Showing papers by "United States Department of the Army published in 2012"
TL;DR: Prevalence and severity of health loss were weakly correlated and age-specific prevalence of YLDs increased with age in all regions and has decreased slightly from 1990 to 2010, but population growth and ageing have increased YLD numbers and crude rates over the past two decades.
7,021 citations
TL;DR: The results for 1990 and 2010 supersede all previously published Global Burden of Disease results and highlight the importance of understanding local burden of disease and setting goals and targets for the post-2015 agenda taking such patterns into account.
6,861 citations
TL;DR: To significantly impact the outcome of combat casualties with PS injury, strategies must be developed to mitigate hemorrhage and optimize airway management or reduce the time interval between the battlefield point of injury and surgical intervention.
Abstract: BACKGROUND: Critical evaluation of all aspects of combat casualty care, including mortality, with a special focus on the incidence and causes of potentially preventable deaths among US combat fatalities, is central to identifying gaps in knowledge, training, equipment, and execution of battlefield trauma care. The impetus to produce this analysis was to develop a comprehensive perspective of battlefield death, concentrating on deaths that occurred in the preYmedical treatment facility (pre-MTF) environment. METHODS: The Armed Forces Medical Examiner Service Mortality Surveillance Division was used to identify Operation Iraqi Freedom and Operation Enduring Freedom combat casualties from October 2001 to June 2011 who died from injury in the deployed environment. The autopsy records, perimortem records, photographs on file, and Mortality Trauma Registry of the Armed Forces Medical Examiner Service were used to compile mechanism of injury, cause of injury, medical intervention performed, Abbreviated Injury Scale (AIS) score, and Injury Severity Score (ISS) on all lethal injuries. All data were used by the expert panel for the conduct of the potential for injury survivability assessment of this study. RESULTS: For the study interval between October 2001 and June 2011, 4,596 battlefield fatalities were reviewed and analyzed. The stratification of mortality demonstrated that 87.3% of all injury mortality occurred in the pre-MTF environment. Of the pre-MTF deaths, 75.7% (n = 3,040) were classified as nonsurvivable, and 24.3% (n = 976) were deemed potentially survivable (PS). The injury/physiologic focus of PS acute mortality was largely associated with hemorrhage (90.9%). The site of lethal hemorrhage was truncal (67.3%), followed by junctional (19.2%) and peripheral-extremity (13.5%) hemorrhage. CONCLUSION: Most battlefield casualties died of their injuries before ever reaching a surgeon. As most pre-MTF deaths are nonsurvivable, mitigation strategies to impact outcomes in this population need to be directed toward injury prevention. To significantly impact the outcome of combat casualties with PS injury, strategies must be developed to mitigate hemorrhage and optimize airway management or reduce the time interval between the battlefield point of injury and surgical intervention. Understanding battlefield mortality is a vital component of the military trauma system. Emphasis on this analysis should be placed on trauma system optimization, evidence-based improvements in Tactical Combat Casualty Care guidelines, data-driven research, and development to remediate gaps in care and relevant training and equipment enhancements that will increase the survivability of the fighting force. (J Trauma Acute Care Surg. 2012;73: S431YS437. Copyright * 2012 by Lippincott Williams & Wilkins)
1,411 citations
TL;DR: The use of TXA with blood component-based resuscitation following combat injury results in improved measures of coagulopathy and survival, a benefit that is most prominent in patients requiring massive transfusion.
Abstract: Objectives To characterize contemporary use of tranexamic acid (TXA) in combat injury and to assess the effect of its administration on total blood product use, thromboembolic complications, and mortality. Design Retrospective observational study comparing TXA administration with no TXA in patients receiving at least 1 unit of packed red blood cells. A subgroup of patients receiving massive transfusion (≥10 units of packed red blood cells) was also examined. Univariate and multivariate regression analyses were used to identify parameters associated with survival. Kaplan-Meier life tables were used to report survival. Setting A Role 3 Echelon surgical hospital in southern Afghanistan. Patients A total of 896 consecutive admissions with combat injury, of which 293 received TXA, were identified from prospectively collected UK and US trauma registries. Main Outcome Measures Mortality at 24 hours, 48 hours, and 30 days as well as the influence of TXA administration on postoperative coagulopathy and the rate of thromboembolic complications. Results The TXA group had lower unadjusted mortality than the no-TXA group (17.4% vs 23.9%, respectively; P = .03) despite being more severely injured (mean [SD] Injury Severity Score, 25.2 [16.6] vs 22.5 [18.5], respectively; P Conclusions The use of TXA with blood component–based resuscitation following combat injury results in improved measures of coagulopathy and survival, a benefit that is most prominent in patients requiring massive transfusion. Treatment with TXA should be implemented into clinical practice as part of a resuscitation strategy following severe wartime injury and hemorrhage.
652 citations
TL;DR: In this paper, the authors quantified ecosystem-service values to help the largest private landowner in Hawaii, Kamehameha Schools, design a land-use development plan that balances multiple private and public values on its North Shore land holdings (Island of O'ahu) of ∼10,600 ha.
Abstract: Recent high-profile efforts have called for integrating ecosystem-service values into important societal decisions, but there are few demonstrations of this approach in practice. We quantified ecosystem-service values to help the largest private landowner in Hawaii, Kamehameha Schools, design a land-use development plan that balances multiple private and public values on its North Shore land holdings (Island of O’ahu) of ∼10,600 ha. We used the InVEST software tool to evaluate the environmental and financial implications of seven planning scenarios encompassing contrasting land-use combinations including biofuel feedstocks, food crops, forestry, livestock, and residential development. All scenarios had positive financial return relative to the status quo of negative return. However, tradeoffs existed between carbon storage and water quality as well as between environmental improvement and financial return. Based on this analysis and community input, Kamehameha Schools is implementing a plan to support diversified agriculture and forestry. This plan generates a positive financial return ($10.9 million) and improved carbon storage (0.5% increase relative to status quo) with negative relative effects on water quality (15.4% increase in potential nitrogen export relative to status quo). The effects on water quality could be mitigated partially (reduced to a 4.9% increase in potential nitrogen export) by establishing vegetation buffers on agricultural fields. This plan contributes to policy goals for climate change mitigation, food security, and diversifying rural economic opportunities. More broadly, our approach illustrates how information can help guide local land-use decisions that involve tradeoffs between private and public interests.
578 citations
Posted Content•
TL;DR: In this article, the authors review the literature on financial literacy, financial education, and consumer financial outcomes, and examine how well the existing literature addresses whether financial education improves financial literacy or personal financial outcomes.
Abstract: In this article we review the literature on financial literacy, financial education, and consumer financial outcomes. We consider how financial literacy is measured in the current literature, and examine how well the existing literature addresses whether financial education improves financial literacy or personal financial outcomes. We discuss the extent to which a competitive market provides incentives for firms to educate consumers or offer products that facilitate informed choice. We review the literature on alternative policies to improve financial outcomes, and compare the evidence to evidence on the efficacy and cost of financial education. Finally, we discuss directions for future research.
556 citations
TL;DR: In this paper, a multispectral expert system used a neural network approach to provide Rapid Response thickness class maps using a spectral library approach based on the shape and depth of near infrared spectral absorption features.
432 citations
TL;DR: This paper conducted a meta-analysis of generational differences on three work-related criteria: job satisfaction, organizational commitment, and intent to turnover, and found that meaningful differences among generations probably do not exist on the workrelated variables and that the differences that appear to exist are likely attributable to factors other than generational membership.
Abstract: Differences among generations on a wide variety of outcomes are of increasing interest to organizations, practitioners, and researchers alike. The goal of this study was to quantitatively assess the research on generational differences in work-related attitudes and to provide guidance for future research and practice. We conducted a meta-analysis of generational differences on three work-related criteria: job satisfaction, organizational commitment, and intent to turnover. Our review of published and unpublished research found 20 studies allowing for 18 generational pairwise comparisons across four generations (Traditionals, Baby Boomers, Generation Xers, and Millennials) on these outcomes using 19,961 total subjects. Corrected mean differences for job satisfaction ranged from .02 to .25, for organizational commitment they ranged from −.22 to .46, and for intent to turnover the range was −.62 to .05. The pattern of results indicates that the relationships between generational membership and work-related outcomes are moderate to small, essentially zero in many cases. The findings suggest that meaningful differences among generations probably do not exist on the work-related variables we examined and that the differences that appear to exist are likely attributable to factors other than generational membership. Given these results, targeted organizational interventions addressing generational differences may not be effective. This is the first known quantitative review of research on generational differences in the workplace.
421 citations
TL;DR: A cooperative policy iteration algorithm is given for graphical games that converges to the best response when the neighbors of each agent do not update their policies, and to the cooperative Nash equilibrium when all agentsupdate their policies simultaneously.
400 citations
TL;DR: These findings support a model in which GP cleavage by endosomal cysteine proteases unmasks the binding site for NPC1, and GP–NPC1 engagement within lysosomes promotes a late step in entry proximal to viral escape into the host cytoplasm.
Abstract: Ebola and Marburg filoviruses cause deadly outbreaks of haemorrhagic fever. Despite considerable efforts, no essential cellular receptors for filovirus entry have been identified. We showed previously that Niemann-Pick C1 (NPC1), a lysosomal cholesterol transporter, is required for filovirus entry. Here, we demonstrate that NPC1 is a critical filovirus receptor. Human NPC1 fulfills a cardinal property of viral receptors: it confers susceptibility to filovirus infection when expressed in non-permissive reptilian cells. The second luminal domain of NPC1 binds directly and specifically to the viral glycoprotein, GP, and a synthetic single-pass membrane protein containing this domain has viral receptor activity. Purified NPC1 binds only to a cleaved form of GP that is generated within cells during entry, and only viruses containing cleaved GP can utilize a receptor retargeted to the cell surface. Our findings support a model in which GP cleavage by endosomal cysteine proteases unmasks the binding site for NPC1, and GP–NPC1 engagement within lysosomes promotes a late step in entry proximal to viral escape into the host cytoplasm. NPC1 is the first known viral receptor that recognizes its ligand within an intracellular compartment and not at the plasma membrane.
302 citations
TL;DR: Among novice raters, the FMS composite score demonstrated moderate to good interrater and intrarater reliability, with acceptable levels of measurement error.
Abstract: Study Design Reliability study. Objectives To determine intrarater test-retest and interrater reliability of the Functional Movement Screen (FMS) among novice raters. Background The FMS is used by various examiners to assess movement and predict time-loss injuries in diverse populations (eg, youth to professional athletes, firefighters, military service members) of active participants. Unfortunately, critical analysis of the reliability of the FMS is currently limited to 1 sample of active college-age participants. Methods Sixty-four active-duty service members (mean ± SD age, 25.2 ± 3.8 years; body mass index, 25.1 ± 3.1 kg/m2) without a history of injury were enrolled. Participants completed the 7 component tests of the FMS in a counterbalanced order. Each component test was scored on an ordinal scale (0 to 3 points), resulting in a composite score ranging from 0 to 21 points. Intrarater test-retest reliability was assessed between baseline scores and those obtained with repeated testing performed 48 to...
TL;DR: Four major categories of scaffold hopping are classified, namely heterocycle replacements, ring opening or closure, peptidomimetics and topology-based hopping, which are used by medicinal chemists to discover equipotent compounds with novel backbones that have improved properties.
TL;DR: It is demonstrated that postexposure antibody treatments can protect NHPs and open avenues for filovirus therapies for human use using established Food and Drug Administration-approved polyclonal or monoclonal antibody technologies.
Abstract: Antibody therapies to prevent or limit filovirus infections have received modest interest in recent years, in part because of early negative experimental evidence. We have overcome the limitations of this approach, leveraging the use of antibody from nonhuman primates (NHPs) that survived challenge to filoviruses under controlled conditions. By using concentrated, polyclonal IgG antibody from these survivors, we treated filovirus-infected NHPs with multiple doses administered over the clinical phase of disease. In the first study, Marburg virus (MARV)-infected NHPs were treated 15 to 30 min postexposure with virus-specific IgG, with additional treatments on days 4 and 8 postexposure. The postexposure IgG treatment was completely protective, with no signs of disease or detectable viremia. MARV-specific IgM antibody responses were generated, and all macaques survived rechallenge with MARV, suggesting that they generated an immune response to virus replication. In the next set of studies, NHPs were infected with MARV or Ebola virus (EBOV), and treatments were delayed 48 h, with additional treatments on days 4 and 8 postexposure. The delayed treatments protected both MARV- and EBOV-challenged NHPs. In both studies, two of the three IgG-treated NHPs had no clinical signs of illness, with the third NHP developing mild and delayed signs of disease followed by full recovery. These studies clearly demonstrate that postexposure antibody treatments can protect NHPs and open avenues for filovirus therapies for human use using established Food and Drug Administration-approved polyclonal or monoclonal antibody technologies.
TL;DR: It is suggested that appropriate selection of biochar oxidant will produce recalcitrant biochars rich in carboxyl functional groups for a long-term heavy metal stabilization strategy in contaminated soils.
Abstract: Long-term effectiveness of biochar for heavy metal stabilization depends upon biochar's sorptive property and recalcitrance in soil. To understand the role of carboxyl functional groups on heavy metal stabilization, cottonseed hull biochar and flax shive steam-activated biochar having a low O/C ratio (0.04-0.06) and high fixed carbon content (~80% dry weight basis) were oxidized using concentrated H(2)SO(4)/HNO(3) and 30% HNO(3). Oxidized and unoxidized biochars were characterized for O/C ratio, total acidity, pH, moisture, ash, volatile matter, and fixed carbon contents, Brunauer-Emmett-Teller surface area, and attenuated total reflectance Fourier transform infrared spectral features. Characterized biochars were amended (2%, 5%, 10%, and 20% in grams of biochar per gram of soil) on a sandy, slightly acidic (pH 6.27) heavy metal contaminated small arms range soil fraction (<250 μm) having low total organic carbon (0.518%) and low cation exchange capacity (0.95 cmol(c) kg(-1)). Oxidized biochars rich in carboxyl functional groups exhibited significantly greater Pb, Cu, and Zn stabilization ability compared to unoxidized biochars, especially in pH 4.9 acetate buffer (standard solution for the toxicity characteristic leaching procedure). Oppositely, only oxidized biochars caused desorption of Sb, indicating a counteracting impact of carboxyl functional groups on the solubility of anions and cations. The results suggested that appropriate selection of biochar oxidant will produce recalcitrant biochars rich in carboxyl functional groups for a long-term heavy metal stabilization strategy in contaminated soils.
TL;DR: The graphene electrode was found to be stable under mechanical flexing and behave as a negative temperature coefficient (NTC) material, exhibiting rapid electrical resistance decrease with temperature increase, which suggests the potential use of the inkjet-printed graphene electrode as a writable, very thin, mechanically flexible, and transparent temperature sensor.
Abstract: Graphene electrode was fabricated by inkjet printing, as a new means of directly writing and micropatterning the electrode onto flexible polymeric materials. Graphene oxide sheets were dispersed in water and subsequently reduced using an infrared heat lamp at a temperature of ~200 °C in 10 min. Spacing between adjacent ink droplets and the number of printing layers were used to tailor the electrode's electrical sheet resistance as low as 0.3 MΩ/□ and optical transparency as high as 86%. The graphene electrode was found to be stable under mechanical flexing and behave as a negative temperature coefficient (NTC) material, exhibiting rapid electrical resistance decrease with temperature increase. Temperature sensitivity of the graphene electrode was similar to that of conventional NTC materials, but with faster response time by an order of magnitude. This finding suggests the potential use of the inkjet-printed graphene electrode as a writable, very thin, mechanically flexible, and transparent temperature sensor.
TL;DR: The most common mTBI-induced visual dysfunctions were associated with near oculomotor deficits, particularly large exophoria, decreased fusion ranges, receded near point of convergence, defective pursuit and saccadic eye movements, decreased amplitude of accommodation, and monocular accommodative facility.
Abstract: The purpose of the present study was to assess the occurrence of visual dysfunctions and associated symptoms in active duty warfighters during the subacute stage of blast-induced mild traumatic brain injury (mTBI). A comprehensive visual and oculomotor function evaluation was performed on 40 U.S. military personnel, 20 with blast-induced mTBI and 20 without. In addition, a comprehensive symptom questionnaire was used to assess the frequency of visual, vestibular, and neuropsychiatric-associated symptoms. The most common mTBI-induced visual dysfunctions were associated with near oculomotor deficits, particularly large exophoria, decreased fusion ranges, receded near point of convergence, defective pursuit and saccadic eye movements, decreased amplitude of accommodation, and monocular accommodative facility. These were associated with reduced reading speed and comprehension and an increased Convergence Insufficiency Symptom Survey score. Photosensitivity was a common visual dysfunction along with he...
05 May 2012
TL;DR: The results show that without email, people multitasked less and had a longer task focus, as measured by a lower frequency of shifting between windows and a longer duration of time spent working in each computer window.
Abstract: We report on an empirical study where we cut off email usage for five workdays for 13 information workers in an organization. We employed both quantitative measures such as computer log data and ethnographic methods to compare a baseline condition (normal email usage) with our experimental manipulation (email cutoff). Our results show that without email, people multitasked less and had a longer task focus, as measured by a lower frequency of shifting between windows and a longer duration of time spent working in each computer window. Further, we directly measured stress using wearable heart rate monitors and found that stress, as measured by heart rate variability, was lower without email. Interview data were consistent with our quantitative measures, as participants reported being able to focus more on their tasks. We discuss the implications for managing email better in organizations.
TL;DR: A generalized approach to design (determine the capacity requirements) is proposed and the management of microgrids with metrics to meet the power quality indexes is demonstrated.
Abstract: Microgrids are receiving attention due to the increasing need to integrate distributed generations and to insure power quality and to provide energy surety to critical loads. Since renewables need to be in the mix for energy surety, a high renewable-energy penetrated microgrid is analyzed in this paper. The standard IEEE 34 bus distribution feeder is adapted and managed as a microgrid by adding distributed generation and load profiles. The 25 kV system parameters are scaled down to 12 kV and renewable sources including solar PV and wind turbines, an energy storage system, and a diesel generator for islanded mode have been added to the 34-bus system. The distribution generations (DG) and renewables are modeled in detail using PSCAD software and practical constraints of the components are considered. The monitoring of the microgrid for measuring power quality and control requirements for these DGs and storage are modeled to maintain the power quality of the system when loads are varied. Renewable sources are modeled with seasonal variation at different locations. The microgrid is monitored at number of buses and the power quality issues are measured and indexes are calculated. This paper proposes a generalized approach to design (determine the capacity requirements) and demonstrates the management of microgrids with metrics to meet the power quality indexes.
TL;DR: In this article, a strong correlation was found between ORR products and the ionic charge density, including those of ionic liquids, and the observed trend was explained in terms of the Lewis acidity of the cation present in the electrolyte using an acidity scale created from 13C NMR chemical shifts and spin-lattice relaxation (T1) times of 13C═O in solutions of these charged ions in propylene carbonate (PC).
Abstract: Oxygen reduction and evolution reactions (ORRs and OERs) have been studied in ionic liquids containing singly charged cations having a range of ionic radii, or charge densities. Specifically, ORR and OER mechanisms were studied using cyclic and rotating disk electrode voltammetry in the neat ionic liquids (ILs), 1-ethyl-3-methylimidazolium bis(trifluoromethylsulfonyl)imide (EMITFSI) and 1-methyl-1-butyl-pyrrolidinium bis(triflouromethanesulfonyl)imide (PYR14TFSI), and in their solutions containing LiTFSI, NaPF6, KPF6, and tetrabutylammonium hexafluorophosphate (TBAPF6). A strong correlation was found between the ORR products and the ionic charge density, including those of the ionic liquids. The observed trend is explained in terms of the Lewis acidity of the cation present in the electrolyte using an acidity scale created from 13C NMR chemical shifts and spin–lattice relaxation (T1) times of 13C═O in solutions of these charged ions in propylene carbonate (PC). The ionic liquids lie in a continuum of a ca...
TL;DR: Most of the respondents are using full-strength sodium hypochlorite and are routinely removing the smear layer during endodontic treatment and almost half are using an adjunct, such as ultrasonic activation, to aid in their irrigation technique.
TL;DR: In three studies, eye movements of participants were recorded while they viewed a single-slide multimedia presentation about how car brakes work and the integrated groups significantly outperformed the separated groups on transfer test score.
Abstract: In three studies, eye movements of participants were recorded while they viewed a single-slide multimedia presentation about how car brakes work. Some of the participants saw an integrated presentation in which each segment of words was presented near its corresponding area of the diagram (integrated group, Experiments 1 and 3) or an integrated presentation that also included additional labels identifying each part (integrated-with-labels group, Experiment 2), whereas others saw a separated presentation in which the words were presented as a paragraph below the diagrams (separated group, Experiments 1 and 2) or as a legend below the diagrams (legend group, Experiment 3). On measures of cognitive processing during learning, the integrated groups made significantly more eye-movements from text to diagram and vice versa (integrative transitions; d = 1.65 in Experiment 1, d = 0.85 in Experiment 2, and d = 1.44 in Experiment 3) and significantly more eye-movements from the text to the corresponding part of the diagram (corresponding transitions; d = 2.02 in Experiment 1 and d = 1.35 in Experiment 3) than the separated groups. On measures of learning outcome the integrated groups significantly outperformed the separated groups on transfer test score in Experiment 1(d = .80) and Experiment 2 (d = .73) but not in Experiment 3 (d = .35). Spatial contiguity encourages more attempts to integrate words and pictures and enables more successful integration of words and pictures during learning, which can result in meaningful learning outcomes.
United States Department of the Army1, Walter Reed Army Institute of Research2, New York University3, Veterans Health Administration4, National Institutes of Health5, Duke University6, Fred Hutchinson Cancer Research Center7, Thailand Ministry of Public Health8, Mahidol University9, Sanofi Pasteur10, Los Alamos National Laboratory11
TL;DR: Early HIV-1 transmission events involve V2 loop interactions, raising the possibility that anti-V2 antibodies in RV144 may have contributed to viral inhibition.
Abstract: The Thai Phase III clinical trial (RV144) showed modest efficacy in preventing HIV-1 acquisition. Plasma collected from HIV-1-uninfected trial participants completing all injections with ALVAC-HIV (vCP1521) prime and AIDSVAX B/E boost were tested for antibody responses against HIV-1 gp120 envelope (Env). Peptide microarray analysis from six HIV-1 subtypes and group M consensus showed that vaccination induced antibody responses to the second variable (V2) loop of gp120 of multiple subtypes. We further evaluated V2 responses by ELISA and surface plasmon resonance using cyclic (Cyc) and linear V2 loop peptides. Thirty-one of 32 vaccine recipients tested (97%) had antibody responses against Cyc V2 at 2 weeks postimmunization with a reciprocal geometric mean titer (GMT) of 1100 (range: 200–3200). The frequency of detecting plasma V2 antibodies declined to 19% at 28 weeks post-last injection (GMT: 110, range: 100–200). Antibody responses targeted the mid-region of the V2 loop that contains conserved ep...
TL;DR: This article examined emotional responses to foods and food concepts (names) and found that emotional responses varied by foods/food names and included many different emotions, including many positive dimensions and only one negative dimension.
TL;DR: In this article, the authors performed a post-hoc analysis of the trial's data to investigate behavioural risk and efficacy every 6 months after vaccination, and found that the vaccine efficacy seemed to peak early and declined quickly.
Abstract: Summary Background The Thai phase 3 HIV vaccine trial RV 144 showed modest efficacy of a vaccine against HIV acquisition. Baseline variables of age, sex, marital status, and risk did not modify vaccine efficacy. We did a post-hoc analysis of the trial's data to investigate behavioural risk and efficacy every 6 months after vaccination. Methods RV 144 was a randomised, multicentre, double-blind, placebo-controlled efficacy trial testing the combination of the HIV vaccines ALVAC-HIV (vCP1521) and AIDSVAX B/E to prevent HIV infection or reduce setpoint viral load. Male and female volunteers aged 18–30 years were recruited from the community. In this post-hoc analysis of the modified intention-to-treat population (16 395 participants), HIV risk behaviour was assessed with a self-administered questionnaire at the time of initial vaccination in the trial and every 6 months thereafter for 3 years. We classified participants' behaviour as low, medium, or high risk. Both the acquisition endpoint and the early viral-load endpoint were examined for interactions with risk status over time and temporal effects after vaccination. Multiple proportional hazards regression models with treatment and time-varying risk covariates were analysed. Findings Risk of acquisition of HIV was low in each risk group, but 9187 (58·2%) participants reported higher-risk behaviour at least once during the study. Participants classified as high or increasing risk at least once during follow-up were compared with those who maintained low-risk or medium-risk behaviour as a time-varying covariate, and the interaction of risk status and acquisition efficacy was significant (p=0·01), with greater benefit in low-risk individuals. Vaccine efficacy seemed to peak early—cumulative vaccine efficacy was estimated to be 60·5% (95% CI 22–80) through the 12 months after initial vaccination—and declined quickly. Vaccination did not seem to affect viral load in either early or late infections. Interpretation Future HIV vaccine trials should recognise potential interactions between challenge intensity and risk heterogeneity in both population and treatment effects. The regimen tested in the RV 144 phase 3 trial might benefit from extended immunisation schedules. Funding US Army Medical Research and Materiel Command and Division of AIDS, National Institute of Allergy and Infectious Disease, National Institutes of Health.
TL;DR: In this article, a recent theoretical proposal is that relational identification generalizes to organizational identification through affective, cognitive, and behavioral mediating mechanisms, and the generalization can be seen as a generalization of relational identification.
Abstract: A recent theoretical proposal is that relational identification generalizes to organizational identification through affective, cognitive, and behavioral mediating mechanisms. The generalization pr...
TL;DR: These findings indicate that, when properly implemented, these methods effectively decontaminate H5N1 on the two FFR models tested and do not drastically affect their filtering function; however, other considerations may influence decisions to reuse FFRs.
Abstract: Filtering facepiece respirators (FFRs) are recommended for use as precautions against airborne pathogenic microorganisms; however, during pandemics demand for FFRs may far exceed availability. Reuse of FFRs following decontamination has been proposed but few reported studies have addressed the feasibility. Concerns regarding biocidal efficacy, respirator performance post decontamination, decontamination cost, and user safety have impeded adoption of reuse measures. This study examined the effectiveness of three energetic decontamination methods [ultraviolet germicidal irradiation (UVGI), microwave-generated steam, and moist heat] on two National Institute for Occupational Safety and Health-certified N95 FFRs (3M models 1860s and 1870) contaminated with H5N1. An aerosol settling chamber was used to apply virus-laden droplets to FFRs in a method designed to simulate respiratory deposition of droplets onto surfaces. When FFRs were examined post decontamination by viral culture, all three decontamination methods were effective, reducing virus load by > 4 log median tissue culture infective dose. Analysis of treated FFRs using a quantitative molecular amplification assay (quantitative real-time polymerase chain reaction) indicated that UVGI decontamination resulted in lower levels of detectable viral RNA than the other two methods. Filter performance was evaluated before and after decontamination using a 1% NaCl aerosol. As all FFRs displayed <5% penetration by 300-nm particles, no profound reduction in filtration performance was caused in the FFRs tested by exposure to virus and subsequent decontamination by the methods used. These findings indicate that, when properly implemented, these methods effectively decontaminate H5N1 on the two FFR models tested and do not drastically affect their filtering function; however, other considerations may influence decisions to reuse FFRs.
TL;DR: A 10-year evaluation of the Joint Theater Trauma Registry database reports the military’s experience with resuscitation and coagulopathy, evaluates the effect of increased plasma and platelet (PLT)–to-red blood cell ratios, and analyzes other recent changes in practice.
Abstract: : BACKGROUND: The Joint Theater Trauma Registry database, begun early in Operation Iraqi Freedom and Operation Enduring Freedom, created a comprehensive repository of information that facilitated research efforts and produced rapid changes in clinical care. New clinical practice guidelines were adopted throughout the last decade. The damage-control resuscitation clinical practice guideline sought to provide high-quality blood products in support of tissue perfusion and hemostasis. The goal was to reduce death from hemorrhagic shock in patients with severe traumatic bleeding. This 10-year review of the Joint Theater Trauma Registry database reports the military s experience with resuscitation and coagulopathy, evaluates the effect of increased plasma and platelet (PLT) to red blood cell ratios, and analyzes other recent changes in practice. METHODS: Records of US active duty service members at least 18 years of age who were admitted to a military hospital from March 2003 to February 2012 were entered into a database. Those who received at least one blood product (n 3,632) were included in the analysis. Data were analyzed with respect to interactions within and between categories (demographics, admission characteristics, hospital course, and outcome). Transfusions were analyzed with respect to time, survival, and effect of increasing transfusion ratios. RESULTS: Coagulopathy was prevalent upon presentation (33% with international normalized ratio Q 1.5), correlated with increased mortality (fivefold higher), and was associated with the need for massive transfusion. High transfusion ratios of fresh frozen plasma and PLT to red blood cellswere correlated with higher survival but not decreased blood requirement. Survivalwas most correlated with PLT ratio, but high fresh frozen plasma ratio had an additive effect (PLT odds ratio, 0.22).
TL;DR: The number of amputations occurring during the current Iraqi and Afghanistan conflicts has increased in 2010 and the first half of 2011, and there is a much higher percentage of amputees who have sustained multiple amputations during current operations than previous conflicts.
Abstract: BACKGROUND: While multiple studies have examined amputations that have occurred during the current conflicts in Iraq and Afghanistan, none of these studies have provided an overarching characterization of all of these injuries. METHODS: A retrospective study of all major extremity amputations sustained by US Service Members from January 2001 through July 30, 2011, was performed. Data obtained from these amputees included amputation level(s), mechanism of injury, time to amputation, Injury Severity Score (ISS), age, rank, number of trauma admissions, and number of troops deployed. RESULTS: There were 1,221 amputees who met inclusion criteria. These amputees sustained a total of 1,631 amputations. The number of amputations performed each year has increased dramatically in 2010 (196) and the first half of 2011 (160) from 2008 (105) and 2009 (94). The number of amputations performed per every 100 traumatic admissions (3.5-14) and the number of amputations per 100,000 deployed troops (2-14) has also increased in 2010 and the first half of 2011. Most amputations occurred at the transtibial (683, 41.8%) and transfemoral (564, 34.5%) levels. Thirty percent of the amputees (366) sustained multiple amputations, and 14% of all amputations (228) performed involved the upper extremity. There were 127 amputees (10%) who underwent their amputation more than 90 days after the date of injury. CONCLUSION: The number of amputations occurring during the current Iraqi and Afghanistan conflicts has increased in 2010 and the first half of 2011. Most amputations involve the lower extremities, and there is a much higher percentage of amputees who have sustained multiple amputations during current operations than previous conflicts. LEVEL OF EVIDENCE: Epidemiologic study, level IV. Language: en
TL;DR: A brief overview of condition based maintenance (CBM) with definitions of various terms, overview of some history, recent developments, applications, and research challenges in the CBM domain is provided in this paper.
Abstract: Purpose – The purpose of this paper is to provide a brief overview of condition based maintenance (CBM) with definitions of various terms, overview of some history, recent developments, applications, and research challenges in the CBM domain.Design/methodology/approach – The article presents the insight into various maintenance strategies and provides their respective merits and demerits in various aspects. It then provides the detailed discussion of CBM that includes applications of various methodologies and technologies that are being implemented in the field. Finally, it ends with open challenges in implementing condition based maintenance systems.Findings – This paper surveys research articles and describes how CBM can be used to optimize maintenance strategies and increase the feasibility and practicality of a CBM system.Practical implications – CBM systems are completely practical to implement and applicable to various domains including automotive, manufacturing, aviation, medical, etc. This paper p...
TL;DR: Fluid needs predicted for running 5-42 km at recreational paces show that fluid losses are <2% body mass; thus, aggressive fluid replacement may not be necessary, and spot measures of urine color or urine-specific gravity to assess hydration status have limitations.
Abstract: This review presents recommendations for fluid needs and hydration assessment for recreational activity. Fluid needs are based on sweat losses, dependent on intensity and duration of the activity, and will vary among individuals. Prolonged aerobic activity is adversely influenced by dehydration, and heat exposure will magnify this effect. Fluid needs predicted for running 5-42 km at recreational paces show that fluid losses are <2% body mass; thus, aggressive fluid replacement may not be necessary. Competitive paces result in greater fluid losses and greater fluid needs. Fluid needs for recreational activity may be low; however, carbohydrate consumption (sport drinks, gels, bars) can benefit high-intensity (≤ 1 h) and less-intense, long-duration activity (≥ 1 h). Spot measures of urine color or urine-specific gravity to assess hydration status have limitations. First morning urine concentration and body mass with gross thirst perception can be simple ways to assess hydration status.