bluuebunny/crossref_metadata_2025_split huggingface dataset:
1 Ground manoeuvre surgical group (GMSG) development – lessons from theatre entry
Authors:   Lt Col Jonathan A Round
Published: May 2023

In 2017, conceptual work began to develop a Role 2 Forward Surgical Capability (FSC) that could be rapidly deployable and manoeuvrable, modular and scalable, delivering Damage Control Resuscitation, Surgery and critical care patient hold. This developmental work was underpinned by lessons from other United Kingdom (UK) Role 2 light manoeuvre capabilities and exercising with a similar French capability. To standardise UK military medical descriptive nomenclature, direction was given to replace FSC with the term Ground Manoeuvre Surgical Group (GMSG).In Autumn 2019, 34 Field Hospital were tasked with delivering a GMSG the following year, supporting a 250-strong Long Range Reconnaissance Group (LRRG) provided by the UK, contributing to the United Nations Multidimensional Integrated Stabilisation Mission in Mali (MINUSMA).Initial planning guidance was to expect long range patrols in a desert environment for four to six weeks duration with no or minimal resupply. Mali has ambient day time temperatures more than 40°C enduring for most of the year. This was judged likely to have significant impact on the safe storage of blood products and components, as well as temperature sensitive drugs while mobile on long range patrols. Existing in-service cold storage equipment was not designed to be operated while mobile nor to operate in a high ambient temperature, risking failure.An innovative integrated temperature control solution was ultimately fielded, consisting of air-conditioned tentage, extended life cold boxes and a power solution to ensure cold box plates could remain frozen in a freezer while mobile on patrol. The integration of these capabilities led to successful delivery of medical support to the LRRG.
2 Combining medical force elements into a medical group in Mali: recommendations from operation newcombe, Mali. An opinion piece
Authors: Hivey Maj E , Lyne-Pirkis Maj C 
Published: May 2023

BackgroundOp NEWCOMBE was the UK contribution to the UN Mission in Mali (MINUSMA) between 2019 and 2023. The UK deployed a Role 1 capability, a small surgical capability (Ground Manoeuvre Surgical Group) and Task Force Headquarters medical subject matter experts for a population at risk of ~300. Over subsequent deployments the Medical Group concept developed with the aim to optimise capability and resource, combining into one sub-Unit.ObservationsCombined operation established a clear chain of command, provided learning opportunities, and enhanced the provision of care available, whilst generating resilience. The Role 1 was able to operate at an increased capacity: >1000 patient consultations over 6 months, mass vaccinations and disease outbreak management. Duplication of assurance, governance and pre-deployment training was reduced. Patients benefited from in Theatre access to imaging, laboratory tests and consultant specialist advice, with early identification of replacement force generation requirements. The combined approach allowed rapid reaction to emergencies or periods of increased medical workload. During three of the five rotations, significant UK and international incidents were managed throughout the patient care pathway utilising the entirety of the Medical Group.ConclusionsFuture deployment models should consider this force enabling approach in the planning, force generation and deployment phases for new Operations. Early identification and adoption of a Medical Group composition ensures pre-deployment risks can be identified and mitigated early, team cohesion can be generated, duplication of training and governance can be prevented whilst optimising the provision of deployed care.
8 Bilateral engagement through sim training
Authors:   Maj (Reserve) Dr. medic Amelie Oberst, MD
Published: May 2023

During the current UN operation, the German team of Role 1 and the long-range reconnaissance group of the UK armed forces engaged in binational trauma simulation training.The simulation was led and designed by a team of British, consisting of two senior anaesthesiologists and one senior surgeon.The scenario was a 25-year-old unresponsive soldier with multiple gunshot wounds and a blocked airway, in a hemodynamically unstable condition. Following a structured trauma approach, the team established a surgical airway, a chest tube, a central venous line, and surgical bleeding control.Besides the classical advantages of simulation training, our exercise provided a better understanding of different approaches and the difference in national protocols, enhanced collaboration between single participants, as well as new impulses for daily work.This simulation training proofed that such a cooperation is supported by a common language, international algorithms, guidelines, as well as a general understanding of crew resource management. Such structures allow international teams to reach a shared goal more quickly and, therefore should be encouraged.
TNT: A Modular Approach to Traversing Physically Heterogeneous NOCs at Bare-wire Latency
Authors: Ravi Gokul Subramanian , Krishna Tushar , Lipasti Mikko 
Published: May 2023

The ideal latency for on-chip network traversal would be the delay incurred from wire traversal alone. Unfortunately, in a realistic modular network, the latency for a packet to traverse the network is significantly higher than this wire delay. The main limiter to achieving lower latency is the modular quantization of network traversal into hops. Beyond this, the physical heterogeneity in real-world systems further complicate the ability to reach ideal wire-only delay.

In this work, we propose
TNT
or
Transparent Network Traversal
. TNT targets ideal network latency by attempting source to destination network traversal as a single multi-cycle ‘long-hop’, bypassing the quantization effects of intermediate routers via transparent data/information flow. TNT is built in a modular tile-scalable manner via a novel control path performing neighbor-to-neighbor interactions but enabling end-to-end transparent flit traversal. Further, TNT’s fine grained on-the-fly delay tracking allows it to cope with physical NOC heterogeneity across the chip.

Analysis on Ligra graph workloads shows that TNT can reduce NOC latency by as much as 43% compared to the state of the art and allows efficiency gains up to 38%. Further, it can achieve more than 3x the benefits of the best/closest alternative research proposal, SMART [
43
].
2023 Guideline for the Management of Patients With Aneurysmal Subarachnoid Hemorrhage: A Guideline From the American Heart Association/American Stroke Association
Authors: Hoh Brian L. , Ko Nerissa U. , Amin-Hanjani Sepideh , Chou Sherry Hsiang-Yi , Cruz-Flores Salvador , Dangayach Neha S. , Derdeyn Colin P. , Du Rose , Hänggi Daniel , Hetts Steven W. , Ifejika Nneka L. , Johnson Regina , Keigher Kiffon M. , Leslie-Mazwi Thabele M. , Lucke-Wold Brandon , Rabinstein Alejandro A. , Robicsek Steven A. , Stapleton Christopher J. , Suarez Jose I. , Tjoumakaris Stavropoula I. , Welch Babu G. 
Published: May 2023

Aim:
The “2023 Guideline for the Management of Patients With Aneurysmal Subarachnoid Hemorrhage” replaces the 2012 “Guidelines for the Management of Aneurysmal Subarachnoid Hemorrhage.” The 2023 guideline is intended to provide patient-centric recommendations for clinicians to prevent, diagnose, and manage patients with aneurysmal subarachnoid hemorrhage.

METHODS:
A comprehensive search for literature published since the 2012 guideline, derived from research principally involving human subjects, published in English, and indexed in MEDLINE, PubMed, Cochrane Library, and other selected databases relevant to this guideline, was conducted between March 2022 and June 2022. In addition, the guideline writing group reviewed documents on related subject matter previously published by the American Heart Association. Newer studies published between July 2022 and November 2022 that affected recommendation content, Class of Recommendation, or Level of Evidence were included if appropriate.

Structure:
Aneurysmal subarachnoid hemorrhage is a significant global public health threat and a severely morbid and often deadly condition. The 2023 aneurysmal subarachnoid hemorrhage guideline provides recommendations based on current evidence for the treatment of these patients. The recommendations present an evidence-based approach to preventing, diagnosing, and managing patients with aneurysmal subarachnoid hemorrhage, with the intent to improve quality of care and align with patients’ and their families’ and caregivers’ interests. Many recommendations from the previous aneurysmal subarachnoid hemorrhage guidelines have been updated with new evidence, and new recommendations have been created when supported by published data.
Genetic variability, heritability, genetic advance, association between fruit yield and yield components of okra (Abelmoschus esculentus L. Moench) accessions grown in two different years
Authors: Justina Komolafe Ronke , Johnson Ariyo Omolayo , Olusanya Alake Christopher , Adebayo Oduwaye Olusegun 
Published: May 2023

Abstract
Genetic improvement of okra for yield is significant because of the nutritional, economic and health benefits inherent in it and to overcome the low genetic potential of the existing varieties and environmental factors which are the major constraints to okra yield. Therefore, this study was carried out to understand the genetic nature of yield, its association with yield components on which selection can be made and to determine the effect of different years on genetic gain. The experiment involved the evaluation of twenty okra accessions in the rainy seasons of year 2019 and 2020 in a randomised complete block design. Data were collected on fourteen characters and analysed. Genotype × Year was highly significant for all the analysed characters. High heritability and high genetic advance as percent of mean were recorded for most of the characters in both years indicating that these traits were less influenced by the environment and presence of additive gene action. Genotypic coefficient of variation, heritability and genetic advance were observed to be higher for some traits in 2019 but lower for those traits in 2020. Pod yield had positive correlation with only plant height at 50% flowering, pod length, number of seeds per pods and peduncle length in both years 2019 and 2020 while the remaining were negatively correlated with pod yield in both years except petiole length and number of pods per plant. Therefore, selection based on these traits could be highly rewarding and may not be considered based on different years.
Damping of Inertial Motions through the Radiation of Near-Inertial Waves in a Dipole Vortex in the Iceland Basin
Authors: Thomas Leif N. , Skyllingstad Eric D. , Rainville Luc , Hormann Verena , Centurioni Luca , Moum James N. , Asselin Olivier , Lee Craig M. 
Published: May 2023

Abstract
Along with boundary layer turbulence, downward radiation of near-inertial waves (NIWs) damps inertial oscillations (IOs) in the surface ocean; however, the latter can also energize abyssal mixing. Here we present observations made from a dipole vortex in the Iceland Basin where, after the period of direct wind forcing, IOs lost over half their kinetic energy (KE) in two inertial periods to radiation of NIWs with minimal turbulent dissipation of KE. The dipole’s vorticity gradient led to a rapid reduction in the NIW’s lateral wavelength via ζ refraction that was accompanied by isopycnal undulations below the surface mixed layer. Pressure anomalies associated with the undulations were correlated with the NIW’s velocity yielding an energy flux of 310 mW m−2 pointed antiparallel to the vorticity gradient and a downward flux of 1 mW m−2 capable of driving the observed drop in KE. The minimal role of turbulence in the energetics after the IOs had been generated by the winds was confirmed using a large-eddy simulation driven by the observed winds.

Significance Statement
We report direct observational estimates of the vector wave energy flux of a near-inertial wave. The energy flux points from high to low vorticity in the horizontal, consistent with the theory of ζ refraction. The downward energy flux dominates the observed damping of inertial motions over turbulent dissipation and mixing.
National Trends and Clinical Outcomes of Type B Aortic Dissection Management at Safety-Net Hospitals
Authors: Cho Nam Yong , Chervu Nikhil , Verma Arjun , Ebrahimian Shayan , Kim Shineui , Rollo Jonathan , Benharash Peyman 
Published: May 2023

Introduction Patients with type B aortic dissection (TBAD) are often underinsured and urgently admitted for open or thoracic endovascular aortic repair (TEVAR). The present study evaluated the association of safety-net status with outcomes among patients with TBAD. Methods The 2012-2019 National Inpatient Sample was queried to identify all adults admitted with type B aortic dissection. Safety-net hospitals (SNHs) were defined as institutions in the top 33% for the annual proportion of uninsured or Medicaid patients. Multivariable regression models were utilized to assess the association of SNH with in-hospital mortality, perioperative complications, length of stay (LOS), hospitalization cost, and non-home discharge. Results Of an estimated 172 595 patients, 61 000 (35.3%) were managed at SNH. Compared to others, patients admitted to SNH were younger, more commonly non-white, and more frequently non-electively admitted. From 2012 to 2019, the annual incidence of type B aortic dissection increased in the overall cohort. Additionally, utilization of TEVAR at non-SNH increased significantly (2012: 6.5% vs 2019: 9.8%), while that of SNH remained similar (2012: 7.4% vs 2019: 7.9%). Patients undergoing open repair had higher mortality at both SNH (12.4 vs 7.8%, P < .001) and non-SNH (13.1 vs 6.1%, P < .001) compared to those receiving TEVAR. After risk adjustment, compared to non-SNH, SNH status was associated with greater odds of mortality, perioperative complications and non-home discharge. Conclusions Our finding suggests that SNH have inferior clinical outcomes for TBAD as well as reduced adoption of endovascular management strategies. Future studies to identify barriers to optimal aortic repair and ameliorate disparities at SNH are warranted.
Factors Associated With Early Amputation in Patients With Chronic Limb Threatening Ischemia
Authors: Cho Nam Yong , Tran Zachary , Bakhtiyar Syed Shahyan , Orellana Manuel , Kronen Elsa , Bowens Nina , Benharash Peyman 
Published: May 2023

Introduction Despite advancements in revascularization procedures, early amputation (EA) among patients with chronic limb threatening ischemia (CLTI) are still common. The present study evaluated clinical outcomes of patients with CLTI and factors associated with EA. Methods The 2016-2019 Nationwide Readmission Database was queried to identify all adults (≥18 years) with CLTI of lower extremities undergoing limb salvage (LS) procedures. The primary outcome of the study was EA within 90 days of discharge. Secondary outcomes included infectious complication, length of stay (LOS), cumulative hospitalization cost and non-home discharge. Results Of 103,703 patients who initially underwent surgical or endovascular revascularization, 10,439 (10.1%) subsequently underwent major amputation within 90 days of discharge. Following risk adjustment, factors associated with higher odds of EA were male sex, low-income quartile, tissue loss due to ulceration or gangrene, end-stage renal disease, and diabetes. Compared to those undergoing open revascularization, patients with endovascular limb salvage had a higher likelihood of having early amputation (AOR 1.41, 95% CI 1.31-1.51). Patients undergoing EA had greater odd of infectious complication, incremental LOS, incremental cost and non-home discharge. Conclusions We identified several risk factors to be associated with EA in patients with CLTI. These findings may supplement the objective performance goals for limb-related outcomes and facilitate institutional limb salvage programs.
Comparison of complement consumption and platelet accumulation between membrane oxygenators coated with a polymer or heparin
Authors: Tagaya Masashi , Murataka Takuo , Okano Shinya , Handa Hiroki , Takahashi Shunsuke 
Published: May 2023

Introduction The membrane oxygenator in extracorporeal circulation circuits is coated with acrylate-copolymer (ACP) or immobilized heparin (IHP) to enhance hemocompatibility. To evaluate the relative features of both coatings, we compared blood components circulated in the circuits with ACP-and IHP-coated membranes in vitro using whole human blood. Methods Whole human blood was heparinized and circulated in two experimental circuits with an ACP-coated reservoir, tubes, and an ACP- or IHP-coated membrane. Platelet (PLT) counts and the amount of total protein (TP), complement component 3 (C3), and complement component 4 (C4) were measured at 0, 8, 16, 24, and 32 h in each experiment ( n = 5). Results The PLT count at 0-h circulation was lower in the IHP-coated than in the ACP-coated circuits ( p = 0.034); however, no significant difference was observed at other time points. Reduction in TP at 8-h and 16-h circulation and in C3 at 32-h circulation was lesser in the ACP-coated than in the IHP-coated circuits ( p = 0.004, 0.034, and 0.027, respectively); reduction in TP and C3 at other time points and C4 at each time point was not significantly different. There were significant interactions between coating type and circulation duration in the PLT, TP, and C3 transitions ( p = 0.008, 0.020, and 0.043, respectively). Conclusions Our findings suggest that ACP-coated membranes can prevent the initial drop in PLT count and C3 consumption over 32 h, whereas IHP-coated membranes could not prevent this drop in extracorporeal circulation. Therefore, ACP-coated membranes are suitable for short- and long-term extracorporeal life support.
Camrelizumab as adjuvant therapy in urothelial carcinomas after radical surgery in people living with HIV
Authors: Wu Menghua , Pang Yuefeng , Zheng Xin , Zhao Jimao 
Published: May 2023

Background Immune checkpoint inhibitors (ICIs) are effective strategies for multiple cancers and may be safe in people living with HIV (PLWH). Camrelizumab is a monoclonal antibody against PD-1 activating T cells against tumor cells. Evidence of camrelizumab’s safety and activity in PLWH with urothelial carcinoma (UC) is lacking. Here, findings in a cohort of people living with HIV with advanced or metastatic urothelial carcinoma are presented. Methods Patients who had locally advanced or metastatic disease after radical surgery were given camrelizumab (200 mg intravenously every 3 weeks). The primary endpoint was objective response per Response Evaluation Criteria in Solid Tumors version 1.1. The second endpoint was adverse events after treatment. Results In total, nine patients were included in this study with a median follow-up of 6.2 months (4.1–20.5). The objective response rate achieved 55%. Tumor response comprised 2 (22%) complete responses and 3 (33%) partial responses. The median of progression-free survival was 6.2 months (95% CI, 9.83–20.63). Only two grade 3 adverse reactions were reported (no toxic deaths or immune-related deaths). Conclusion Camrelizumab showed potent antitumor activity and acceptable safety in PLWH with advanced or metastatic urothelial carcinoma.
Long-term patient-reported outcome measures of fingertip coverage with a homodigital unipedicle neurovascular island flap
Authors: Rob Edouard , Druel Thibault , Jalaguier Thomas , Walch Arnaud , Gazarian Aram 
Published: May 2023

We report the long-term patient-reported outcomes and objective outcomes of a homodigital neurovascular island flap for distal phalangeal amputations in the fingers (with the thumb excluded) for 20 patients at a median follow-up of 4.4 years (IQR 2.2 to 12.3). We assessed the global subjective and aesthetic outcomes, range of motion, sensitivity and strength. The patient-reported median subjective global score was 7.5/10 points (IQR 7 to 9) and the aesthetic score was 8/10 points (IQR 8 to 9). Range of motion, sensitivity and strength were similar to the uninjured side. Stiffness was present in more than half of the cases; 14 patients had a hook nail deformity and seven patients reported symptomatic cold intolerance. At a long-term follow-up, the patient-reported outcome measures and objective outcomes of this flap are satisfactory and it is a safe and reliable flap. Level of evidence: IV
Identifying relevant diffusion MRI microstructure biomarkers relating to exposure to repeated head impacts in contact sport athletes
Authors: Chen Junbo , Chung Sohae , Li Tianhao , Fieremans Els , Novikov Dmitry S , Wang Yao , Lui Yvonne W 
Published: May 2023

Purpose Repeated head impacts (RHI) without concussion may cause long-term sequelae. A growing array of diffusion MRI metrics exist, both empiric and modeled and it is hard to know which are potentially important biomarkers. Common conventional statistical methods fail to consider interactions between metrics and rely on group-level comparisons. This study uses a classification pipeline as a means towards identifying important diffusion metrics associated with subconcussive RHI. Methods 36 collegiate contact sport athletes and 45 non-contact sport controls from FITBIR CARE were included. Regional/whole brain WM statistics were computed from 7 diffusion metrics. Wrapper-based feature selection was applied to 5 classifiers representing a range of learning capacities. Best 2 classifiers were interpreted to identify the most RHI-related diffusion metrics. Results Mean diffusivity (MD) and mean kurtosis (MK) are found to be the most important metrics for discriminating between athletes with and without RHI exposure history. Regional features outperformed global statistics. Linear approaches outperformed non-linear approaches with good generalizability (test AUC 0.80–0.81). Conclusion Feature selection and classification identifies diffusion metrics that characterize subconcussive RHI. Linear classifiers yield the best performance and mean diffusion, tissue microstructure complexity, and radial extra-axonal compartment diffusion (MD, MK, De,⊥) are found to be the most influential metrics. This work provides proof of concept that applying such approach to small, multidimensional dataset can be successful given attention to optimizing learning capacity without overfitting and serves an example of methods that lead to better understanding of the myriad of diffusion metrics as they relate to injury and disease.