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The purpose of this study was to use the Eating Disorder Inventory-2 (EDI-2) to compare disordered eating pathology between female intercollegiate athletes and a control group of nonathletic subjects enrolled in an advanced program of study. Analysis of variance (ANOVA) procedures revealed no significant difference (NSD) (p > .05) between any of the athletic groups or the control group on any EDI-2 subscale, and there was no significant difference between 'lean' sports, other sports, and the control group. There was also NSD on EDI-2 subscale scores on the basis of age. African Americans had significantly lower scores on the Body Dissatisfaction and Impulse Regulation subscales than white Americans. Chi-square analysis revealed NSD between any groups in percentage of respondents scoring above anorexic norms. The results did not indicate a greater amount of disordered eating in female athletes compared to nonathlete controls. [ABSTRACT FROM AUTHOR]

High-energy-density lithium sulfur (Li-S) batteries suffer heavily from the polysulfide shuttle effect, a result of the dissolution and transport of intermediate polysulfides from the cathode, into the electrolyte, and onto the anode, leading to rapid cell degradation. If this primary mechanism of cell failure is to be overcome, the distribution, dynamics, and degree of polysulfide transport must first be understood in depth. In this work, operando optical fluorescence microscope imaging of optically accessible Li-S cells is shown to enable real-time qualitative visualization of the spatial distribution of lithium polysulfides, both within the electrolyte and porous cathode. Quantitative determinations of spatial concentration are also possible at a low enough concentration. The distribution throughout cycling is monitored, including direct observation of polysulfide shuttling to the anode and consequent dendrite formation. This was enabled through the optimization of a selective fluorescent dye, verified to fluoresce proportionally with concentration of polysulfides within Li-S cells. This ability to directly and conveniently track the spatial distribution of soluble polysulfide intermediates in Li-S battery electrolytes, while the cell operates, has the potential to have a widespread impact across the field, for example, by enabling the influence of a variety of polysulfide mitigation strategies to be assessed and optimized, including in this work the LiNO 3 additive.

Objectives: Certain occupations are associated with greater risk of triggering a sudden cardiac event because of high levels of physical exertion and extreme thermal environments in which they occur. The extent to which sports officials--particularly high school (HS) American football referees--experience these conditions is unknown. Forty-six male HS officials (72% White/Caucasian; age = 48 ± 12 years, body mass index = 31.7 ± 6.6 kg·m -2 ) were studied to quantify the physiological strain and physical demands of officiating., Methods: Referee demographics (e.g., experience, habitual exercise), pre-game urine specific gravity (U SG ), thermal (peak core temperature [T core ]) and cardiovascular (average heart rate [HR]) strain, kinematic activity (e.g., total distance, speed, mechanical intensity), and environmental conditions were measured during 10 regular season varsity HS football games (≈2.5 h each) in the Southeastern United States (average wet bulb globe temperature and relative humidity: 18.9 ± 6.0 °C and 78.2% ± 12.1%). Analyses included descriptive statistics, bivariate correlations, and linear regression., Results: Referees covered 5.2 ± 1.2 km per game, eliciting average HR and peak T core of 71.5% ± 8.0% HR max and 38.3 ± 0.5 °C, respectively; 38% began games dehydrated (U SG  = 1.026 ± 0.004). Multiple regression analyses revealed that obesity ( β  = 0.34), not participating in regular exercise ( β  = -0.36), and officiating at lower mechanical intensity ( β  = -0.33) predicted greater cardiovascular strain (all p ≤ 0.03). White/Caucasian race/ethnicity ( β  = 0.59), younger age ( β  = -0.46), and obesity ( β  = 0.28) predicted greater thermal strain (all p ≤ 0.01)., Conclusion: HS football referees experienced elevated levels of physiological strain while officiating, with individual factors modulating the magnitude of strain. Strategies aimed at reducing obesity, increasing exercise participation, and improving cardiovascular health should be emphasized to mitigate strain and prevent cardiac events.

It is widely accepted that the commercial application of lithium-sulfur batteries is inhibited by their short cycle life, which is primarily caused by a combination of Li dendrite formation and active material loss due to polysulfide shuttling. Unfortunately, while numerous approaches to overcome these problems have been reported, most are unscalable and hence further hinder Li-S battery commercialization. Most approaches suggested also only tackle one of the primary mechanisms of cell degradation and failure. Here, we demonstrate that the use of a simple protein, fibroin, as an electrolyte additive can both prevent Li dendrite formation and minimize active material loss to enable high capacity and long cycle life (up to 500 cycles) in Li-S batteries, without inhibiting the rate performance of the cell. Through a combination of experiments and molecular dynamics (MD) simulations, it is demonstrated that the fibroin plays a dual role, both binding to polysulfides to hinder their transport from the cathode and passivating the Li anode to minimize dendrite nucleation and growth. Most importantly, as fibroin is inexpensive and can be simply introduced to the cell via the electrolyte, this work offers a route toward practical industrial applications of a viable Li-S battery system., Competing Interests: The authors declare no competing financial interest., (© 2023 The Authors. Published by American Chemical Society.)

Pseudomonas aeruginosa (PsA) is an opportunistic bacterial pathogen that causes life-threatening infections in individuals with compromised immune systems and exacerbates health concerns for those with cystic fibrosis (CF). PsA rapidly develops antibiotic resistance; thus, novel therapeutics are urgently needed to effectively combat this pathogen. Previously, we have shown that a novel cationic Zinc (II) porphyrin (ZnPor) has potent bactericidal activity against planktonic and biofilm-associated PsA cells, and disassembles the biofilm matrix via interactions with eDNA In the present study, we report that ZnPor caused a significant decrease in PsA populations in mouse lungs within an in vivo model of PsA pulmonary infection. Additionally, when combined with an obligately lytic phage PEV2, ZnPor at its minimum inhibitory concentration (MIC) displayed synergy against PsA in an established in vitro lung model resulting in greater protection of H441 lung cells versus either treatment alone. Concentrations above the minimum bactericidal concentration (MBC) of ZnPor were not toxic to H441 cells; however, no synergy was observed. This dose-dependent response is likely due to ZnPor's antiviral activity, reported herein. Together, these findings show the utility of ZnPor alone, and its synergy with PEV2, which could be a tunable combination used in the treatment of antibiotic-resistant infections.

The electrode drying process (DP) is a crucial step in the lithium-ion battery manufacturing chain and plays a fundamental role in governing the performance of the cells. The DP is extremely complex, with the dynamics and their implication in the production of electrodes generally being poorly understood. To date, there is limited discussion of these processes in the literature due to the limitation of the existing in situ metrology. Here, ultrasound acoustic measurements are demonstrated as a promising tool to monitor the physical evolution of the electrode coating in situ . These observations are validated by gravimetric analysis to show the feasibility of the technique to monitor the DP and identify the three different drying stages. A possible application of this technique is to adjust the drying rates based upon the ultrasound readings at different drying stages and to speed up the drying time. These findings prove that this measurement can be used as a cost-effective and simple tool to provide characteristic diagnostics of the electrode, which can be applied in large-scale coating manufacturing.

The electrode drying process is a crucial step in the manufacturing of lithium-ion batteries and can significantly affect the performance of an electrode once stacked in a cell. High drying rates may induce binder migration, which is largely governed by the temperature. Additionally, elevated drying rates will result in a heterogeneous distribution of the soluble and dispersed binder throughout the electrode, potentially accumulating at the surface. The optimized drying rate during the electrode manufacturing process will promote balanced homogeneous binder distribution throughout the electrode film; however, there is a need to develop more informative in situ metrologies to better understand the dynamics of the drying process. Here, ultrasound acoustic-based techniques were developed as an in situ tool to study the electrode drying process using NMC622-based cathodes and graphite-based anodes. The drying dynamic evolution for cathodes dried at 40 and 60 °C and anodes dried at 60 °C were investigated, with the attenuation of the reflective acoustic signals used to indicate the evolution of the physical properties of the electrode-coating film. The drying-induced acoustic signal shifts were discussed critically and correlated to the reported three-stage drying mechanism, offering a new mode for investigating the dynamic drying process. Ultrasound acoustic-based measurements have been successfully shown to be a novel in situ metrology to acquire dynamic drying profiles of lithium-ion battery electrodes. The findings would potentially fulfil the research gaps between acquiring dynamic data continuously for a drying mechanism study and the existing research metrology, as most of the published drying mechanism research studies are based on simulated drying processes. It shows great potential for further development and understanding of the drying process to achieve a more controllable electrode manufacturing process.

Significance: Football helmet visors are popular among players and may increase safety. However, they may also be costly or impractical, or impair the evaluation of head and neck injury. Determining an objective list of vision-related clinical conditions may help meet risk-benefit ratios while increasing access to care to athletes with special needs., Purpose: The purpose of this study was to determine an objective list of vision-related conditions that may benefit from clear and tinted football helmet visor use in athletes., Methods: After comprehensive dilated eye examinations on 58 Division I collegiate football players at the University of Alabama at Birmingham between February 2017 and June 2018, an expert panel in vision care, sports medicine, and football equipment convened to determine vision-related conditions most important for clear or tinted football helmet visor use., Results: In August 2018, the list drafted by the expert vision and sports medical panel in which a clear football helmet visor might be justified included conditions associated with retinal detachment and unilateral or binocular vision loss as well as high refractive error, refractive surgery, corneal compromise, and other conditions, which would necessitate additional eye protection. Of the 58 players examined, 3 (5%) were determined to have eye conditions that would require a clear visor as deemed by the expert panel, and 3 (5%) were determined to have eye conditions for which a clear visor was recommended. No players met indications for a tinted visor including congenital eye conditions that limit useful vision in daylight or bright-light environments, acquired conditions that may increase light sensitivity, and light-induced systemic conditions., Conclusions: This objective list of eye and vision-related systemic conditions is intended to mitigate the risk of long-term eye damage and/or vision deprivation. Clear and especially tinted football helmet visors require the sports medicine team to evaluate factors that will maximize the vision, head, and neck health of the athlete while increasing accessibility to sports for individuals with unique abilities., Competing Interests: Conflict of Interest Disclosure: None of the authors have reported a financial conflict of interest., (Copyright © 2021 American Academy of Optometry.)

Flatt, AA, Esco, MR, Allen, JR, Robinson, JB, Bragg, A, Keith, CM, Fedewa, MV, and Earley, RL. Cardiac-autonomic responses to in-season training among Division-1 college football players. J Strength Cond Res 34(6): 1649-1656, 2020-Despite having to endure a rigorous in-season training schedule, research evaluating daily physiological recovery status markers among American football players is limited. The purpose of this study was to determine whether recovery of cardiac-autonomic activity to resting values occurs between consecutive-day, in-season training sessions among college football players. Subjects (n = 29) were divided into groups based on position: receivers and defensive backs (SKILL, n = 10); running backs, linebackers, and tight-ends (MID-SKILL, n = 11) and linemen (LINEMEN, n = 8). Resting heart rate (RHR) and the natural logarithm of the root mean square of successive differences multiplied by 20 (LnRMSSD) were acquired at rest in the seated position before Tuesday and Wednesday training sessions and repeated over 3 weeks during the first month of the competitive season. A position × time interaction was observed for LnRMSSD (p = 0.04), but not for the RHR (p = 0.33). No differences in LnRMSSD between days was observed for SKILL (Tuesday = 82.8 ± 9.3, Wednesday = 81.9 ± 8.7, p > 0.05). Small reductions in LnRMSSD were observed for MID-SKILL (Tuesday = 79.2 ± 9.4, Wednesday = 76.2 ± 9.5, p ≤ 0.05) and LINEMEN (Tuesday = 79.4 ± 10.5, Wednesday = 74.5 ± 11.5, p ≤ 0.05). The individually averaged changes in LnRMSSD from Tuesday to Wednesday were related to PlayerLoad (r = 0.46, p = 0.02) and body mass (r = -0.39, p = 0.04). Cardiac-parasympathetic activity did not return to resting values for LINEMEN or MID-SKILL before the next training session. Larger reductions in LnRMSSD tended to occur in players with greater body mass despite having performed lower workloads, although some individual variability was observed. These findings may have implications for how coaches and support staff address training and recovery interventions for players demonstrating inadequate cardiovascular recovery between sessions.

The importance of reliable battery diagnostic systems has grown substantially in recent years as a result of the use of high power Li-ion battery packs in an increasingly diverse range of applications. Here, spatially resolved ultrasound acoustic measurements are used to analyse the condition of Li-ion electrodes. Ultrasonic measurements are performed on a commercial mobile phone battery over the full operating voltage window with the lithiation and delithiation of electrodes observed at 36 locations on the surface of the cell. X-ray computed tomography was performed on the cell to ascertain the internal architecture and features that enabled the architecture of the battery to be correlated with the acoustic signature. Analyses of the acoustic signals obtained suggest that the anode and cathode layers can be identified by examining the change in attenuation associated with the charging process. It is also seen that expansions of the electrode layers are inhibited by the presence of the anode current collecting tab in the battery which leads to spatial inhomogeneities in the expansion of the electrode layer examined within the cell.

Flatt, AA, Esco, MR, Allen, JR, Robinson, JB, Earley, RL, Fedewa, MV, Bragg, A, Keith, CM, and Wingo, JE. Heart rate variability and training load among National Collegiate Athletic Association Division 1 college football players throughout spring camp. J Strength Cond Res 32(11): 3127-3134, 2018-The purpose of this study was to determine whether recovery of cardiac-autonomic activity to baseline occurs between consecutive-day training sessions among positional groups of a collegiate football team during Spring camp. A secondary aim was to evaluate relationships between chronic (i.e., 4-week) heart rate variability (HRV) and training load parameters. Baseline HRV (lnRMSSD&#95;BL) was compared with HRV after ∼20 hours of recovery before next-day training (lnRMSSDpost20) among positional groups composed of SKILL (n = 11), MID-SKILL (n = 9), and LINEMEN (n = 5) with a linear mixed model and effect sizes (ES). Pearson and partial correlations were used to quantify relationships between chronic mean and coefficient of variation (CV) of lnRMSSD (lnRMSSD&#95;chronic and lnRMSSDcv, respectively) with the mean and CV of PlayerLoad (PL&#95;chronic and PL&#95;cv, respectively). A position × time interaction was observed for lnRMSSD (p = 0.01). lnRMSSD&#95;BL was higher than lnRMSSDpost20 for LINEMEN (p < 0.01; ES = large), whereas differences for SKILL and MID-SKILL were not statistically different (p > 0.05). Players with greater body mass experienced larger reductions in lnRMSSD (r = -0.62, p < 0.01). Longitudinally, lnRMSSDcv was significantly related to body mass (r = 0.48) and PL&#95;chronic (r = -0.60). After adjusting for body mass, lnRMSSDcv and PL&#95;chronic remained significantly related (r = -0.43). The ∼20-hour recovery time between training sessions on consecutive days may not be adequate for restoration of cardiac-parasympathetic activity to baseline among LINEMEN. Players with a lower chronic training load throughout camp experienced greater fluctuation in lnRMSSD (i.e., lnRMSSDcv) and vice versa. Thus, a capacity for greater chronic workloads may be protective against perturbations in cardiac-autonomic homeostasis among American college football players.

Neuropsychological (NP) performance has been associated with psychosocial treatment outcomes in nonpain conditions, but has never been investigated in chronic pain. We performed a secondary analysis on the association of baseline NP performance with treatment outcomes among veterans with chronic pain (N = 117) undergoing an 8-week acceptance and commitment therapy (ACT) intervention. Participants completed measures of pain interference, pain severity, quality of life, activity levels, depression, and pain-related anxiety at baseline, midtreatment, and post-treatment. Executive functioning, working memory, processing speed, learning, and verbal memory were assessed at baseline. All study measures significantly improved from baseline to post-treatment. NP performance was related to changes in depression and pain-related anxiety during treatment. Specifically, relatively lower executive functioning and processing speed was associated with greater decreases in depressive symptoms, and relatively lower processing speed was associated with greater decreases in pain-related anxiety. Consistent with research in nonpain conditions, those with relatively lower NP functioning received greater benefit from psychosocial treatment, although most study outcomes did not differ as a function of NP performance. Our results suggest relatively lower NP functioning is not contraindicated for participation in psychosocial interventions like ACT but instead may be associated with greater relief., Perspective: This study suggests that NP functioning is unrelated to changes in pain interference associated with ACT, and that those with relatively lower NP functioning may experience greater reductions in depressive symptoms and pain-related anxiety. This article contains important information for researchers and clinicians interested in cognition and chronic pain., (Published by Elsevier Inc.)

This article describes two case studies using an interdisciplinary intervention for homebound older adults who experience fear of falling, resulting in debility and isolation. The patients discussed received separate home visits from a physical therapist (two and four visits) and psychologist (six and eight visits) and intervention components included an initial assessment of physical ability, prescription of home exercise program, exposure therapy, and cognitive restructuring. Both patients reported satisfaction with the fear of falling intervention and showed improved ability to walk, both in distance and in requiring less assistance. These findings suggest significant positive treatment effects can be achieved through interdisciplinary exposure-based interventions aimed at reducing unrealistic fear of falling and associated avoidance behaviors. Similar interventions should be considered for more systematic evaluation of effects and mechanisms of change as well as inclusion in interdisciplinary treatment planning.

The rise of antibiotic resistant bacteria is posing a serious threat to human health. For example, resistant strains of Pseudomonas aeruginosa have resulted in untreatable and potentially lethal infections in both cystic fibrosis and immunocompromised patients. Due to the growing need for alternative treatment options, bacteriophage, or phage, therapy is gaining considerable attention. While previous studies have demonstrated the effectiveness of phage in combating persistent bacterial infections, there is currently a lack of knowledge regarding the host immunological response following phage exposure. In the present study, the bioresponses of an enhanced in vitro model were characterized following exposure to either DMS3 or PEV2, P. aeruginosa targeting phages. Results demonstrated a PEV2-dependent increase in IL-6 and TNF-α production, but no changes associated with DMS3 exposure. Additionally, following the establishment of an in vitro infection model, DMS3 was found to successfully protect mammalian lung cells from P. aeruginosa. Taken together, the biocompatibility and antibacterial effectiveness distinguish DMS3 bacteriophage as a strong candidate for phage therapy. However, as DMS3 is pilin dependent and bacterial receptor expression varies significantly, this work highlights the necessity of generating phage cocktails.

Introduction: The purpose of this study is to determine the effect of collimation on the lifetime attributable risk (LAR) of cancer incidence in all body organs (effective risk) in patients undergoing antero-posterior (AP) examinations of the spine. This is of particular importance for patients suffering from scoliosis as in their case regular repeat examinations are required and also because such patients are usually young and more susceptible to the effects of ionising radiation than are older patients., Methods: High sensitivity thermo-luminescent dosimeters (TLDs) were used to measure radiation dose to all organs of an adult male dosimetry phantom, positioned for an AP projection of the thoraco-lumbar spine. Exposures were made, first applying tight collimation and then subsequently with loose collimation, using the same acquisition factors. In each case, the individual TLDs were measured to determine the local absorbed dose and those representing each organ averaged to calculate organ dose. This information was then used to calculate the effective risk of cancer incidence for each decade of life from 20 to 80, and to compare the likelihood of cancer incidence when using tight and loose collimation., Results: The calculated figures for effective risk of cancer incidence suggest that the risk when using loose collimation compared to the use of tight collimation is over three times as high and this is the case across all age decades from 20 to 80., Conclusion: Tight collimation can greatly reduce radiation dose and risk of cancer incidence. However collimation in scoliotic patients can be necessarily limited., (Copyright © 2017 The College of Radiographers. Published by Elsevier Ltd. All rights reserved.)

Catastrophic failure of lithium-ion batteries occurs across multiple length scales and over very short time periods. A combination of high-speed operando tomography, thermal imaging and electrochemical measurements is used to probe the degradation mechanisms leading up to overcharge-induced thermal runaway of a LiCoO 2 pouch cell, through its interrelated dynamic structural, thermal and electrical responses. Failure mechanisms across multiple length scales are explored using a post-mortem multi-scale tomography approach, revealing significant morphological and phase changes in the LiCoO 2 electrode microstructure and location dependent degradation. This combined operando and multi-scale X-ray computed tomography (CT) technique is demonstrated as a comprehensive approach to understanding battery degradation and failure.

In the present study, the use of bacteriophages to prevent growth and/or biofouling by Pseudomonas aeruginosa PAO1 was investigated in microcosms containing Jet A aviation fuel as the carbon source. Bacteriophages were found to be effective at preventing biofilm formation but did not always prevent planktonic growth in the microcosms. This result was at odds with experiments conducted in nutrient-rich medium, demonstrating the necessity to test antimicrobial and antifouling strategies under conditions as near as possible to the 'real world'. The success of the bacteriophages at preventing biofilm formation makes them potential candidates as antifouling agents for fuel systems.

Dual-energy x-ray absorptiometry (DXA) imaging is considered to provide a valid and reliable estimation of body composition when stringent scanning protocols are adopted. However, applied practitioners are not always able to achieve this level of control and the subsequent impact on measurement precision is not always taken into account when evaluating longitudinal body composition changes. The primary aim of this study was to establish the reliability of DXA in an applied elite sport setting to investigate whether real body composition changes can be detected. Additionally, the performance implications of these changes during the training year were investigated. Forty-eight well-trained athletes (from four diverse sports) underwent two DXA scans using a 'real-world' approach (with limited pre-scan controls), typically within 48 h, to quantify typical error of measurement (TEM). Twenty-five athletes underwent further scans, before and after specific training and competition blocks. 'True' body composition changes were evaluated using 2  ×  TEM thresholds. Twelve bob skeleton athletes also performed countermovement jump and leg press tests at each time point. Many 'true' body composition changes were detected and coincided with the primary training emphases (e.g. lean mass gains during hypertrophy-based training). Clear relationships (r  ±  90% CI) were observed between performance changes (countermovement jump and leg press) and changes in lean mass (0.53  ±  0.26 and 0.35  ±  0.28, respectively) and fat mass (-0.44  ±  0.27 and  -0.37  ±  0.28, respectively). DXA was able to detect real body composition changes without the use of stringent scanning controls. Associations between changes in body composition and performance demonstrated the potential influence of these changes on strength and power indices.

Performance improvement is reliant on information and data, as you cannot improve what you do not measure. The US military went to war in 2001 without an integrated trauma care system to collect and analyze combat casualty care data. By 2006, the conflict in Afghanistan began appreciating the capture and consolidation of hospital care documentation into the Department of Defense Trauma Registry. In contrast, a paucity of documentation has existed for prehospital or tactical combat casualty care (TCCC). Using the 75th Ranger casualty documentation model established in 2005, the Joint Trauma System developed a casualty data collection system for prehospital care using the TCCC Card, the TCCC After Action Report (AAR), and the Prehospital Trauma Registry. In 2013, this system was mandated for use by US forces in Afghanistan. The Joint Trauma System also created and deployed a prehospital team to be an integral part of the Joint Theater Trauma System in Afghanistan. This prehospital team provided prehospital training and facilitated prehospital data capture. Described and analyzed in this report are prehospital data captured in Afghanistan from 2013 to 2014 using the TCCC Card and the TCCC AAR.

In addition to life-saving interventions, the assessment of pain and subsequent administration of analgesia are primary benchmarks for quality emergency medical services care which should be documented and analyzed. Analyze US combat casualty data from the Department of Defense Trauma Registry (DoDTR) with a primary focus on prehospital pain assessment, analgesic administration and documentation. Retrospective cohort study of battlefield prehospital and hospital casualty data were abstracted by DoDTR from available records from 1 September 2007 through 30 June 2011. Data included demographics; injury mechanism; prehospital and initial combat hospital pain assessment documented by standard 0-to-10 numeric rating scale; analgesics administered; and survival outcome. Records were available for 8,913 casualties (median ISS of 5 [IQR 2 to 10]; 98.7% survived). Prehospital analgesic administration was documented for 1,313 cases (15%). Prehospital pain assessment was recorded for 581 cases (7%; median pain score 6 [IQR 3 to 8]), hospital pain assessment was recorded for 5,007 cases (56%; median pain score5 [CI95% 3 to 8]), and 409 cases (5%) had both prehospital and hospital pain assessments that could be paired. In this paired group, 49.1% (201/409) had alleviation of pain evidenced by a decrease in pain score (median 4,, IQR 2 to 5); 23.5% (96/409) had worsening of pain evidenced by an increase in pain score (median 3, CI95 2.8 to 3.7, IQR 1 to 5); 27.4% (112/409) had no change; and the overall difference was an average decrease in pain score of 1.1 (median 0, IQR 0 to 3, p < 0.01). Time-series analysis showed modest increases in prehospital and hospital pain assessment documentation and prehospital analgesic documentation. Our study demonstrates that prehospital pain assessment, management, and documentation remain primary targets for performance improvement on the battlefield. Results of paired prehospital to hospital pain scores and time-series analysis demonstrate both feasibility and benefit of prehospital analgesics. Future efforts must also include an expansion of the prehospital battlefield analgesic formulary.

Tracking the dynamic morphology of active materials during operation of lithium batteries is essential for identifying causes of performance loss. Digital volume correlation (DVC) is applied to high-speed operando synchrotron X-ray computed tomography of a commercial Li/MnO 2 primary battery during discharge. Real-time electrode material displacement is captured in 3D allowing degradation mechanisms such as delamination of the electrode from the current collector and electrode crack formation to be identified. Continuum DVC of consecutive images during discharge is used to quantify local displacements and strains in 3D throughout discharge, facilitating tracking of the progression of swelling due to lithiation within the electrode material in a commercial, spiral-wound battery during normal operation. Displacement of the rigid current collector and cell materials contribute to severe electrode detachment and crack formation during discharge, which is monitored by a separate DVC approach. Use of time-lapse X-ray computed tomography coupled with DVC is thus demonstrated as an effective diagnostic technique to identify causes of performance loss within commercial lithium batteries; this novel approach is expected to guide the development of more effective commercial cell designs.

Since 2009, out-of-hospital care of junctional hemorrhage bleeding from the trunk-appendage junctions has changed, in part, due to the newly available junctional tourniquets (JTs) that have been cleared by the US Food and Drug Administration. Given four new models of JT available in 2014, several military services have begun to acquire, train, or even use such JTs in care. The ability of users to be trained in JT use has been observed by multiple instructors. The experience of such instructors has been broad as a group, but their experience as individuals has been neither long nor deep. A gathering into one source of the collective experience of trainers of JT users could permit a collation of useful information to include lessons learned, tips in skill performance, identification of pitfalls of use to avoid, and strategies to optimize user learning. The purpose of the present review is to record the experiences of several medical personnel in their JT training of users to provide a guide for future trainers., (2015.)

The United States has achieved unprecedented survival rates, as high as 98%, for casualties arriving alive at the combat hospital. Our military medical personnel are rightly proud of this achievement. Commanders and Servicemembers are confident that if wounded and moved to a Role II or III medical facility, their care will be the best in the world. Combat casualty care, however, begins at the point of injury and continues through evacuation to those facilities. With up to 25% of deaths on the battlefield being potentially preventable, the prehospital environment is the next frontier for making significant further improvements in battlefield trauma care. Strict adherence to the evidence-based Tactical Combat Casualty Care (TCCC) Guidelines has been proven to reduce morbidity and mortality on the battlefield. However, full implementation across the entire force and commitment from both line and medical leadership continue to face ongoing challenges. This report on prehospital trauma in the Combined Joint Operations Area?Afghanistan (CJOA-A) is a follow-on to the one previously conducted in November 2012 and published in January 2013. Both assessments were conducted by the US Central Command (USCENTCOM) Joint Theater Trauma System (JTTS). Observations for this report were collected from December 2013 to January 2014 and were obtained directly from deployed prehospital providers, medical leaders, and combatant leaders. Significant progress has been made between these two reports with the establishment of a Prehospital Care Division within the JTTS, development of a prehospital trauma registry and weekly prehospital trauma conferences, and CJOA-A theater guidance and enforcement of prehospital documentation. Specific prehospital trauma-care achievements include expansion of transfusion capabilities forward to the point of injury, junctional tourniquets, and universal approval of tranexamic acid., (2015.)

Prevention and mitigation of thermal runaway presents one of the greatest challenges for the safe operation of lithium-ion batteries. Here, we demonstrate for the first time the application of high-speed synchrotron X-ray computed tomography and radiography, in conjunction with thermal imaging, to track the evolution of internal structural damage and thermal behaviour during initiation and propagation of thermal runaway in lithium-ion batteries. This diagnostic approach is applied to commercial lithium-ion batteries (LG 18650 NMC cells), yielding insights into key degradation modes including gas-induced delamination, electrode layer collapse and propagation of structural degradation. It is envisaged that the use of these techniques will lead to major improvements in the design of Li-ion batteries and their safety features.

Background: Servicemembers injured in combat often experience moderate to severe acute pain. Early and effective pain control in the prehospital setting has been shown to reduce the sequelae of untreated pain. Current data suggest that lack of point-of-injury (POI) analgesia has significant, downstream effects on healthcare quality and associated costs., Methods: This was a process improvement project to determine the current rate of adherence to existing prehospital pain management guidelines. The records of patients who had sustained a major injury and met current Tactical Combat Casualty Care (TCCC) criteria for POI analgesia from July 2013 through March 2014 were reviewed to determine if pain medication was given in accordance with existing guidelines, including medication administration and routes. On 31 October 2013, the new TCCC guidelines were released. The "before" period was from July 2013 through October 2013. The "after" period was from November 2013 through March 2014., Results: During the project period, there were 185 records available for review, with 135 meeting TCCC criteria for POI analgesia (68 pre-, 66 postintervention). Prior to 31 October 2013, 17% of study patients received analgesia within guidelines at the POI compared with 35% in the after period. The most common medication administered pre-and post-release was oral transmucosal fentanyl citrate. Special Operations Forces had higher adherence rates to TCCC analgesia guidelines than conventional forces, but these still were low., Conclusion: Less than half of all eligible combat casualties receive any analgesia at the POI. Further research is needed to determine the etiology of such poor adherence to current TCCC guidelines., (2015.)

The current study evaluated the effectiveness of a community-based elder abuse intervention program that assists suspected victims of elder abuse and self-neglect through a partnership with local law enforcement. This program, Eliciting Change in At-Risk Elders, involves building alliances with the elder and family members, connecting the elder to supportive services that reduce risk of further abuse, and utilizing motivational interviewing-type skills to help elders overcome ambivalence regarding making difficult life changes. Risk factors of elder abuse decreased over the course of the intervention and nearly three-quarters of participants made progress on their treatment goal, advancing at least one of Prochaska and DiClemente's (1983) stages of change (precontemplation, contemplation, preparation, action, and maintenance). Forty-three percent of elders moved into the stages of action and maintenance regarding their goal. The usefulness of eliciting change via longer-term relationships with vulnerable elders in entrenched elder abuse situations is discussed.

A new technique combining in situ X-ray diffraction using synchrotron radiation and infrared thermal imaging is reported. The technique enables the application, generation and measurement of significant thermal gradients, and furthermore allows the direct spatial correlation of thermal and crystallographic measurements. The design and implementation of a novel furnace enabling the simultaneous thermal and X-ray measurements is described. The technique is expected to have wide applicability in material science and engineering; here it has been applied to the study of solid oxide fuel cells at high temperature.

Junctional hemorrhage, bleeding that occurs at the junction of the trunk and its appendages, is the most common preventable cause of death from compressible hemorrhage on the battlefield. As of January 2014, four types of junctional tourniquets have been developed and cleared by the U.S. Food and Drug Administration (FDA). Successful use of the Abdominal Aortic Tourniquet (AAT™) and Combat Ready Clamp (CRoC™) has already been reported. We report here the first known prehospital use of the SAM® Junctional Tourniquet (SJT) for a battlefield casualty with inguinal junctional hemorrhage., (2014.)

Objective: We sought to determine whether Contingency Telemedical Support (CTS) improves the success rate and efficiency of primary care providers performing critical actions during simulated combat trauma resuscitation. Critical actions included advanced airway, chest decompression, extremity hemorrhage control, hypothermia prevention, antibiotics and analgesics, and hypotensive resuscitation, among others., Background: Recent studies report improved survival associated with skilled triage and treatment in the out-of-hospital/preoperative phase of combat casualty care. Historically, ground combat units are assigned primary care physicians and physician assistants as medical staff, due to resource limitations. Although they are recognized as optimal resuscitators, demand for military trauma surgeons and emergency physicians exceeds supply and is unlikely to improve in the near term., Methods: A prospective trial of telemedical mentoring during a casualty resuscitation encounter was studied using a high-fidelity patient simulator (HFPS). Subjects were randomized and formed into experimental (CTS) or control teams. CTS team leaders were equipped with a headset/microphone interface and telementored by a combat-experienced emergency physician or trauma surgeon. A standardized, scripted clinical scenario and HFPS were used with 14 critical actions. At completion, subjects were surveyed. Statistical approach included contingency table analysis, two-tailed t-test, and correlation coefficient. This study was reviewed and approved by our institutional review board (IRB)., Results: Eighteen CTS teams and 16 control teams were studied. By intention-to-treat ITT analysis, 89% of CTS teams versus 56% of controls completed all life-threatening inventions (LSIs) (p<.01); 78% versus 19% completed all critical actions (p<.01); and 89% versus 56% established advanced airways within 8 minutes (p<.06). Average time to completion in minutes (95% confidence interval [CI] 95) was 12 minutes (10?14) for CTS versus 18 (16?20) for controls, with 75% of control teams not completing all critical actions., Conclusion: In this model, real-time telementoring of simulated trauma resuscitation was feasible and improved accuracy and efficiency of non?emergency-trained resuscitators. Clinical validation and replicated study of these findings for guiding remote damage control resuscitation are warranted., (2014.)

We show that, by making use of the linked tensor objects inherent to the approach, Orbital-optimised Quasi-Variational Coupled Cluster Theory (OQVCCD) leads naturally to a computationally-trivial, rigorously extensive, and orbital-invariant renormalization of the standard (T) correction for the perturbative inclusion of the effects of connected triple excitations. The resulting prototype method, renormalized perturbative triple OQVCCD (R-OQVCCD(T)), is demonstrated to predict potential energy curves for single bond-breaking processes of significantly higher accuracy than OQVCCD with the standard perturbative triple-excitation correction (OQVCCD(T)) itself, and to be in good numerical correspondence with the existing renormalized (R-CCSD(T)) and completely renormalized (CR-CCSD(T)) coupled-cluster singles doubles triples methods, while continuing to provide descriptions of multiple bond-breaking processes of OQVCCD(T) quality.

We present further evidence that closed-shell single-reference coupled cluster theory can be used as a reliable predictive tool even when multiple chemical bonds are broken, provided that a near-variational, rather than a projective, ansatz is used. Building on the Optimized-orbital Quasi-Variational Coupled Cluster Doubles (OQVCCD) method by adding the standard perturbative treatment of triple excitations, the OQVCCD(T) method provides outstanding accuracy for the dissociation of multiply bonded molecules and other problems involving strong nondynamic correlation of the electrons. We find that in the case of singly bonded molecules, OQVCCD and OQVCCD(T) perform similarly to the equivalent Brueckner Coupled Cluster Doubles approaches, BCCD and BCCD(T). However, when multiple bonds are broken, such as in acetylene and dicarbon, OQVCCD(T) is capable of predicting both qualitatively and quantitatively accurate potential energy curves, unlike the standard methods based on traditional coupled cluster theory, and for approximately the same computational cost.