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Handbook of Thermal Conductivity
Number of Followers: 6  Subscription journalISSN (Print) 1874-8783 Published by Elsevier  [2974 journals]
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- 1 No NEWS is good NEWS - a machine learning approach to improve
physiological early warning scoring-
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Authors: Pang; A.
Pages: e1 - e1
Abstract: BackgroundCurrent Early Warning Scoring (EWS) systems in clinical practice are threshold rules-based systems using physiological data to highlight patients at risk of impending in-hospital death.Examples include the National Early Warning Score (NEWS2) and the Electronic Cardiac Arrest Triage (eCART) score, the standards of care within the UK and the USA, respectively.The current EWS modelling framework has two limitations. Firstly, they consider risk at a single time point and, therefore, cannot consider trajectories. Secondly, they negate relational information between covariates by decomposing physiological signals into a single value.We propose using Long Short-Term Memory (LSTM) units, a Machine Learning (ML) technique that uses time-series modelling and neural networks to address these limitations and better utilise the available information.MethodsWe extracted the sequences of vital signs, NEWS2, and eCART values within a 72-hour observation window from MIMIC-IV, a dataset containing anonymised electronic healthcare records. We masked the last 24 hours for each sequence and trained multiple ML models to identify patients at risk of death. We compare the models’ discriminative ability using the metrics, recall, F1-score, AUROC and AUPRC and conducted 10-fold stratified cross-validation.ResultsThe LSTM model has statistically significant performance advantages in F1-score ( 0.3391 ±0.0093), AUROC ( 0.7399 ±0.0119), and AUPRC ( 0.337 ±0.0212). The clinical benefit of such a model allows clinicians to correctly identify more at-risk patients without increasing the false alarm rate.We hypothesise that this ML pipeline can be used to predict other clinical outcomes of interest, such as a requirement for escalation of care/additional organ support, which is the focus of future work.ConclusionsOur results demonstrate that the ML time-series framework can utilise trajectory information to give further context and significantly improve the prediction of impending death. We propose any future EWS systems should incorporate physiological time-series.
PubDate: 2025-01-28T01:35:13-08:00
DOI: 10.1136/bmjmilitary-2024-RSMabstracts.1
Issue No: Vol. 171, No. 1 (2025)
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- 2 The effects of multidisciplinary team (MDT) residential rehabilitation
versus outpatient physiotherapy for the management of non-arthritic hip
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Authors: Coppack, R; Cassidy, R, Bilzon, J, Houston, A, Papadopoulou, T, Bennett, A.
Pages: e1 - e1
Abstract: BackgroundDespite the acceptance of residential MDT rehabilitation in the UK military, there is no evidence supporting its use in the management of non-arthritic hip pain (NAHP). This study compared the effects of a residential MDT care programme with physiotherapy led outpatient treatment on the clinical outcomes in UK military personnel with NAHP.MethodsThis was a single-blind, parallel group RCT. UK military personnel (N=87, 11 female), mean age 31 yrs (SD 7.1) were randomly allocated to receive: (1) a 7-day MDT residential rehabilitation course or, (2) conventional physiotherapy led outpatient care. The primary outcomes were pain (visual analogue scale, VAS 0-100mm) and physical function (Hip and Groin Outcome Score [HAGOS] activities in daily living [ADL] score). Secondary outcomes included hip muscle strength, hip range of motion, and walking ability (six-minute walk test [6MWT]). All outcome scores were taken at baseline (T1), after treatment (T2) and at 3-months (T3).ResultsThere were no significant between-group differences for VAS pain scores after treatment (T2) -3.05 (95%CI, -13.9 to 7.8, P=0.4), or at 3-months (T3), 4.5 (95% CI, -6.1 to 15.1, P=0.4). The mean reduction in pain from T1 to T3 for the residential group was 10.1 mm which reached the minimal clinically important difference (MCID) threshold of 10 mm. The mean (SD) HAGOS ADL scores improved from 68.7 (19.7) to 72.6 (23.0) in the residential group and 67.9 (21.9) to 74.4 (22.6) in the physiotherapy group. There were significant between-group differences for secondary outcomes after treatment (T2) in favour of outpatient physiotherapy that were not maintained at T3.ConclusionsThis is the first global RCT to compare residential rehabilitation with outpatient care in adults with NAHP. There were no significant between group differences at 3-months for any self-report or physical test scores. Outpatient physiotherapy showed superior muscle strength, HAGOS and 6MWT outcomes after treatment. Both residential and outpatient treatment resulted in improved function and pain outcomes and can be recommended in the UK military rehabilitation setting.
PubDate: 2025-01-28T01:35:13-08:00
DOI: 10.1136/bmjmilitary-2024-RSMabstracts.2
Issue No: Vol. 171, No. 1 (2025)
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- 3 Retrospective cohort study of all cause gastrointestinal illness in camp
Qargha, Afghanistan in August 2020-
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Authors: Riley, M; Makin, S, Greig, O, Taylor, H.
Pages: e1 - e1
Abstract: IntroductionCamp Qargha (QAA), a British led NATO base in Kabul, had a history of gastrointestinal outbreaks. August 2020 saw an outbreak identified. Controlling outbreaks and understanding their causes is vital for preserving operational effectiveness. We describe the outbreak and use a retrospective cohort study to test the hypothesis that two-person-rooms are a potential risk factor.MethodData collected for clinical and outbreak management was described. Organisms were detected using BioFire® Film Array® Gastrointestinal Panel. Using Stata v.17, we conducted univariate and multivariable binomial logistic regression (MVA) for all GI illness and for specific pathogens detected to estimate adjusted risk ratios (aRRs) with 95% confidence Intervals (CI).Results36 presentations of gastrointestinal illness in 33 service-personnel during a 24-day outbreak saw 132 working days lost. Diarrhoeagenic e. coli, cryptosporidium, norovirus, and shigella were identified as potential causative organisms, with symptomatic duration, isolation and impact on operational effectiveness greatest in those with shigella or cryptosporidium. On MVA we did not find being in a two person room to be a risk factor (aRR 1.5; 95%CI 0.7-3.2). We did find risk of any GI illness increased 1.7 (95%CI; 0.9-3.0) times, and 1.2 (95%CI 1.0-1.4) times for being part of operational team 1 or living adjacent to another case respectively. Being part of operational team 1 was also a risk factor for enteropathogenic and enterotoxigenic E.coli infection.ConclusionTwo-person rooms weren’t a significant risk factor for gastrointestinal outbreaks. This is an important negative finding to inform the balance of outbreak control and operational wellbeing where social isolation can be detrimental. Targeted behavioural control measure education should be considered for identified at risk groups in the future. In terms of operational impact, cryptosporidium was the most significant cause of days lost. Further research by military enteric diseases specialists into cryptosporidium illness and spread in deployed settings is recommended.
PubDate: 2025-01-28T01:35:13-08:00
DOI: 10.1136/bmjmilitary-2024-RSMabstracts.3
Issue No: Vol. 171, No. 1 (2025)
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- 4 The impact of different resuscitation fluids on cellular energy
metabolism in traumatic injury and haemorrhagic shock-
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Authors: Cottey, L; Crossland, H, Mallinson, J, Greenhaff, P, Smith, J, Watts, S.
Pages: e1 - e1
Abstract: IntroductionTrauma is a leading cause of death and despite trauma care improvements, survival rates remain unchanged for critically injured patients. Cellular energy stress occurs early following trauma, potentially representing a therapeutic target for prolonged care.We aimed to determine the degree of cellular energy stress in two porcine trauma and haemorrhagic shock (THS) models resuscitated with saline, fresh whole blood (FWB) and fresh frozen plasma (FFP).MethodsTwo studies were conducted under the Animals (Scientific Procedures) Act 1986. THS1 involved soft tissue, liver injury and 30% total blood volume haemorrhage; THS2 as before with ongoing haemorrhage (4ml/kg/hr). Resuscitation took place for 450 minutes followed by terminal anaesthesia. Muscle samples for ATP, phosphocreatine (PCr) and lactate content were taken at baseline (neck); and pre-mortem following resuscitation from neck (NIR), non-injured limb (HNS) and injured limb (HS). Descriptive data are reported as mean±standard deviation. A p-value of ≤0.05 determined significance.ResultsThe studies involved 57 animals (THS1, n=29, weight 50.7±1.0kg; THS2, n=28, weight 53.7±2.3kg). There was increased model severity with reduced survival to 450 minutes in THS2 compared to THS1. In both studies, the saline group had the lowest survival.THS2 demonstrated increased cellular energy stress compared to THS1 across all treatment groups and sites, with increased lactate and reduced PCr. ATP content was lower in THS2 at the HNS, p
PubDate: 2025-01-28T01:35:13-08:00
DOI: 10.1136/bmjmilitary-2024-RSMabstracts.4
Issue No: Vol. 171, No. 1 (2025)
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- 5 Post-infectious sequelae of cryptosporidiosis in a military cohort
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Authors: Hale, I; Toriro, R.
Pages: e1 - e1
Abstract: BackgroundInfectious gastroenteritis is a common medical presentation in deployed military settings. Post-infectious sequelae in military populations are rarely reported. Following a British military cryptosporidiosis outbreak in Kenya in 2022, and subsequent molecular characterisation of faecal samples from consented study participants, we conducted a longitudinal cohort-study investigating health impacts following resolution of acute Cryptosporidium hominis infection.MethodThe study has followed up 40 military personnel at 3-months, 6-months and 12-months post-acute Cryptosporidium hominis infection. Telephone consultations were conducted by a Medical Officer using a bespoke questionnaire to identify gastrointestinal and systemic symptoms which may present post-infection. Clinical consultation was used to exclude other causes of these symptoms. Findings were recorded as consultations in patient medical notes then anonymised and, entered into Microsoft Excel. Follow-up is ongoing, and we plan to calculate confidence intervals for proportions, 95% confidence intervals for risk ratios, chi squared for trend and to examine association between symptoms and case status with logistic regressions.ResultsNew symptoms reported at 3-months included; diarrhoea 9/40 (22.5%), abdominal pain 5/40 (12.5%), nausea 5/40 (12.5%), bloating 5/40 (12.5%), myalgia 4/40 (10%), fatigue 4/40 (10%), joint pain 3/40 (7.5%), and weight loss 2/40 (5%). At the 6-month point, diarrhoeal symptoms persisted in 7/40 (17.5%), abdominal pain persisted in 2/40 (5%) and weight loss was reported in 4/40 (10%). At 12-months one participant reported referral to gastroenterology, diarrhoea was reported in 2/40 (5%) and abdominal pain reported in 3/40 (7.5%).ConclusionsOn-site diagnostic capability in remote settings, and further molecular sequencing enabled identification of a novel C.hominis subtype. Findings demonstrate unexpectedly high rates of post-infectious sequelae, particularly diarrhoea, following acute cryptosporidiosis in healthy military personnel. This post-infectious sequalae, in military personnel, may negatively impact their wellbeing and potentially impact their medical deployability. Patient education on potential health impacts post cryptosporidiosis infection would encourage appropriate health-seeking behaviour.
PubDate: 2025-01-28T01:35:13-08:00
DOI: 10.1136/bmjmilitary-2024-RSMabstracts.5
Issue No: Vol. 171, No. 1 (2025)
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- 6 Preliminary analysis of validated serum osteoarthritis biomarkers in the
ADVANCE cohort suggests a relationship between trauma exposure and
osteoarthritis pathophysiology-
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Authors: OSullivan; O.
Pages: e1 - e1
Abstract: BackgroundOsteoarthritis (OA) is not a degenerative condition of an ageing population, but a multi-faceted, heterogeneous condition, influenced by individual factors with genetic, environmental, and traumatic triggers. OA is a leading cause of disability globally and can occur within 3-5 years after a significant injury, especially in those in their 20’s-30’s. 10% of US Military medical discharges are OA-attributable, which is currently under-recognised and under-reported in the UK Military. This study aims to identify serum biomarkers associated with radiographic OA (rOA), pain and function to enable potential future early diagnosis and intervention for pre-clinical OA.MethodsStored baseline serum samples from the ADVANCE cohort (n=1145) were tested for validated OA biomarkers (Affinity, London), demonstrating extracellular matrix (CTX-II, COMP, PIIANP), inflammation (TNFa, IL1b, IL17a) and metabolic (leptin, adiponectin) processes. Baseline X-rays (Kellgren-Lawrence, K-L, grade), questionnaires and functional tests from the same visit were utilised. Preliminary unadjusted parametric and non-parametric (normality dependent) univariable analysis was performed, dichotomised by exposure to major trauma or presence of rOA.ResultsExposed participants (n=579) had higher rates of rOA, worse pain and lower function (all p
PubDate: 2025-01-28T01:35:13-08:00
DOI: 10.1136/bmjmilitary-2024-RSMabstracts.6
Issue No: Vol. 171, No. 1 (2025)
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- Defence Medical Services and Colt Foundation Research & Quality
Improvement Meeting 2023, Royal College of Surgeons of England-
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Authors: Melhuish, J; Barker-Davies, R, Breeze, J, Wilson, D.
Pages: e1 - e1
PubDate: 2025-01-28T01:35:13-08:00
DOI: 10.1136/bmjmilitary-2024-RSMabstracts
Issue No: Vol. 171, No. 1 (2025)
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- Research agenda for physical activity promotion to enhance health and
performance in the military community-
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Authors: Webber, B. J; Deuster, P. A, Fraser, J. J, Nindl, B. C, Phillips, E. M, Piercy, K. L, Stiegmann, R. A, Bornstein, D. B.
Pages: 1 - 3
PubDate: 2025-01-28T01:35:13-08:00
DOI: 10.1136/military-2023-002565
Issue No: Vol. 171, No. 1 (2025)
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- Is prone positioning a valid intervention for ARDS in the deployed
intensive care unit'-
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Authors: Maclean, N; Davies, P, Lewis, S.
Pages: 4 - 7
Abstract: Prone positioning is an intervention used for patients with acute respiratory distress syndrome (ARDS) whose hypoxia is worsening despite conventional treatment. Previously used infrequently, it became an important treatment escalation strategy for hypoxia during the COVID-19 pandemic. Current evidence for prone positioning suggests increased survivability in intubated patients with moderate to severe ARDS who are prone for>12 hours a day. As a relatively low-cost, low-tech intervention with a growing evidence base, the viability of prone positioning in the deployed land environment is considered in this article. The practical technique of prone positioning is easy to teach to healthcare staff experienced in manual handling. However, it requires significant resources, in particular staff numbers, and time to execute and maintain, and necessitates a pressure-minimising mattress. Additionally, staff are placed at increased risk of musculoskeletal injuries and potential exposure to aerosolised microbes if there is a disconnection of the breathing system. We conclude that in the deployed 2/1/2/12 facility (or larger), with access to higher staff numbers and high-specification mattresses, prone positioning is a valid escalation technique for intubated hypoxic patients with ARDS. However, in smaller facilities where resources are constrained, its implementation is unlikely to be achievable.
Keywords: COVID-19
PubDate: 2025-01-28T01:35:13-08:00
DOI: 10.1136/military-2022-002302
Issue No: Vol. 171, No. 1 (2025)
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- The Defence General Practitioner: an Updated Definition and Model
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Authors: Holland, T. J; Smith, M, King, K.
Pages: 8 - 11
Abstract: The geopolitical setting has changed significantly since the definition of UK Armed Forces General Practice was published in 2012. New operating models require medical services to provide smaller teams operating at greater reach from secondary care and logistical support. The Defence Medical Services have reorganised to meet these changing needs. Defence general practices (DGPs) are key enablers of the Defence strategic effort, both integral to deployed units, in preparing forces for deployment and managing their rehabilitation back to fitness. A formal role performance statement (RPS) has been created to guide the training and development of DGPs to meet these changing requirements. The RPS details the additional scope of practice, beyond the national GP licensing standard, in which DGPs work. In this article, we compare and contrast the RPS with the previous definition of a DGP. The resultant updated model recharacterises the extended roles into five themes of DGP built on the foundation of the Royal College of General Practitioners curriculum. This new model provides the platform on which to develop the clinical specialty over the next decade and highlights avenues for educational interventions to develop future generations of DGPs.
PubDate: 2025-01-28T01:35:13-08:00
DOI: 10.1136/military-2023-002635
Issue No: Vol. 171, No. 1 (2025)
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- Management of war-related facial wounds in Ukraine: the Lviv military
hospital experience-
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Authors: Sinyuk, M; Polishchuk, V, Yuschak, P, Burachok, I.
Pages: 12 - 15
Abstract: The Lviv Military Medical Centre is the main hospital responsible for the management of wounded military personnel in Western Ukraine. Since the full-scale invasion of our country in 2022, we have had to rapidly adapt our department to managing a large influx of complex facial battle injuries. These wounds are generally from large explosive fragments such as from shells and commonly produce avulsive defects of the facial bones and overlying soft tissues. Using representative cases, we aim to discuss management of these extensive injuries and guide the future direction of our service, particularly in surgical training such as microvascular anastomosis.
Keywords: Editor''s choice
PubDate: 2025-01-28T01:35:13-08:00
DOI: 10.1136/military-2023-002527
Issue No: Vol. 171, No. 1 (2025)
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- Cost of the Defence Medical Services Patient Group Directive for a
10-minute tranexamic acid (TXA) infusion in trauma: a bolus is safe and
saves lives-
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Authors: Gluyas-Harris, J; McConnell, D.
Pages: 16 - 18
Abstract: Tranexamic acid (TXA) is a life-saving drug that reduces the risk of death from haemorrhage. Intervention is time critical with benefit decreasing with delayed administration. The current Joint Service Publication Patient Group Directive (PGD) for giving TXA during the tactical field care phase of the operational patient care pathway specifies it is given over 10 min via intravenous infusion based on TXA’s Summary of Product Characteristics. This paper aims to explore the risks of administering TXA as a bolus rather than a 10-minute infusion. There is little evidence to support the risk of quoted adverse events from bolus administration of TXA, good-quality evidence for the mortality benefit of early administration and some evidence that bolus dosing is safe. The Defence Medical Service should consider a default PGD of rapid TXA administration to maximise mortality benefit.
PubDate: 2025-01-28T01:35:13-08:00
DOI: 10.1136/military-2023-002471
Issue No: Vol. 171, No. 1 (2025)
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- Epidemiology of traumatically injured Yemeni civilians treated at the
Omani National Trauma Centre over a 2-year period: a retrospective cohort
study-
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Authors: Ramaraj, P; Al-Buluchi, T, Al-Shaqsi, S, Al-Kashmiri, A, Perkins, Z. B, De'Ath, H. D.
Pages: 19 - 25
Abstract: IntroductionArmed conflict is a growing global cause of death, posing a significant threat to the resilience of global health systems. However, the burden of disease resulting from the Yemeni Civil War remains poorly understood. Approximately half of healthcare facilities in Yemen are non-operational, and around 15% of the population has been displaced. Consequently, neighbouring countries’ trauma systems have been providing care to the injured. The objective of this study was to investigate the epidemiology and management of Yemeni civilian victims injured during the war who were subsequently extracted and treated at the study centre in Oman.MethodsWe conducted a retrospective cohort study, including all Yemeni civilians treated for traumatic injuries at the study centre from January 2015 to June 2017. We extracted data on age, sex, date of attendance, mechanism of injury, injuries sustained and treatment.ResultsA total of 254 injured patients were identified. Their median age was 25 (range 3–65) years and 244 (96.1%) were male. Explosions (160 patients, 63.0%) were the most common mechanism of injury, and fractures (n=232 fractures, 42.3% of all injuries; in 149 patients, 58.7% of all patients) the most common injury. Eighty-four of the 150 patients (56%) who received operative management at the study centre were receiving a second procedure after an index procedure outside of Oman.One hundred and twenty-eight (50.4%) patients experienced permanent loss of function in at least one body part and/or limb loss.ConclusionsThis study demonstrates the downstream needs of Yemeni civilians who were evacuated to the study centre, revealing a considerable burden of morbidity associated with this population. The findings emphasise key areas that receiving hospitals should prioritise in resource allocation when managing conflict-wounded evacuees. Additionally, the study underscores the need for holistic rehabilitation for civilian casualties displaced by conflict.
PubDate: 2025-01-28T01:35:13-08:00
DOI: 10.1136/military-2023-002509
Issue No: Vol. 171, No. 1 (2025)
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- Prognostic value of ultrasound tissue characterisation for a recurrence of
mid-portion Achilles tendinopathy in military service members: a
prospective cohort study-
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Authors: Paantjens, M. A; Helmhout, P. H, Backx, F. J. G, Martens, M. T. A. W, Bakker, E. W. P.
Pages: 26 - 32
Abstract: IntroductionTendon structure in mid-portion Achilles tendinopathy (mid-AT) appears poorly associated with symptoms. Yet, degenerative tendon changes on imaging have been associated with an increased risk of mid-AT. We aimed to investigate the prognostic value of ultrasound tissue characterisation (UTC) for a mid-AT recurrence in service members reporting to be recovered following standard care.MethodsMid-portion aligned fibrillar structure was quantified post-treatment in 37 participants. Recurrences were determined after 1 year of follow-up, based on self-perceived recurrence (yes/no) combined with a decrease in post-treatment Victorian Institute of Sports Assessment–Achilles score of at least the minimal important change of 7 points. Receiver operating characteristic curve analyses were used to determine a threshold for dichotomisation of outcomes for aligned fibrillar structure (normal representation/under-representation). Using multivariable logistic regression, the association between a mid-AT recurrence (yes/no) and the dichotomised aligned fibrillar structure was determined.ResultsEight participants (22%) experienced a recurrence. The threshold for aligned fibrillar structure was set at 73.2% (95% CI: 69.4% to 77.8%) according to Youden’s index. Values below this threshold were significantly associated with a mid-AT recurrence (odds ratio (OR) 9.7, 95% CI: 1.007 to 93.185). The OR for a mid-AT recurrence was 1.1 (95% CI: 1.002 to 1.150) for each additional month of symptom duration. The explained variance of our multivariable logistic regression model was 0.423; symptom duration appeared to be a better predictor than aligned fibrillar structure.ConclusionsThis study identified mid-portion aligned fibrillar structure and symptom duration as potential prognostic factors for a mid-AT recurrence in military service members. The threshold for aligned fibrillar structure of 73.2% can guide preventative interventions (eg, training load adjustments or additional tendon load programmes) aiming to improve tendon structure to minimise the future recurrence risk.Trial registration numberhttps://www.toetsingonline.nl/to/ccmo_search.nsf/Searchform'OpenForm, file number ToetsingOnline NL69527.028.19
Keywords: Open access
PubDate: 2025-01-28T01:35:13-08:00
DOI: 10.1136/military-2023-002521
Issue No: Vol. 171, No. 1 (2025)
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- Multicomponent telerehabilitation programme for older veterans with
multimorbidity: a programme evaluation-
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Authors: Rauzi, M. R; Abbate, L. M, Lum, H. D, Cook, P. F, Stevens-Lapsley, J. E.
Abstract: IntroductionOlder veterans with multimorbidity experience physical, mental and social factors which may negatively impact health and healthcare access. Physical function, behaviour change skills and loneliness may not be addressed during traditional physical rehabilitation. Thus, a multicomponent telerehabilitation programme could address these unmet needs. This programme evaluation assessed the safety, feasibility and change in patient outcomes for a multicomponent telerehabilitation programme.MethodsIndividuals were eligible if they were a veteran/spouse, age ≥50 years and had ≥3 comorbidities. The telerehabilitation programme included four core components: (1) High-intensity rehabilitation, (2) Coaching interventions, (3) Social support and (4) Technology. Physical therapists delivered the 12-week programme and collected patient outcomes at baseline, 4 weeks, 8 weeks and 12 weeks. Programme evaluation measures included safety events (occurrence and type), feasibility (adherence) and patient outcomes (physical function). Safety and feasibility outcomes were analysed using descriptive statistics. The mean pre-post programme difference and 95% CI for patient outcomes were generated using paired t-tests.ResultsTwenty-one participants enrolled in the telerehabilitation programme; most were male (81%), white (72%) and non-Hispanic (76%), with an average of 5.7 (3.0) comorbidities. Prevalence of insession safety events was 3.2% (0.03 events/session). Fifteen (71.4%) participants adhered to the programme (attended ≥80% of sessions). Mean (95% CI) improvements for physical function are as follows: 4.7 (2.4 to 7.0) repetitions for 30 s sit to stand, 6.0 (4.0 to 9.0) and 5.0 (2.0 to 9.0) repetitions for right arm curl and left arm curl, respectively, and 31.8 (15.9 to 47.7) repetitions for the 2 min step test.ConclusionThe telerehabilitation programme was safe, feasible and demonstrated preprogramme to postprogramme improvements in physical function measures while addressing unmet needs in a vulnerable population. These results support a randomised clinical trial while informing programme and process adaptations.
PubDate: 2025-01-28T01:35:13-08:00
DOI: 10.1136/military-2023-002535
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