bluuebunny/crossref_metadata_2025_split huggingface dataset:
Data gaps and opportunities for modeling cancer health equity
Authors: Trentham-Dietz Amy , Corley Douglas A , Del Vecchio Natalie J , Greenlee Robert T , Haas Jennifer S , Hubbard Rebecca A , Hughes Amy E , Kim Jane J , Kobrin Sarah , Li Christopher I , Meza Rafael , Neslund-Dudas Christine M , Tiro Jasmin A 
Published: November 2023

Abstract
Population models of cancer reflect the overall US population by drawing on numerous existing data resources for parameter inputs and calibration targets. Models require data inputs that are appropriately representative, collected in a harmonized manner, have minimal missing or inaccurate values, and reflect adequate sample sizes. Data resource priorities for population modeling to support cancer health equity include increasing the availability of data that 1) arise from uninsured and underinsured individuals and those traditionally not included in health-care delivery studies, 2) reflect relevant exposures for groups historically and intentionally excluded across the full cancer control continuum, 3) disaggregate categories (race, ethnicity, socioeconomic status, gender, sexual orientation, etc.) and their intersections that conceal important variation in health outcomes, 4) identify specific populations of interest in clinical databases whose health outcomes have been understudied, 5) enhance health records through expanded data elements and linkage with other data types (eg, patient surveys, provider and/or facility level information, neighborhood data), 6) decrease missing and misclassified data from historically underrecognized populations, and 7) capture potential measures or effects of systemic racism and corresponding intervenable targets for change.
Black Family Forest Owners in the Southeastern United States: A Case Study in Six Counties
Authors: Robillard Amanda , Johnson Gaither Cassandra , Schelhas John , Butler Brett J 
Published: November 2023

AbstractThe USDA Forest Service, National Woodland Owner Survey asks family forest owners (FFOs) about their attitudes and intentions regarding their forestland. Historically, the number of responses from Black or African American FFOs has been very low, but it is uncertain whether this is because of nonresponse bias or that there are relatively few Black FFOs. To get a better understanding of these FFOs and to test a method to increase response rates, an intensified survey effort was conducted in three southern states: Alabama, North Carolina, and South Carolina. Analyses indicate that Black FFOs have slightly different objectives, activities, and ownership structure for their forestland than their White counterparts, who have traditionally represented the majority of FFOs.Study Implications: By conducting an experiment to increase response rates from Black family forest owners to the National Woodland Owner Survey, we find traditional methodology is not effective. More importantly, we see this group has moderately different responses than their White counterparts. This has wide ranging implications for landowner assistance programs and other initiatives that have been designed on the premise that we are accurately capturing responses from all woodland owners.
Outcomes for Arthroplasties in Military Health: A Retrospective Analysis of Direct Versus Purchased Care
Authors: Haag Austin , Hosein Sharif , Lyon Samuel , Labban Muhieddine , Wun Jolene , Herzog Peter , Cone Eugene B , Schoenfeld Andrew J , Trinh Quoc-Dien 
Published: November 2023

ABSTRACT

Introduction
The Department of Defense is reforming the military health system where surgeries are increasingly referred from military treatment facilities (MTFs) with direct care to higher-volume civilian hospitals under purchased care. This shift may have implications on the quality and cost of care for TRICARE beneficiaries. This study examined the impact of care source and surgical volume on perioperative outcomes and cost of total hip arthroplasties (THAs) and total knee arthroplasties (TKAs).

Materials and Methods
We examined TRICARE claims for patients who underwent THA or TKA between 2006 and 2019. The 30-day readmissions, complications, and costs between direct and purchased care were evaluated using the logistic regression model for surgical outcomes and generalized linear models for cost.

Results
We included 71,785 TKA and THA procedures. 11,013 (15.3%) were performed in direct care. They had higher odds of readmissions (odds ratio, OR 1.29 [95% CI, 1.12-1.50]; P &lt; 0.001) but fewer complications (OR 0.83 [95% CI, 0.75-0.93]; P = 0.002). Within direct care, lower-volume facilities had more complications (OR 1.27 [95% CI, 1.01-1.61]; P = 0.05). Costs for index surgeries were significantly higher at MTFs $26,022 (95% CI, $23,393-$28,948) vs. $20,207 ($19,339-$21,113). Simulating transfer of care to very high-volume MTFs, estimated cost savings were $4,370/patient and $20,229,819 (95% CI, $17,406,971-$25,713,571) in total.

Conclusions
This study found that MTFs are associated with lower odds of complications, higher odds of readmission, and higher costs for THA and TKA compared to purchased care facilities. These findings mean that care in the direct setting is adequate and consolidating care at higher-volume MTFs may reduce health care costs.
Ultrasound-Activated Piezoelectric Polyvinylidene Fluoride–Trifluoroethylene Scaffolds for Tissue Engineering Applications
Authors: Bryan Andrew E , Krutko Maksym , Westphal Jennifer , Sheth Maulee , Esfandiari Leyla , Harris Greg M 
Published: November 2023

ABSTRACT
Severe peripheral nervous system (PNS) injuries have limited options for therapeutic solutions to regain functional recovery. This can be attributed in part to the lack of regeneration pathways promoted by recapitulating chemical, physical, and electrical cues to direct nerve guidance. To address this, we examined ultrasonic stimulation of a piezoelectric polyvinylidene fluoride–triflouroethylene (PVDF-TrFE) scaffold as a potentially clinically relevant therapy for PNS regeneration. Owing to the piezoelectric modality of PVDF-TrFE, we hypothesize that ultrasound stimulation will activate the scaffold to electrically stimulate cells in response to the mechanical deformation mediated by sound waves. Biocompatible PVDF-TrFE scaffolds were fabricated to be used as an ultrasound-activated, piezoelectric biomaterial to enhance cellular activity for PNS applications. NIH-3T3 fibroblasts were cultured on PVDF-TrFE nanofibers and stimulated with low-, medium-, or high-powered ultrasound. 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyl-2H-tetrazolium bromide (MTT) assays were performed on fibroblasts to measure the metabolic activity of the cells following stimulation. MTT assays showed that ultrasound-stimulated fibroblasts on PVDF-TrFE scaffolds had increased metabolic activity as power was increased, whereas on plain polystyrene, an opposite trend was observed where cells had a decreased metabolic activity with ascending levels of ultrasound power. Ultrasound-stimulated PVDF-TrFE nanofibers hold exciting potential as a therapy for PNS injuries by promoting increased metabolic activity and proliferation. The ability to noninvasively stimulate implantable piezoelectric nanofibers to promote mechanical and electrical stimulation for nerve repair offers a promising benefit to severe trauma patients.
Integrating Battlefield Documentation into Virtual Reality Medical Simulation Training: Virtual Battlefield Assisted Trauma Distributed Observation Kit (BATDOK)
Authors: Sarma Karthik V , Barrie Michael G , Dorsch John R , Andre Tanner W , Polson Jennifer S , Ribeira Rosie J , Andre Tyler B , Ribeira Ryan J 
Published: November 2023

ABSTRACT

Introduction
Clinical documentation is an essential component of the provision of medical care, enabling continuity of information across provider and site handoffs. This is particularly important in the combat casualty care setting when a single casualty may be treated by four or more or five completely disparate teams across the roles of care. The Battlefield Assisted Trauma Distributed Observation Kit (BATDOK) is a digital battlefield clinical documentation system developed by the Air Force Research Laboratory to address this need. To support the deployment of this tool, we integrated BATDOK into a commercially available virtual reality (VR) medical simulation platform used by the U.S. Air Force and Defense Health Agency personnel in order to provide an immersive simulation training experience which included battlefield documentation.

Methods
A multidisciplinary team consisting of medical educators, VR simulation engineers, emergency physicians and pararescuemen, and BATDOK developers first developed a specification for a virtual BATDOK capability, including a detailed listing of learning objectives, critical interfaces and task plans, and sensor integrations. These specifications were then implemented into the commercially available Virtual Advancement of Learning for Operational Readiness VR Medical Simulation System and underwent developmental testing and evaluation during pararescueman training exercises at the Air Force Special Operations Command Special Operations Center for Medical Integration and Development.

Results and Conclusions
The BATDOK capability was successfully implemented within the VR Medical Simulation System. The capability consisted of a virtual tablet with replicated interfaces and capabilities based on the developed specifications. These capabilities included integrated point-of-care ultrasound capability, multi-patient management, vitals sign monitoring with sensor pairing and continuous monitoring, mechanism of injury documentation (including injury pattern documentation), intervention logging (including tourniquets, dressing, airways, lines, tubes and drains, splints, fluids, and medications), and event logging. The capability was found to be operational and in alignment with learning objectives and user acceptance goals.
Impact of Blast Overpressure on the Pharmacokinetics of Various Antibiotics in Sprague Dawley Rats
Authors: Rios Kariana E , Selig Daniel J , Pavlovic Radmila , Alamneh Yonas , Vuong Chau , Nadeau Robert John , Pannone Kristina M , Deluca Jesse P , Long Joseph B , Sajja Venkatasivasai S , Tyner Stuart , Antonic Vlado , Getnet Derese , Bobrov Alexander G 
Published: November 2023

ABSTRACT

Introduction
Combat injuries are complex and multimodal. Most injuries to the extremities occur because of explosive devices such as improvised explosive devices. Blast exposure dramatically increases the risk of infection in combat wounds, and there is limited available information on the best antibiotic treatments for these injuries. We previously demonstrated that mice exposed to blast displayed a delayed clearance of cefazolin from the plasma and liver; further semi-mechanistic modeling determined that cefazolin concentrations in the skin of these mice were reduced. Our objective was to investigate the effects of blast on the pharmacokinetics of antibiotics of different types used for the treatment of combat wounds in the rat model.

Materials and Methods
Male Sprague Dawley rats were exposed to blast overpressure followed by injection of a bolus of animal equivalent doses of an antibiotic (cefazolin, cefepime, ertapenem, or clindamycin) into the tail vein at 1-hour post-blast exposure. Blood was collected at predetermined time points via repeated sampling from the tail vein. Animals were also euthanized at predetermined time points, at which time liver, kidney, skin, and blood via cardiac puncture were collected. Antibiotic concentrations were determined by ultra-performance liquid chromatography–tandem mass spectrometry.

Results
Blast-exposed rats exhibited a similar rate of clearance compared to non-blasted rats in the blood, liver, kidney, and skin, which is inconsistent with the data regarding cefazolin in blast-exposed mice.

Conclusions
Our results in rats do not recapitulate our previous observation of delayed cefazolin clearance in mice following the blast overpressure exposure. Although using rats permitted us to collect multiple blood samples from the same animals, rats may not be a suitable model for measuring the pharmacokinetics of antibiotics following blast. The interpretation of the results may be challenging because of variation in data among rat subjects in the same sample groups.
Pelvis-Sacrum-Lumbar Spine Injury Characteristics From Underbody Blast Loading
Authors: Yoganandan Narayan , Baisden Jamie , Moore Jason , Pintar Frank , Vedantam Aditya , Shabani Saman , Barnes David , Loftis Kathryn 
Published: November 2023

ABSTRACT

Introduction
Combat-related injuries from improvised explosive devices occur commonly to the lower extremity and spine. As the underbody blast impact loading traverses from the seat to pelvis to spine, energy transfer occurs through deformations of the combined pelvis-sacrum-lumbar spine complex, and the time factor plays a role in injury to any of these components. Previous studies have largely ignored the role of the time variable in injuries, injury mechanisms, and warfighter tolerance. The objective of this study is to relate the time or temporal factor using a multi-component, pelvis-sacrum-lumbar spinal column complex model.

Materials and Methods
Intact pelvis-sacrum-spine specimens from pre-screened unembalmed human cadavers were prepared by fixing at the superior end of the lumbar spine, pelvis and abdominal contents were simulated, and a weight was added to the cranial end of the fixation to account for torso effective mass. Prepared specimens were placed on the platform of a custom vertical accelerator device and aligned in a seated soldier posture. An accelerometer was attached to the seat platen of the device to record the time duration to peak velocity. Radiographs and computed tomography images were used to document and associate injuries with time duration.

Results
The mean age, stature, weight, body mass index, and bone density of 12 male specimens were as follows: 65 ± 11 years, 1.8 ± 0.01 m, 83 ± 13 kg, 27 ± 5.0 kg/m2, and 114 ± 21 mg/cc. They were equally divided into short, medium, and long time durations: 4.8 ± 0.5, 16.3 ± 7.3, and 34.5 ± 7.5 ms. Most severe injuries associated with the short time duration were to pelvis, although they were to spine for the long time duration.

Conclusions
With adequate time for the underbody blast loading to traverse the pelvis-sacrum-spine complex, distal structures are spared while proximal/spine structures sustain severe/unstable injuries. The time factor may have implications in seat and/or seat structure design in future military vehicles to advance warfighter safety.
Behavioral Health–related Reasons for Permanent Duty Limitation Profiles in the U.S. Army: Population-Based Data from 2017 to 2019
Authors: Carreno-Davidson Jamie T , Faller Theresa N , Richardson Melissa D , Roy Tanja C 
Published: November 2023

ABSTRACT

Introduction
When warfighters are unable to fight, they are formally removed from battle through temporary or permanent duty limitation profiles. This study uses a population-based data repository to characterize permanent behavioral health (BH)–related profiles across the army for an identified 2-year period. The absolute risk of a permanent duty limitation for specific BH categories was also examined.

Materials and Methods
This study utilized a retrospective population-based design to identify all new BH diagnoses across the U.S. Army. Service members identified as having a new BH diagnosis were tracked for 12 months following the diagnosis to determine the recommendation of a permanent duty limitation profile.

Results
From 2017 to 2018, 16% (n = 102,440) of service members received a “new” BH diagnosis. Less than 10% (9.5%; n = 9,752) of soldiers diagnosed with a BH disorder were issued a permanent BH-related duty profile within 12 months of the initial diagnosis. The absolute risk of a permanent profile was highest for soldiers diagnosed with a psychotic or delusional disorder (42%; n = 324) followed by dissociative or somatoform disorders (26%; n = 178) and eating disorders (23%; n = 108).

Conclusions
Military regulations dictating medical readiness and retention standards reflect both the standards required for mission readiness and a layer of medical protection for the service member. This study provides important information on the relationship between a new BH diagnosis and the likelihood that a service member will be referred for a retirement evaluation.
Acclimation Protocol to Minimize Stress in Immobilized Rats During Non-Invasive Multimodal Sensing of the Autonomic Nervous System
Authors: Kirby Ana Karina , Pancholi Sidharth , Suresh Shruthi , Anderson Zada , Chesler Caroline , Everett IV Thomas H , Duerstock Bradley S 
Published: November 2023

ABSTRACT

Introduction
Rodent models are often used in spinal cord injury investigations to measure physiological parameters but require rats to be restrained during data collection to prevent motion and stress-induced artifacts.

Materials and Methods
A 4-week acclimation protocol was developed to reduce sympathetic activity during experimentation to collect clean data. Physiological parameters were analyzed throughout the acclimation protocol using surface-based electrodes and an implanted sensor. The sensor was used to extract systolic blood pressure, skin nerve activity, and heart rate variability parameters.

Results
Our protocol exposed a minimal increase in sympathetic activity during experimentation despite long periods of restraint. The data suggest that the acclimation protocol presented successfully minimized changes in physiological parameters because of prolonged restraint.

Conclusions
This is necessary to ensure that physiological recordings are not affected by undue stress because of the process of wearing the sensor. This is important when determining the effects of stress when studying dysautonomia after spinal cord injury, Parkinson’s disease, and other neurological disorders.
Fiscal Year 2018 National Defense Authorization Act, Section 734, Weapon Systems Line of Inquiry: Overview and Blast Overpressure Tool—A Module for Human Body Blast Wave Exposure for Safer Weapons Training
Authors: Spencer Rachel W , Brokaw Elizabeth , Carr Walter , Chen Zhijian J , Garfield Bradley A , Garimella Harsha T , Gharahi Hamidreza , Iampaglia Joseph , Lalis Lisa , Przekwas Andrzej , Skotak Maciej , Xynidis Michael A , Dominijanni Andrew , Dias George , Danley Lura , Gupta Raj K 
Published: November 2023

ABSTRACT

Introduction
Experiences by service members in recent conflicts and training environments illuminate concerns about the possible effects of blast overpressure (BOP) exposure on brain health. Section 734 of the National Defense Authorization Act for Fiscal Year (FY) 2018 (Public Law 115-91) requires that the Secretary of Defense conducts a longitudinal medical study on blast pressure exposure of members of the Armed Forces during combat and training, and the Assistant Secretary of Defense for Health Affairs was assigned responsibility for fulfilling requirements. The study’s goal is to improve DoD’s understanding of the impact of BOP exposure from weapon systems on service members’ brain health and inform policy for risk mitigation, unit readiness, and health care decisions. This article focuses on the activities of the Weapon Systems Line of Inquiry (LOI) and the development of a prototype BOP Tool.

Materials and Methods
The DoD established the Section 734 Workgroup, which developed a program structure with five LOIs. The Weapon Systems LOI coordinated, collated, and analyzed information on BOP resulting from heavy weapons and blast events to inform strategies, and accounted for emerging research on health effects and performance. Ongoing research was leveraged to develop a BOP Tool as a standalone module and for integration into the Range Managers Toolkit.

Results
The effort identified opportunities for the DoD to improve the clarity of communications about BOP exposure, risk, and safety; establish methods to leverage emerging research; and develop a prototype BOP Tool to predict exposure loads when firing heavy weapons in training.

Conclusions
It is recommended that the DoD revises requirements and policy to improve and standardize safety guidance throughout research, development, testing, and evaluation; acquisition; and training. The validated BOP Tool allows users to generate a scenario to predict BOP exposure and allows service members to modify them during planning for safer training.
A Randomized Controlled Trial of Precision Nutrition Counseling for Service Members at Risk for Metabolic Syndrome
Authors: McCarthy Mary S , Colburn Zachary T , Yeung Ka Yee , Gillette Laurel H , Hung Ling-Hong , Elshaw Evelyn 
Published: November 2023

ABSTRACT

Introduction
Metabolic syndrome (MetS) is a threat to the active component military as it impacts health, readiness, retention, and cost to the Military Health System. The most prevalent risk factors documented in service members’ health records are high blood pressure (BP), low high-density lipoprotein cholesterol, and elevated triglycerides. Other risk factors include abdominal obesity and elevated fasting blood glucose. Precision nutrition counseling and wellness software applications have demonstrated positive results for weight management when coupled with high levels of participant engagement and motivation.

Materials and Methods
In this prospective randomized controlled trial, trained registered dietitians conducted nutrition counseling using results of targeted sequencing, biomarkers, and expert recommendations to reduce the risk for MetS. Upon randomization, the treatment arm initiated six weekly sessions and the control arm received educational pamphlets. An eHealth application captured diet and physical activity. Anthropometrics and BP were measured at baseline, 6 weeks, and 12 weeks, and biomarkers were measured at baseline and 12 weeks. The primary outcome was a change in weight at 12 weeks. Statistical analysis included descriptive statistics and t-tests or analysis of variance with significance set at P &lt; .05.

Results
Overall, 138 subjects enrolled from November 2019 to February 2021 between two military bases; 107 completed the study. Demographics were as follows: 66% male, mean age 31 years, 66% married, and 49% Caucasian and non-Hispanic. Weight loss was not significant between groups or sites at 12 weeks. Overall, 27% of subjects met the diagnostic criteria for MetS on enrollment and 17.8% upon study completion. High deleterious variant prevalence was identified for genes with single-nucleotide polymorphisms linked to obesity (40%), cholesterol (38%), and BP (58%). Overall, 65% of subjects had low 25(OH)D upon enrollment; 45% remained insufficient at study completion. eHealth app had low adherence yet sufficient correlation with a valid reference.

Conclusions
Early signs of progress with weight loss at 6 weeks were not sustained at 12 weeks. DNA-based nutrition counseling was not efficacious for weight loss.