Military medicine
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Multicenter Study Observational Study
Relation of Aerobic Activity to Cognition and Well-being in Chronic Mild Traumatic Brain Injury: A LIMBIC-CENC Study.
Because chronic difficulties with cognition and well-being are common after mild traumatic brain injury (mTBI) and aerobic physical activity and exercise (PAE) is a potential treatment and mitigation strategy, we sought to determine their relationship in a large sample with remote mTBI. ⋯ An association between the aerobic activity level and the preselected primary cognitive performance outcome was not demonstrated using this study sample and methods. However, higher aerobic activity levels were associated with better subjective well-being. This supports a clinical recommendation for regular aerobic exercise among persons with chronic or remote mTBI. Future longitudinal analyses of the exercise-cognition relationship in chronic mTBI populations are recommended.
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Remote military operations require rapid response times for effective relief and critical care. Yet, the military theater is under austere conditions, so communication links are unreliable and subject to physical and virtual attacks and degradation at unpredictable times. Immediate medical care at these austere locations requires semi-autonomous teleoperated systems, which enable the completion of medical procedures even under interrupted networks while isolating the medics from the dangers of the battlefield. However, to achieve autonomy for complex surgical and critical care procedures, robots require extensive programming or massive libraries of surgical skill demonstrations to learn effective policies using machine learning algorithms. Although such datasets are achievable for simple tasks, providing a large number of demonstrations for surgical maneuvers is not practical. This article presents a method for learning from demonstration, combining knowledge from demonstrations to eliminate reward shaping in reinforcement learning (RL). In addition to reducing the data required for training, the self-supervised nature of RL, in conjunction with expert knowledge-driven rewards, produces more generalizable policies tolerant to dynamic environment changes. A multimodal representation for interaction enables learning complex contact-rich surgical maneuvers. The effectiveness of the approach is shown using the cricothyroidotomy task, as it is a standard procedure seen in critical care to open the airway. In addition, we also provide a method for segmenting the teleoperator's demonstration into subtasks and classifying the subtasks using sequence modeling. ⋯ Results indicate that the proposed interaction features for the segmentation and classification of surgical tasks improve classification accuracy. The proposed method for learning surgemes from demonstrations exceeds popular methods for skill learning. The effectiveness of the proposed approach demonstrates the potential for future remote telemedicine on battlefields.
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Observational Study
Mental Health Predictors of Response to Standard Medical Intervention at a Military Pain Specialty Clinic.
Chronic pain among active duty service members can negatively impact operational readiness and contributes to significant health care costs within military treatment facilities. Response to standard medical intervention (SMI) for chronic pain is highly variable. The objective of the current study was to examine whether mental health indicators predict individual variation in response to SMI for chronic pain in a military pain specialty clinic. ⋯ Higher pretreatment PTSD and fatigue symptoms may portend poorer response to SMI for chronic pain. Poor response to treatment may also be predicted by lower pretreatment anger. Further investigation is warranted to identify the best strategies for treating chronic pain in military treatment facilities when these conditions are identified during initial evaluation.
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Randomized Controlled Trial
Predictors of Sustained Response to Functional Restoration in a Military Population.
The purpose of this study was to determine if improvement in pain impact and functional performance following a functional restoration (FR) program was sustained up to 6 months posttreatment and to identify predictors of sustained improvement. ⋯ This study supports the investment of treatment time in FR to yield sustained clinically meaningful improvement, as observed in over 40% of this study's military participants. Pretreatment predictors of sustained response included lower pain catastrophizing and absence of neuropathic pain. Further research is needed to determine if treatments that improve pain catastrophizing and neuropathic pain will result in sustained improvement in pain impact and functional performance following FR program participation.
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Apps that support telemedicine on the battlefield typically run on classified devices and transmit information over classified networks, whereas the medical data the apps create and transmit are unclassified. Current systems treat these data as classified, so a cross-domain solution is required to transfer the data back to an unclassified domain, which adds delays and costs to the process of transmitting critical data needed to treat injured warfighters. To address this gap, ATC-NY developed DroidChamber, which is a software-based Android system that enables multilevel security and which runs on smartphones and tablets. DroidChamber enables warfighters to execute apps in multiple security domains without risking information leakage. ⋯ DroidChamber improves telemedicine applications by enabling the warfighter to share information without requiring a cross-domain guard that may erroneously block some data. Using DroidChamber, a warfighter can use a single mobile device to manage/transmit data at different security levels, thereby reducing the cost and complexity of a mission.