bluuebunny/crossref_metadata_2025_split huggingface dataset:
The Microsoft HoloLens 2 Provides Accurate Biomechanical Measures of Performance During Military-Relevant Activities in Healthy Adults
Authors: Miller Koop Mandy , Rosenfeldt Anson B , Owen Kelsey , Zimmerman Eric , Johnston Joshua , Streicher Matthew C , Albright Alec , Penko Amanda L , Alberts Jay L 
Published: November 2023

ABSTRACT

Introduction
Augmented reality systems, like the HoloLens 2 (HL2), have the potential to provide accurate assessments of mild traumatic brain injury (mTBI) symptoms in military personnel by simulating complex military scenarios while objectively measuring the user’s movements with embedded motion sensors. The aim of this project was to determine if biomechanical measures of marching and squatting, derived from the HL2 motion sensors, were statistically equivalent, within 5%, to metrics derived from the gold-standard three-dimensional motion capture (MoCap) system.

Materials and Methods
Sixty-four adults (18-45 years; 34 males) completed a squatting and a marching task under single- (motor) and dual-task (motor + cognitive) conditions. Positional data from the HL2 and MoCap were simultaneously collected during the tasks and used to calculate and compare biomechanical outcomes. The HL2’s augmented reality capabilities were utilized to deliver the cognitive component of the marching dual task.

Results
Equivalence testing indicated the HL2 and MoCap measures were within 5% in all squatting metrics—trial time, squat duration, squat velocity, squat depth, and dwell time. Marching metrics, including trial time, step count, stepping rate, and step interval, were also equivalent between the two systems. The mean reaction time for responses during the Stroop test was 810 (125) milliseconds per response.

Conclusions
Biomechanical outcomes characterizing performance during two common military movements, squatting and marching, were equivalent between the HL2 and MoCap systems in healthy adults. Squatting and marching are two military-relevant tasks that require strength, motor coordination, and balance to perform, all of which are known to be affected by mTBI. Taken together, the data provide support for using the HL2 platform to deliver military-specific assessment scenarios and accurately measure performance during these activities. Utilizing objective and quantitative measures of motor function may enhance the management of military mTBI and reduce unnecessary risk to service members.
Sustained vs. Intratidal Recruitment in the Injured Lung During Airway Pressure Release Ventilation: A Computational Modeling Perspective
Authors: Cruz Andrea F , Herrmann Jacob , Ramcharran Harry , Kollisch-Singule Michaela , Tawhai Merryn H , Bates Jason H.T , Nieman Gary F , Kaczka David W 
Published: November 2023

ABSTRACT

Introduction
During mechanical ventilation, cyclic recruitment and derecruitment (R/D) of alveoli result in focal points of heterogeneous stress throughout the lung. In the acutely injured lung, the rates at which alveoli can be recruited or derecruited may also be altered, requiring longer times at higher pressure levels to be recruited during inspiration, but shorter times at lower pressure levels to minimize collapse during exhalation. In this study, we used a computational model to simulate the effects of airway pressure release ventilation (APRV) on acinar recruitment, with varying inspiratory pressure levels and durations of exhalation.

Materials and Methods
The computational model consisted of a ventilator pressure source, a distensible breathing circuit, an endotracheal tube, and a porcine lung consisting of recruited and derecruited zones, as well as a transitional zone capable of intratidal R/D. Lung injury was simulated by modifying each acinus with an inflation-dependent surface tension. APRV was simulated for an inhalation duration (Thigh) of 4.0 seconds, inspiratory pressures (Phigh) of 28 and 40 cmH2O, and exhalation durations (Tlow) ranging from 0.2 to 1.5 seconds.

Results
Both sustained acinar recruitment and intratidal R/D within the subtree were consistently higher for Phigh of 40 cmH2O vs. 28 cmH2O, regardless of Tlow. Increasing Tlow was associated with decreasing sustained acinar recruitment, but increasing intratidal R/D, within the subtree. Increasing Tlow was associated with decreasing elastance of both the total respiratory system and transitional subtree of the model.

Conclusions
Our computational model demonstrates the confounding effects of cyclic R/D, sustained recruitment, and parenchymal strain stiffening on estimates of total lung elastance during APRV. Increasing inspiratory pressures leads to not only more sustained recruitment of unstable acini but also more intratidal R/D. Our model indicates that higher inspiratory pressures should be used in conjunction with shorter exhalation times, to avoid increasing intratidal R/D.
Head Flail Corridors From Sled Impact Acceleration Tests for Use in Occupant-Centric Vehicle Design
Authors: Olszko Ardyn , Abraczinskas Alicia , McGovern Shannon , Robinette Allison , Vasquez Kimberly , Chancey Valeta Carol , Brozoski Frederick 
Published: November 2023

ABSTRACT

Introduction
In aircraft crashes, injuries to the head and upper torso are frequently reported, with head injury reported most frequently of all body regions. Because preventing flail of the head and body is of utmost importance for occupant survival, the Aircraft Crash Survival Design Guide (ACSDG), the guide to crashworthy aircraft design, published flail envelopes. However, the ACSDG flail envelopes are based on a single test with an anthropomorphic test device subjected to a frontal acceleration. In this article, human research volunteer (HRV) response data are used to calculate head flail corridors and evaluate the ACSDG flail envelopes.

Materials and Methods
Data from HRV sled tests were obtained from the historical Naval Biodynamics Laboratory collection of the Biodynamics Data Resource. Digitized high-speed film for each test was tracked and processed to represent the head flail response in a format amenable to corridor development. Time-based and position-based head flail corridors were developed for groups of exposure-matched tests and then compared to the ACSDG flail envelopes.

Results
A collection of 714 HRV sled tests conducted in six different impact directions ranging from 3 to 15 g was used to develop time-based and position-based head flail corridors for 39 match groups. The ACSDG vertical limit and anteroposterior limit and curve were not exceeded by the flail corridors, but the lateral limit and curve were exceeded by 4.6 cm to 15.8 cm.

Conclusions
The flail corridors provide a useful baseline for representing the well-restrained occupant response at lower, non-injurious exposure levels and across multiple impact directions. Under these conditions, the ACSDG lateral limit and curve are not adequate. At higher exposure levels or with modified restraints, seating, or equipment, the ACSDG vertical limit and anteroposterior limit and curves may also be inadequate.
Recommendations for a Military Health System Auditory Blast Injury Prevention Standard
Authors: Brokaw Elizabeth B , S. Brungart Douglas , M. Byrne Ryan , A. Flamme Greg , Gupta Raj , Jokel Charles R , Kujawa Sharon G , Lalis Lisa , L. McKinley Richard , Murphy William J , W. Spencer Rachel , J. Smalt Christopher , F. Zagadou Brissi 
Published: November 2023

ABSTRACT

Introduction
Although existing auditory injury prevention standards benefit warfighters, the Department of Defense could do more to understand and address auditory injuries (e.g., hearing loss, tinnitus, and central processing deficits) among service members. The Blast Injury Prevention Standards Recommendation (BIPSR) Process is designed to address the needs of all the Military Services for biomedically valid Military Health System (MHS) Blast Injury Prevention Standards.

Materials and Methods
Through the BIPSR Process, stakeholders provided their intended uses and requested functionalities for an MHS Blast Injury Prevention Standard. The BIPSR Process established a broad-based, non-advocacy panel of auditory injury Subject Matter Expert (SME) Panel with members drawn from industry, academia, and government. The SME Panel selected evaluation factors, weighted priorities, and then evaluated the resulting candidate MHS Auditory Blast Injury Prevention Standards against the evaluation criteria. The SME Panel members provided rationales for their decisions, documented discussions, and used iterative rounds of feedback to promote consensus building among members. The BIPSR Process used multi-attribute utility theory to combine members’ evaluations and compare the candidate standards.

Results
The SME Panel identified and collated information about existing auditory injury datasets to identify gaps and promote data sharing and comprehensive evaluations of standards for preventing auditory blast injury. The panel evaluated the candidate standards and developed recommendations for an MHS Blast Injury Prevention Standard.

Conclusions
The BIPSR Process illuminated important characteristics, capabilities, and limitations of candidate standards and existing datasets (e.g., limited human exposure data to evaluate the validity of injury prediction) for auditory blast injury prevention. The evaluation resulted in the recommendation to use the 8-hour Equivalent Level (LAeq8hr) as the interim MHS Auditory Blast Injury Prevention Standard while the community performs additional research to fill critical knowledge gaps.
DroidChamber: Multilevel Security for Mobile Devices to Support Telemedicine on the Battlefield
Authors: McVearry Kenneth A 
Published: November 2023

ABSTRACT

Introduction
Apps that support telemedicine on the battlefield typically run on classified devices and transmit information over classified networks, whereas the medical data the apps create and transmit are unclassified. Current systems treat these data as classified, so a cross-domain solution is required to transfer the data back to an unclassified domain, which adds delays and costs to the process of transmitting critical data needed to treat injured warfighters. To address this gap, ATC-NY developed DroidChamber, which is a software-based Android system that enables multilevel security and which runs on smartphones and tablets. DroidChamber enables warfighters to execute apps in multiple security domains without risking information leakage.

Materials and Methods
DroidChamber v6 is a collection of mobile device management and security containerization technologies targeting Android 6, and it applies these technologies by leveraging Linux kernel operating-system-level virtualization technologies. DroidChamber v10 takes advantage of Android Work Profiles and Samsung’s Knox technology in Android 10, which provides the ability to provision separate “work” and “personal” profiles that securely isolate applications; apps within each profile can further be isolated through the built-in Android controls and the Knox Application Policy.

Results
DroidChamber is a software-based Android system, so it requires no added hardware to be attached or integrated with an end-user device. DroidChamber’s innovation is isolation of specific Android app resources (e.g., networking) enforced with fine-grained security policies. With DroidChamber, a medic can connect their device to different security domains, giving a wider range of access to medical information in a tactical environment.

Conclusions
DroidChamber improves telemedicine applications by enabling the warfighter to share information without requiring a cross-domain guard that may erroneously block some data. Using DroidChamber, a warfighter can use a single mobile device to manage/transmit data at different security levels, thereby reducing the cost and complexity of a mission.
A Preliminary Description of the Health of Women Navy Divers: An Examination of Linked Medical, Personnel, and Dive Log Data for 47 Women Divers Who Separated Between 2008 and 2018
Authors: Maguire Brian J , Hughes Linda M , Field Sandra L , Nordness Robert 
Published: November 2023

ABSTRACT

Introduction
Although women have always served in the U.S. Armed Forces, it has only been in the last half century that systematic examinations have been done on the health issues experienced by military women. Still, little is known about how occupational health risks among Navy divers might vary between men and women. Our objective was to use available data to examine health issues among all separating divers and then determine how prevalence rates varied between men and women for diagnoses made within the diver’s last year of active duty service.

Materials and Methods
For this retrospective observational study, medical records and personnel data were linked with dive logs at the individual level. We calculated sex-specific prevalence rates and relative risks per 1,000 divers by major diagnostic categories and by specific disease diagnoses.

Results
We identified 47 women among the 4,623 active duty Navy divers (1.0%) who separated between 2008 and 2018. Ages varied between 19 and 54 years (M = 33, SD = 8) for women, compared to men who were 18-65 years (M = 35, SD = 9). When compared to men, women had about six times the rate of diseases of the genitourinary system, twice the rate of respiratory system diseases, and about four times as many diagnoses of disorders of the lacrimal system.

Conclusions
The findings of much higher relative risks for women for conditions such as genitourinary disease, skin conditions, and acute respiratory infections require follow-up research to look for causes and potential risk reduction interventions. Future research must determine specific and relative risks as a necessary precursor to developing, implementing, and testing potentially sex-specific risk reduction and health improvement interventions.
Evidence-Based Strategies to Enhance Weight Management Programs for Adult Military Beneficiaries: A Narrative Review
Authors: Bukhari Asma S , Knowles Wendi L , Reagan Joanna J , Schwartz Julie A , Lindberg Tammy J , Hough Heather L , Wagaman Lisa M , Young Kristen L , Harward Jennifer B , Feeney Kimberly A , Weinstein James L 
Published: November 2023

ABSTRACT

Introduction
Overweight and obesity trends are on the rise among both civilian and military beneficiaries. The purpose of this narrative review was to evaluate nutrition, behavioral, lifestyle, pharmacotherapy, and alternative approaches to weight management (WM) among adults with a focus toward identifying gaps and evidence-based strategies that could support or enhance current and future WM programming among military adult beneficiaries.

Materials and Methods
A trained research team identified publications (January 2013-January 2020) for abstract review using key search terms and inclusion criteria. Two independent researchers conducted both the abstract review and full-paper bias scoring using selected Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) criteria. All eligible studies were assessed for bias and categorized based on key themes. The study was registered in PROSPERO, the international prospective register of systematic reviews.

Results
The research team identified 741 articles, with 278 meeting final inclusion criteria. The mean bias score was 7.5 ± 3.9 (score of 0-13; higher indicating fewer bias factors), with 64% scoring ≥9. Factors contributing to low bias included intervention compliance, dropout rate, and inability to blind participants. The most common published weight-loss interventions included a combination of therapies (59%), diet/supplement (17%), other approaches (12%), behavior change (7%), and exercise (6%). Themes identified to improve WM outcomes included leveraging technology, increasing intervention interactions, community support, emphasis on early weight loss, pharmacotherapy risk–benefit, enhanced behavioral component, resistance exercise, mindfulness, and benefits of quality-of-life measures.

Conclusions
Reviewers identified several validated tools and techniques to augment and update existing WM programming to improve health and weight outcomes. The review affirmed use of individualized dietary patterns and not a “one-size-fits-all approach” as well as incorporating more comprehensive and team-approached treatments to make the best use of tools and strategies to enhance outcomes.
Surgical Team Structure: How Familiarity and Team Size Influence Communication Effectiveness in Military Surgical Teams
Authors: Stucky Christopher H , Kabo Felichism W , De Jong Marla J , House Sherita L , Wymer Joshua A 
Published: November 2023

ABSTRACT

Introduction
Preventable patient harm has persisted in health care despite recent advances to reduce errors. There is increasing recognition that non-technical skills, including communication and relationships, greatly impact interprofessional team performance and health care quality. Team familiarity and size are critical structural components that potentially influence information flow, communication, and efficiency.

Methods
In this exploratory, prospective, cross-sectional study, we investigated the key structural components of surgical teams and identified how surgical team structure shapes communication effectiveness. Using total population sampling, we recruited surgical clinicians who provide direct patient care at a 138-bed military medical center. We used statistical modeling to characterize the relationship between communication effectiveness and five predictors: team familiarity, team size, surgical complexity, and the presence of surgical residents and student anesthesia professionals.

Results
We surveyed 137 surgical teams composed of 149 multidisciplinary clinicians for an 82% response rate. The mean communication effectiveness score was 4.61 (SD = 0.30), the average team size was 4.53 (SD = 0.69) persons, and the average surgical complexity was 10.85 relative value units (SD = 6.86). The surgical teams exhibited high variability in familiarity, with teams co-performing 26% (SD = 0.16) of each other’s surgeries. We found for every unit increase in team familiarity, communication effectiveness increased by 0.36 (P ≤ .05), whereas adding one additional member to the surgical team decreased communication effectiveness by 0.1 (P ≤ .05). Surgical complexity and the influence of residents and students were not associated with communication effectiveness.

Conclusions
For military surgical teams, greater familiarity and smaller team sizes were associated with small improvements in communication effectiveness. Military leaders can likely enhance team communication by engaging in a thoughtful and concerted program to foster cohesion by building familiarity and optimizing team size to meet task and cognitive demands. We suggest leaders develop bundled approaches to improve communication by integrating team familiarity and team size optimization into current evidence-based initiatives to enhance performance.
Systematic Improvements to the Army’s Deployment Cycle Resilience Training Using a Comprehensive, Iterative Process
Authors: Kirk Michelle A , Nolet Jason M , Adrian Amanda L , Knust Susannah K 
Published: November 2023

ABSTRACT

Introduction
To support soldier readiness and mitigate the mental health consequences of deployments, Army regulation mandates soldiers to receive Deployment Cycle Resilience Training (DCRT) throughout their deployment cycle. A recent evaluation revealed several issues with the existing version that threatened the relevancy and usefulness of the training. The present article details the systematic approach taken by the Research Transition Office at the Walter Reed Army Institute of Research to revise the DCRT curriculum and presents the revision updates that are now included in DCRT version 3.

Method
Curriculum developers (n = 2) with subject matter expertise relevant to the project followed an iterative process that was critical to the efficacy of the revisions. Developers used the existing DCRT modules as the curriculum framework and utilized several materials to inform the revisions to include Army doctrine, data from the quality improvement evaluation conducted by the Walter Reed Army Institute of Research, and the current research related to the deployment cycle, resilience, and behavior change. Internal and external stakeholders (n = 31) provided iterative feedback to ensure each of the six modules met DCRT revision objectives.

Results
The revised DCRT curriculum was implemented in August 2021. The resulting revisions included an increase in inclusivity, an emphasis on growth opportunities, an integrative approach to the deployment cycle phases, and greater practical application. Additionally, the curriculum incorporates best practices found to enhance the delivery of resilience-based psychoeducational interventions, specifically within high-risk occupational settings like the military.

Conclusions
The revisions outlined in this article enhance the training quality and potential effectiveness of DCRT, which can positively influence soldier and family readiness and mission success. Furthermore, the deliberate and iterative curriculum revision process can serve as a guide to other curriculum development projects, specifically within the military context. Implementation considerations and potential limitations are provided, and future directions are discussed to include the ongoing evaluation.
The Potential of an Embedded Mental Health Services Program Toward Increasing Health Care–Seeking Behaviors Among U.S. Air Force Aircrew: A Mixed-Methods Study
Authors: Martinez Rachael N , Galloway Kristin , Thompson Christopher 
Published: November 2023

ABSTRACT

Introduction
The U.S. Air Force implemented the Integrated Operational Support model, which involves embedding health care professionals within operational units to meet the health needs of the airmen. This study assessed the extent to which airmen sought out both traditional and embedded mental health services, as well as perceptions of factors that hinder or encourage health care–seeking behaviors.

Materials and Methods
A mixed-methods approach including a web-based occupational psychological health assessment and semi-structured interviews was used to assess airmen’s experiences with seeking mental health care services.

Results
A total of 447 Remotely Piloted Aircraft operators participated in an occupational psychological health assessment (42% response rate) in 2018, and 15 airmen across five high operational tempo, restricted-access installations completed a semi-structured interview (60% participation rate) in 2021. From the occupational assessment, females (33%) sought care from the traditional mental health clinic significantly more than males (21%; χ2 = 5.10, P = .02). However, there were no significant gender differences in seeking embedded mental health services. Respondents who had not sought out help from either the traditional clinic or embedded services were significantly more likely to seek assistance from embedded mental health services (M = 4.29, SD = 2.09) over the traditional clinic (M = 3.92, SD = 1.90), t(205) = 4.94, P &lt; .001. A resounding interview theme was the deep appreciation that airmen expressed for the availability of embedded mental health professionals. Airmen also discussed factors that hinder health care–seeking behaviors with the top-reported factor being the stigma associated with seeking mental health. The top three reported factors that encourage health care–seeking behaviors included leadership and mental health professionals normalizing care, trust in embedded mental health professionals, and ease of access to care.

Conclusions
Findings suggest that having mental health professionals integrated within the unit brings the care straight to the airmen and may reduce the stigma associated with airmen asking for help.