challenges, the DOD has established various Centers of Excellence to focus efforts to protect, treat, train, and educate service members concerning risks and potential injuries. Using the hearing health domain as a pilot, this effort used DOD methods to evaluate all facets of successful health behavior change (HBC) practices within a military environment and developed a framework and pathway for HBC.

Methods
The DOD uses the Joint Capabilities Integration and Development System (JCIDS) to ensure new DOD capabilities are identified and fielded in a manner that is interoperable, resilient, and supportables. The study sponsor for the Health Behavioral Change Framework study is the Defense Health Agency Deputy Assistant Director for Research and Engineering (R&E). The main objective of this group was to ensure that final products would both meet the requirements as defined by the JCIDS process, as well as be used by the operational force in addressing HBCs that improve readiness of the joint force.

Results
The Health Behavior Change Guidebook applies to all organizations across the DOD and military health system that may participate in or support specific tasks related to the design, conduct, and assessment of the HBC campaign. The advantage of the process is the ability to define gaps and solutions at an enterprise level. The HBC framework can be applied to a variety of health domains to include behavioral health.

Conclusions
Use of the “Guidebook for Design, Conduct and Assessment of Health Behavior Change Campaign Within the DOD” and DOTMLPF-P analysis will move Defense Health Agency toward more disciplined use of the JCIDS. The HBC framework allowed the Hearing Center of Excellence to lead the hearing health community to create a capability-based assessment for hearing HBC.
Developing a Comparative Effective Methodology for Technology Usability During a Simulated Casualty Event
Authors: Schmidt Patricia M , Ortman Holly , Gaudaen James C , Markins Larry , Manemeit Carl , Knisely Benjamin , Pamplin Jeremy C 
Published: November 2023

ABSTRACT

Introduction
Future combat environments will be complex, making effective care for multi-domain battlefield injuries more challenging. Technology and resources are essential to reduce provider burden enabling more accurate assessments, decision-making support, expanded treatment, and outcome improvements. Experimentation exercises to evaluate concepts and technologies to incorporate into the Army’s future force ensure rapid and continuous integration across air, land, sea, space, and cyberspace domains to overmatch adversaries. A medical lane was first integrated on the communications networks for experimentation in 2022. We describe a project to develop a method for empirically comparing devices intended to support combat casualty care through high-fidelity simulation in preparation for an Army experimentation exercise.

Methods
Six medics participated in a series of high-fidelity simulation medical casualty injury scenarios with and without technology devices. The participants provided usability information about their care delivery experiences using the System Usability Scale and Adapted Telehealth Usability Questionnaire-Telemedicine and Advanced Technology Research Command and qualitative feedback.

Results
A comparative effectiveness design compared the devices regarding their usability, size, weight, and power with the addition of cost, connectivity, and cyber security, and the qualitative feedback this methodology holistically assessed the technologies as they were applied in the combat casualty care scenario.

Conclusions
Results were used by decision makers to determine technology inclusion in experimentation exercise, develop proof of concept methodology to scale for the exercise, and provide technology developers feedback for iterative updates of their devices before participation in experimentation exercise. This project supports the body of simulation studies conducted to understand combat casualty care. It is one of few empirical medical technology assessments with medical personnel end user input that has been reported. The methodology incorporates a user-centered design for rapid technology improvements before fielding.
Medical Evaluation Readiness Information Toolset (MERIT): Developing a Data-driven Decision Support Tool to Augment Complex Clinical Decisions
Authors: Tang Huang , Lipman Drew , Armstrong Rachel , Dempsey Dennis 
Published: November 2023

ABSTRACT

Introduction
Medical readiness continues to be a significant concern for the military. DoD policy directs medical authorities to refer service members to the Disability Evaluation System (DES) when the course of further recovery is relatively predictable or within 1 year of diagnosis, whichever is sooner. The Medical Evaluation Readiness Information Toolset (MERIT) is an application that leverages artificial intelligence within a clinical decision support tool to provide clinicians with predictions of a service member’s likelihood of referral to the DES for the top 24 medical conditions that result in separation from the service, which represent more than 90% of all referral cases to the DES since 2000.

Materials and Methods
Data spanned 19 years and contained records for over 3 million army service members. The MERIT team incorporated a novel approach using a Gamma window function to weight recent medical data more than older medical data in the creation of a “Disease Severity Index” (DSI) that summarized the progression of a health deterioration process per medical condition code. Time-dependent medical encounter data were aggregated into an individual-level DSI. The identified features including the DSI were used in logistic regression and random forest models to predict whether a service member is likely to be referred to the DES. Models were constructed for each of the top 24 unfitting medical conditions.

Results
MERIT produced a set of high-performing classification models with area under the receiver operating characteristics curves across all conditions exceeding 0.919 using logistic regression for all conditions.

Conclusions
This project demonstrated with a high degree of accuracy that MERIT, using a combination of ICD codes and personnel records, can be used to develop an individual risk profile for each service member.
TCCC Decision Support With Machine Learning Prediction of Hemorrhage Risk, Shock Probability
Authors: Nemeth Christopher , Amos-Binks Adam , Rule Gregory , Laufersweiler Dawn , Keeney Natalie , Flint Isaac , Pinevich Yuliya , Herasevich Vitaly 
Published: November 2023

ABSTRACT

Introduction
Expected future delays in evacuation during near-peer conflicts in remote locales are expected to require extended care including prolonged field care over hours to days. Such delays can increase potential complications, such as insufficient blood flow (shock), bloodstream infection (sepsis), internal bleeding (hemorrhage), and require more complex treatment beyond stabilization. The Trauma Triage Treatment and Training Decision Support (4TDS) system is a real-time decision support system to monitor casualty health and identify such complications. The 4TDS software prototype operates on an Android smart phone or tablet configured for use in the DoD Nett Warrior program. It includes machine learning models to evaluate trends in six vital signs streamed from a sensor placed on a casualty to identify shock probability, internal hemorrhage risk, and need for a massive transfusion.

Materials and Methods
The project team used a mixed methods approach to create and evaluate the system including literature review, rapid prototyping, design requirements review, agile development, an algorithm “silent test,” and usability assessments with novice to expert medics from all three services.

Results
Both models, shock (showing an accuracy of 0.83) and hemorrhage/massive transfusion protocol, were successfully validated using externally collected data. All usability assessment participants completed refresher training scenarios and were able to accurately assess a simulated casualty’s condition using the phone prototype. Mean responses to statements on evaluation criteria [e.g., fit with Tactical Combat Casualty Care (TCCC), ease of use, and decision confidence] fell at five or above on a 7-point scale, indicating strong support.

Conclusions
Participatory design ensured 4TDS and machine learning models reflect medic and clinician mental models and work processes and built support among potential users should the system transition to operational use. Validation results can support 4TDS readiness for FDA 510k clearance as a Class II medical device.
Acute Hearing Deficits associated with Weapons Exposure in Section 734 Blast Overpressure Study (BOS)
Authors: Kulinski Devon , Carr Walter , Garfield Bradley A , Salib Jonathan , Dirks Coral , Sheffield Benjamin , Brungart Douglas S 
Published: November 2023

ABSTRACT

Introduction
This prospective, multi-site, observational study describes ongoing efforts in support of the Fiscal Year 2018 National Defense Authorization Act (NDAA) Section 734 Blast Overpressure Study (BOS) to identify the acute effects impulse and blast exposure have on hearing abilities of the Warfighter in various military training environments.

Materials and Methods
Hearing thresholds, a binaural tone detection task, and auditory symptoms were collected before and immediately following weapons exposure across nine military training environments from January 2020 to October 2022. An additional 25 non-exposed control participants also completed the behavioral test battery. A boothless audiometer was used to measure hearing ability in the field. Sound level meters were attached on-body to record the exposure environment throughout training.

Results
Mean threshold change for the blast-exposed group was worse than the control group. Of the 188 blast-exposed participants, 23 experienced a temporary threshold shift (TTS) acutely after exposure. A decrease in binaural tone detection performance and increased symptom severity was found when comparing blast-exposed participants with a TTS versus those without a significant change in hearing. A complex but consistent relationship between measured exposure level (LAeq8hr) and the magnitude of the resulting TTS is suggested in the available data.

Conclusions
Recent discussions on Section 734 studies examining the effects of repetitive blast exposure have indicated that hearing-related issues were a critical problem that needed additional research. Study outcomes provide highly repeatable results across various weapons systems with hazardous blast exposure. This standardized set of hearing assessment tools for evaluating acute effects of noise under field conditions has been critically important in improving our understanding of TTS in prospective human subject research.
US Soldiers’ Individual and Unit-level Factors Associated with Perceptions of Disinformation in the Military Context
Authors: Duffy Farifteh Firoozmand , McDonnell Gerald P , Auslander Margeaux V , Bricault Stephanie A , Kim Paul Y , Rachlin Nicholas W , Quartana Phillip J 
Published: November 2023

ABSTRACT

Introduction
Although the US Government considers threats of misinformation, disinformation, and mal-information to rise to the level of terrorism, little is known about service members’ experiences with disinformation in the military context. We examined soldiers’ perceptions of disinformation impact on the Army and their units. We also investigated associations between disinformation perceptions and soldiers’ sociodemographic characteristics, reported use of fact-checking, and perceptions of unit cohesion and readiness

Methods
Active-duty soldiers (N = 19,465) across two large installations in the Southwest US completed an anonymous online survey

Results
Sixty-six percent of soldiers agreed that disinformation has a negative impact on the Army. Thirty-three percent of soldiers perceived disinformation as a problem in their unit. Females were more likely to agree that disinformation has a negative impact on the Army and is a problem in their unit. Higher military rank was associated with lower odds of agreeing that disinformation is a problem in units. Most soldiers were confident about their ability to recognize disinformation (62%) and reported using fact-checking resources (53%), and these factors were most often endorsed by soldiers who agreed that disinformation is a problem for the Army and their unit. Soldiers’ perceptions of unit cohesion and readiness were negatively associated with the perception that disinformation is a problem in their unit

Conclusion
While the majority of soldiers viewed disinformation as a problem across the Army, fewer perceived it as problematic within their units. Higher levels of reported fact-checking were most evident among those who perceived disinformation as a problem, suggesting that enhancing awareness of the problem of disinformation alone could help mitigate its deleterious impact. Perceptions of disinformation problems within units were associated with soldiers’ perceptions of lower unit cohesion and readiness, highlighting misinformation, disinformation, and mal-information’s impact on force readiness. Limitations and future directions are discussed.
The Adoption Problem and the Epistemology of Logic
Authors: Birman Romina 
Published: November 2023

Abstract
After introducing the adoption problem (AP) as the claim that certain basic logical principles cannot be adopted, I offer a characterization of this notion as a two-phase process consisting in (1) the acceptance of a basic logical principle, and (2) the development, in virtue of Phase 1, of a practice of inferring in accordance with that principle. The case of a subject who does not infer in accordance with universal instantiation is considered in detail. I argue that the AP has deep and wide implications for the epistemology of logic, extending well beyond Kripke’s original target, viz. Putnam’s proposal for the empirical revision of logic and its background Quinean epistemology. In particular, the AP questions whether basic logical principles could have a fundamental role in our inferential practices, drawing our attention to the nature of basic inferences and the need to have a clearer conception of them before taking a stand on the matter of the epistemic justification of the logical principles.
Kripke, Quine, the ‘Adoption Problem’ and the Empirical Conception of Logic
Authors: Boghossian Paul , Wright Crispin 
Published: November 2023

Abstract
Recently, there has been a significant upsurge of interest in what has come to be known as the 'Adoption Problem', first developed by Saul Kripke in 1974. The problem purports to raise a difficulty for Quine’s anti-exceptionalist conception of logic. In what follows, we first offer a statement of the problem and argue that, so understood, it depends upon natural but resistible assumptions. We then use that discussion as a springboard for developing a different adoption problem, arguing that, for a significant class of basic logical principles, there is indeed a difficulty in seeing how they might be ‘freely adopted,’ thereby vindicating something close to the spirit of Kripke’s original claim. This first part of our argument will enforce a significant qualification of Quine’s claim that basic logical principles can be empirically confirmed. In the concluding sections of the paper, we turn to the question, specifically, of the empirical revisability of logic, arguing that when proper attention is paid to the role of reasoning in theory revision, it does indeed emerge that anti-exceptionalism, in full generality, is untenable.
Coherent deflection pattern and associated temperature enhancements in the near-Sun solar wind
Authors: Laker Ronan , Horbury T S , Woodham L D , Bale S D , Matteini L 
Published: November 2023

ABSTRACT
Measurements of transverse magnetic field and velocity components from Parker Solar Probe have revealed a coherent quasi-periodic pattern in the near-Sun solar wind. As well as being Alfvénic and arc-polarized, these deflections were characterized by a consistent orientation and an increased proton core temperature, which was greater parallel to the magnetic field. We show that switchbacks represent the largest deflections within this underlying structure, which is itself consistent with the expected outflow from interchange reconnection simulations. Additionally, the spatial scale of the deflections was estimated to be around 1 Mm on the Sun, comparable to the jetting activity observed at coronal bright points within the base of coronal plumes. Therefore, our results could represent the in situ signature of interchange reconnection from coronal bright points within plumes, complementing recent numerical and observational studies. We also found a consistent relationship between the proton core temperature and magnetic field angle across the Parker Solar Probe encounters and discussed how such a persistent signature could be more indicative of an in situ mechanism creating a local increase in temperature. In future, observations of minor ions, radio bursts, and remote sensing images could help further establish the connection between reconnection events on the Sun and signatures in the solar wind.
The tidal excitation of r modes in a solar-type star orbited by a giant planet companion and the effect on orbital evolution – II. The effect of tides in the misaligned case
Authors: Papaloizou J C B , Savonije G J 
Published: November 2023

ABSTRACT
We extend the study of Papaloizou and Savonije of the tidal interactions of close orbiting giant planets with a central solar-type star to the situation where the spin axis of the central star and the orbital angular momentum are misaligned. We determine the tidal response taking into account the possibility of the excitation of r modes and the effect of tidal forcing due to potential perturbations that have zero frequency in a non-rotating frame. Although there is near resonance with r modes with degree l′ = 1 and orders m = ±1, half widths turn out to be sufficiently narrow so that in practice dissipation rates are found to be similar to those produced by non-resonant potential perturbations. We use our results to determine the evolution of the misalignment for the full range of initial inclination angles taking account of the spin-down of the central star due to magnetic braking. Overall we find the rate of tidal evolution to be unimportant for a one Jupiter mass planet with orbital period ∼3.7 d over a main-sequence lifetime. However, it becomes significant for higher mass planets and shorter orbital periods, approximately scaling as the square of the planet mass and the inverse fourth power of the orbital period.
Building Phylogenetic Trees From Genome Sequences With kSNP4
Authors: Hall Barry G , Nisbet Jeremiah 
Published: November 2023

Abstract
Performing phylogenetic analysis with genome sequences maximizes the information used to estimate phylogenies and the resolution of closely related taxa. The use of single-nucleotide polymorphisms (SNPs) permits estimating trees without genome alignments and permits the use of data sets of hundreds of microbial genomes. kSNP4 is a program that identifies SNPs without using a reference genome, estimates parsimony, maximum likelihood, and neighbor-joining trees, and is able to annotate the discovered SNPs. kSNP4 is a command-line program that does not require any additional programs or dependencies to install or use. kSNP4 does not require any programming experience or bioinformatics experience to install and use. It is suitable for use by students through senior investigators. It includes a detailed user guide that explains all of the many features of kSNP4. In this study, we provide a detailed step-by-step protocol for downloading, installing, and using kSNP4 to build phylogenetic trees from genome sequences.
Re-emphasising the importance of catheter-based angiography to differentiate polyarteritis nodosa from cutaneous arteritis: Two case reports
Authors: Suzuki Koji , Akiyama Mitsuhiro , Kondo Yasushi , Saito Shuntaro , Kikuchi Jun , Hanaoka Hironari , Kaneko Yuko 
Published: November 2023

ABSTRACT
Polyarteritis nodosa (PAN) is a systemic necrotising vasculitis with a poor prognosis, characterised by inflammation and necrosis of medium-sized arteries. PAN patients can present with a wide range of systemic manifestations, whereas cutaneous arteritis (CA) is a restricted manifestation to skin of the disease with a more favourable prognosis. Thus, differentiation between PAN and CA is crucial. Here, we present two cases that were initially diagnosed as CA due to the limited presence of systemic symptoms, but were finally diagnosed as PAN through catheter-based angiography. Although contrast-enhanced computed tomography and computed tomographic angiography are increasingly used to diagnose PAN, neither case had any abnormal findings on these examinations. Our cases therefore underscore that catheter-based angiography is critical for differentiation between PAN and CA, even in cases with limited systemic symptoms.