Combat Medic-Performed Auscultation Versus Thoracic Ultrasound Image Interpretation for Pneumothorax Detection: Look or Listen?

Background Pneumothorax (PTX) is a potentially life-threatening condition encountered by U.S. Army combat medics on the battlefield. PTX, when left untreated, can progress to tension PTX, a leading cause of preventable death on the battlefield which can be difficult to diagnose based on physical exam alone due to variable physical exam findings. Prior literature shows medics can accurately use point-of-care ultrasound (POCUS) to diagnose PTX in cadaver and porcine models; however, no studies have directly compared the diagnostic accuracy of ultrasound (US) and physical exams performed by this population. We sought to compare medic diagnostic accuracy of a simulated PTX using these two diagnostic modalities. Methodology We conducted a prospective, observational study in which medics from the Flight Paramedic Program at Joint Base San Antonio-Sam Houston, TX received a standardized 30-minute training on physical exam and US diagnosis of PTX, followed by a 20-minute hands-on US familiarization session. Participants were then randomly selected into cohorts to evaluate 12 high-fidelity manikin lung fields and 12 thoracic US video clips for the presence of PTX in a simulated combat environment. Cohorts evaluated the same manikins and thoracic US video clips but in opposing sequences. Our primary outcome compared the sensitivity and specificity of PTX identification via thoracic US image interpretation and physical exam. Results In total, 21 medics evaluated 252 hemithoraces and interpreted 252 thoracic US images. We found a statistically significant difference favoring medics' sensitivity with US image interpretation over physical exam to detect PTX (85.7% vs. 72.4%, p = 0.004). There was no statistically significant difference in specificity between these modalities (81.9% vs. 69.4%, p = 0.139). Conclusions After brief training, medics demonstrated greater sensitivity to detect PTX using thoracic US image interpretation compared to physical exam in a simulated combat environment. Further studies involving medics' ultrasound image acquisition capability in human patients in austere combat environments are warranted.

A comparative analysis of punching in boxing and sanda: kinematic differences based on the cross and uppercut.

Background: This research aims to compare the differences in kinematic parameters associated with cross and uppercut punches between Sanda athletes (SA) and Boxing athletes (BA) to analyze their impacts on peak punching speed. Methods: The punches of BA (n = 20) and SA (n = 20) were compared utilizing a three-dimensional (3D) framework and high-speed cameras in terms of 13 key parameters. An independent samples t-test (α = 0.05) was employed to analyze the differences in punching between BA and SA. Meanwhile, a stepwise multiple linear regression equation was developed to analyze the influence of selected parameters on peak punching speed. Results: The results reveal that, among the 13 kinematic parameters, the six cross-related parameters and four uppercut-related parameters are significantly different (both p ≤ 0.05). The results of multivariate regression analysis unveils that the peak punching speed for the cross are influenced by the anteroposterior position of the center of gravity (in BA) and the maximum angular velocity of the shoulder (in SA). In contrast, for both BA and SA, the maximum angular velocity of the shoulder plays a critical impact on uppercut. Conclusions: These findings indicate that trunk and upper limbs significantly influence the peak punching speed, which provides suggestions for daily training regimen of SA and BA as well as their coaches.

Perception of success among adults practicing various fighting arts.

Problem statement: Goal orientations, which influence learning and motivation, are categorized into task orientation (focused on skill development and personal mastery) and ego orientation (focused on outperforming others and gaining recognition). This study aims to explore how different demographics perceive success in martial arts. Approach and purpose: The research questions focused on identifying correlations between perceptions of success and demographic factors: (1) sex, (2) age, (3) type of martial art practiced, and (4) nationality. These factors were examined to understand their impact on success perceptions among martial arts practitioners. Materials and methods: The study utilized the Perception of Success Questionnaire (POSQ) to gather data from 268 participants-142 from Poland and 126 from Ukraine-selected through voluntary participation. Statistical analyses included standard deviation, coefficient of variability, Spearman's rank correlation, and ANOVA for multifactor analysis. Results: The study revealed a weak correlation between the type of martial art practiced and perception of success (r s = 0.38), indicating that the style of martial art has limited influence on success perception. There was a weak correlation between nationality and perception of success (r s = 0.20), suggesting cultural factors do not play a role. A strong correlation was found between age and perception of success (r s = 0.80), highlighting how perceptions evolve with age. A significant correlation was also found between sex and perception of success (r s = 0.90), which may reflect broader cultural patterns influenced by globalization. Conclusion: While the study identifies important demographic correlations affecting perceptions of success in martial arts, the findings are constrained by the sample size and demographic distribution, which limits the generalizability of the results. Further research with a larger and more diverse sample is recommended to deepen understanding.

Anaerobic Performance Profiling in Elite Amateur Boxers.

While anaerobic fitness is highly important for the performance in Olympic (amateur) boxing, the relationship between anaerobic performance metrics is poorly understood, and profiling boxers according to their anaerobic capacity is still a challenge. With the current study in elite amateur boxers, we aimed to compare the metabolic and cardiovascular responses to different maximal tests and the intercorrelations between performance indices (peak and mean power, duration of the test, punching frequency) of several all-out tests and their correlation to physiological response metrics (blood lactate and heart rate, HR). Twelve male Olympic boxers performed a battery of tests, including 30 s Wingate cycling and arm cranking, boxing bag punching, steep uphill treadmill running to exhaustion, and progressive treadmill running VO2max test. Performance indices of different anaerobic tests were not closely correlated except for the duration of uphill running with body weight scaled (relative) peak and mean power produced during Wingate cycling test and absolute mean power of both Wingate tests. The number of punches landed on a bag per 30 s was associated only with relative power achieved during Wingate cycling test. HRpeak but not peak lactate response correlated strongly across exercise tasks. Finally, no correlation between the highly developed aerobic and anaerobic capacity, suggests a complex picture of the adaptation in elite amateur boxers.

Improved Antioxidant Status after Diet Supplementation with Novel Natural-Based Supplement in Combat Athletes.

BACKGROUND: Intense physical activity is known to generate high levels of oxidative stress, and supplementation with bioactive products with powerful antioxidant effects is often recommended. In this context, the present study aims to evaluate the potential benefits of supplementing the diet of professional combat fighters with a new bioactive formulation based on Aronia melanocarpa (black chokeberry) and bee pollen, a natural combination with a balanced ratio of macro- and micronutrients, rich in proteins and polyphenols. METHODS: A total of 31 professional combat fighters were selected to participate in this study. Due to allergic medical history, two were excluded, and the remaining 29 were divided into two groups: 14 in the control and 15 in the supplementation group. The supplemented group consumed daily 40 g of novel supplement based on a combination of dried black chokeberry and bee pollen (1:2 ratio) for 4 weeks. RESULTS: A statistically significant increase in plasma antioxidant capacity was observed in the supplemented group compared to control related to the time and group factors at the end of this study. During this study, a significant increase in neutrophils was recorded in both groups. Supplementation with black chokeberry and bee pollen generated no significant modifications in inflammatory markers, body composition, glycemia, maximum aerobic capacity, blood glycemia, hemoglobin or red cell line. CONCLUSION: This clinical study pointed out a positive result in terms of plasma antioxidant capacity upon administration of the novel nutraceutical formulation.

Traumatic brain injury is associated with the subsequent risk of atrial fibrillation or atrial flutter.

BACKGROUND: Traumatic brain injury (TBI) is associated with a variety of adverse long-term outcomes and increases sympathetic nervous system activation, which could increase the risk of arrhythmias including atrial fibrillation or atrial flutter (AF/AFL). OBJECTIVE: We examined episodes of TBI and subsequent AF/AFL in a large cohort of post-9/11 servicemembers and veterans. METHODS: The variable of interest was TBI, stratified by severity (mild, moderate/severe, and penetrating). The outcome was a subsequent diagnosis of AF/AFL. We used Fine-Gray competing risks models to evaluate the potential risk imparted by TBI on subsequent AF/AFL. RESULTS: Of the 1,924,900 participants included in the analysis, 369,891 (19.2%) experienced an episode of documented TBI. Most were young (63% <35 years), male (81.7%), and non-Hispanic White (62.7%). AF/AFL was diagnosed in 22,087 patients. On univariate analysis, only penetrating TBI (hazard ratio [HR], 2.02; 95% confidence interval [CI], 1.84-2.23; P < .001) was associated with AF/AFL compared with veterans without TBI. After adjustment in the full multivariable model (adjusted for age, sex, race and ethnicity, service branch, rank, component, and comorbidities), mild (HR 1.27, 95% CI 1.22-1.32; P < .001), moderate/severe (HR, 1.34; 95% CI, 1.24-1.44; P < .001), and penetrating TBI (HR, 1.82; 95% CI, 1.65-2.02; P < .001) were significantly associated with AF/AFL compared with no TBI. Post hoc analyses demonstrated that the risk of AF/AFL was concentrated in female and younger patients. CONCLUSION: We found that an episode of TBI, particularly penetrating TBI, significantly increased the risk for AF/AFL. Further work is needed to delineate the long-term risk of arrhythmias after TBI.

A Comparative Analysis of High-Intensity Technique-Specific Intervals and Short Sprint Interval Training in Taekwondo Athletes: Effects on Cardiorespiratory Fitness and Anaerobic Power.

Technique-specific high-intensity interval training (HIITTS) has been proven to be an effective method to enhance the sport-specific bio-motor abilities of taekwondo athletes. However, studies regarding its effects on comprehensive measures of cardiorespiratory fitness are limited. Furthermore, there is a lack of clarity regarding the extent of individual adaptations to this method compared to HIIT in the form of repeated sprints (HIITRS). This study compared the individual adaptations to HIITRS and HIITTS on cardiorespiratory fitness and anaerobic power in trained taekwondo athletes (age = 19.8 ± 1.3 years; body mass = 75.4 ± 9.1 kg; height = 1.73 ± 0.0 .m). All participants completed three sessions per week of a 60-minute regular taekwondo training. Following the 60-minute training, participants completed 3 sets of 10 × 4 s all-out HIITRS or same sets of repeated kicks with both legs (HIITTS) over a 6-week training period. In both groups, rest intervals were set at 15 seconds between efforts and one minute between sets. Before and after the training period, participants underwent a series of lab- and field-based tests to evaluate cardiorespiratory fitness and bio-motor abilities. Both interventions resulted in significant improvements in maximum oxygen uptake (V̇O2max), O2 pulse (V̇O2/HR), first ventilatory threshold (VT1), second ventilatory threshold (VT2), cardiac output (Q̇max), stroke volume (SV), peak power output (PPO), average power output (APO), squat jump (SJ), and countermovement jump (CMJ). However, linear speed (20-m speed time) and taekwondo-specific agility test (TSAT) only responded to HIITRS. HIITRS resulted in greater changes in V̇O2max, V̇O2/HR, VT2, and Q̇max, and higher percentage of responders in measured parameters than HIITTS. In addition, HIITRS elicited lower inter-individual variability (CV) in percent changes from pre- to post-training in all measured variables. These results suggest that incorporating 3 sessions per week of HIITRS into regular taekwondo training results in significantly greater and more homogenized adaptations in cardiorespiratory fitness and bio-motor abilities than HIITTS among trained taekwondo athletes.

Posttraumatic growth among Israeli female combat veterans: The mediating roles of posttraumatic stress symptoms and self-efficacy.

Posttraumatic growth (PTG) is a possible common reaction to exposure to potentially traumatic events (PTEs) during military service. However, knowledge about correlates of PTG among female combat veterans is sparse. This study examines associations between combat exposure, posttraumatic stress symptoms (PTSS), general self-efficacy (GSE), and PTG among Israeli female veterans. This is a cross-sectional studyA volunteer sample of female Israeli combat veterans (n = 616) and non-combat veterans (n = 484) responded to self-report questionnaires. Combat veterans reported higher levels of combat exposure, PTSS, GSE, and PTG, as compared to non-combat veterans. Among combat veterans, combat exposure and GSE were associated with greater PTG. Importantly, PTSS and GSE mediated the link between combat exposure and PTG. The study's findings are among the first to report about possible psychological growth outcomes among Israeli combat veterans. Clinicians treating female veterans coping with combat trauma should be aware of the heterogeneity of reactions to military service challenges and the importance of enhancing veterans' GSE to facilitate PTG.

Tactical Psychiatric Care: Proposed Guideline.

There is no concise guideline on how to manage a full range of emergency psychiatric conditions that are likely to be encountered on the battlefield. This article examines the best practices on how to best assess and treat suicidality, psychosis, agitation, malingering, and combat stress reactions in accordance with multiple clinical practice guidelines. The result is a proposed model for battlefield emergency psychiatric care.

Blast injuries: The experience of a level 1 trauma center.

BACKGROUND: There is a global surge in blast injuries, which are associated with high morbidity and mortality. To our knowledge, there are no guidelines for the management of blast injuries in the trauma bay. METHODS: This single-center retrospective cohort study utilized data on all patients admitted to our emergency department (ED) with terror- or combat-related injuries between October 7, 2023 (Gaza Iron Swords War onset) and February 4, 2024. The primary outcome was trauma severity indicated by either an injury severity score (ISS) >15 and/or need for acute care. We also analyzed the mechanisms of injuries, focusing on those resulting from blasts. RESULTS: Of 208 patients who were admitted following terror-and combat related injuries, 109 patients (101 males [93 %], median age 24.0 years) were admitted following blast injuries. Of them, 88 % were military personnel and 12 % were civilians, with a median ISS of 8 [IQR:4.0-17.0]. The level of trauma was severe in 48 patients (44 %). Tertiary sub-category of blast injuries (P =0.004), chest (P =0.032), abdomen (P =0.018), and lower extremities (P =0.044) injuries were significantly associated with severe trauma. Blast injuries mandated the urgent availability of specialist personnel and appropriate equipment to contend with multiple life-threatening sequelae of exposure to blasts upon the arrival of the victims to emergency services. CONCLUSION: Blast injuries present unique challenges in management and demand a multidisciplinary approach and specialized resources. We present an algorithm for terror- and combat-related blast injuries treated in our trauma bay. The step-by-step procedures may be applicable to any blast injury sustained under variable conditions.

No Replication of Alzheimer's Disease Genetics as a Moderator of Combat Exposure's Association with PTSD risk in 138,592 Combat Veterans.

Large-scale cohort and epidemiological studies suggest that posttraumatic stress disorder (PTSD) confers risk for late-onset Alzheimer's disease (AD) and related dementias (ADRD); however, the basis for this association remains unclear. Several prior studies of military Veterans have reported that carriers of the apolipoprotein E (APOE) ε4 gene variant are at heightened risk for the development of PTSD following combat exposure, suggesting that PTSD and ADRD may share some genetic risk. This cohort study was designed to further examine the hypothesis that ADRD genetic risk also confers risk for PTSD. To do so, we examined APOE ε4 and ε2 genotypes, an AD polygenic risk score (PRS), and other Veteran-relevant risk factors for PTSD in age-stratified groups of individuals of European (n = 123,372) and African (n = 15,220) ancestry in the US Department of Veterans Affairs' Million Veteran Program. Analyses revealed no significant main effect associations between the APOE ε4 (or ε2) genotype or the AD PRS on PTSD severity or diagnosis. There were also no significant interactions between measures of AD genetic risk and either combat exposure severity or history of head injury in association with PTSD in any age group. We conclude that the association between PTSD and the primary ADRD genetic risk factor, APOE ε4, that was reported previously was not replicable in the largest relevant dataset in the world. Thus, the epidemiological association between PTSD and ADRD is not likely to be driven by the major genetic factors underlying ADRD risk.

Investigation of ComBat Harmonization on Radiomic and Deep Features from Multi-Center Abdominal MRI Data.

ComBat harmonization has been developed to remove non-biological variations for data in multi-center research applying artificial intelligence (AI). We investigated the effectiveness of ComBat harmonization on radiomic and deep features extracted from large, multi-center abdominal MRI data. A retrospective study was conducted on T2-weighted (T2W) abdominal MRI data retrieved from individual patients with suspected or known chronic liver disease at three study sites. MRI data were acquired using systems from three manufacturers and two field strengths. Radiomic features and deep features were extracted using the PyRadiomics pipeline and a Swin Transformer. ComBat was used to harmonize radiomic and deep features across different manufacturers and field strengths. Student's t-test, ANOVA test, and Cohen's F score were applied to assess the difference in individual features before and after ComBat harmonization. Between two field strengths, 76.7%, 52.9%, and 26.7% of radiomic features, and 89.0%, 56.5%, and 0.1% of deep features from three manufacturers were significantly different. Among the three manufacturers, 90.1% and 75.0% of radiomic features and 89.3% and 84.1% of deep features from two field strengths were significantly different. After ComBat harmonization, there were no significant differences in radiomic and deep features among manufacturers or field strengths based on t-tests or ANOVA tests. Reduced Cohen's F scores were consistently observed after ComBat harmonization. ComBat harmonization effectively harmonizes radiomic and deep features by removing the non-biological variations due to system manufacturers and/or field strengths in large multi-center clinical abdominal MRI datasets.

Experimental investigation of a viscoelastic liner to reduce under helmet overpressures and shock wave reflections.

Introduction: Shock wave overpressure exposures can result in blast-induced traumatic brain injury (bTBI) in warfighters. Although combat helmets provide protection against blunt impacts, the protection against blast waves is limited due to the observed high overpressures occurring underneath the helmet. One route to enhance these helmets is by incorporating viscoelastic materials into the helmet designs, reducing pressures imposed on the head. This study aims to further investigate this mitigation technique against under-helmet overpressures by adding a viscoelastic liner to the inside of a combat helmet. Methods: The liner's effectiveness was evaluated by exposing it to free-field blasts of Composition C-4 at overpressures ranging from 27.5 to 165 kPa (4 - 24 psi) and comparing shock waveform parameters to an unlined helmet. Blasts were conducted using an instrumented manikin equipped with and without a helmet and then with a helmet modified to incorporate a viscoelastic liner. Evaluation of blast exposure results focused on the waveform parameters of peak pressure, impulse and positive phase duration. Results: The results show that peak overpressure was higher when wearing a helmet compared to not wearing a helmet. However, the helmet with the viscoelastic liner reduced the average peak overpressures compared to the helmet alone. For the lowest overpressure tested, 27.5 kPa, the helmet liner decreased the overpressure on the top of the head by 37.6%, with reduction reaching 26% at the highest overpressure exposure of 165 kPa. Additionally, the inclusion of the viscoelastic material extended the shock waveforms' duration, reducing the rate the shock wave was applied to the head. The results of this study show the role a helmet and helmet design play in the level of blast exposure imposed on a wearer. The testing and evaluation of these materials hold promise for enhancing helmet design to better protect against bTBI.

A novel intervention for acute stress reaction: exploring the feasibility of ReSTART among Norwegian soldiers.

Background: Soldiers in combat may experience acute stress reactions (ASRs) in response to trauma. This can disrupt function, increasing both immediate physical danger and the risk for post-trauma mental health sequelae. There are few reported strategies for managing ASRs; however, recent studies suggest a novel peer-based intervention as a promising approach.Objectives: This study assesses the feasibility of ReSTART training, a peer-based course designed to prepare soldiers to manage ASRs. ReSTART builds on programmes established by US and Israeli militaries. The current study evaluates the ReSTART programme in a Norwegian setting, across distinct groups of soldiers, professionals and conscripts.Methods: Participants included professional soldiers deploying to Mali and conscripts with 6 months of service, who completed the ReSTART training course and surveys administered pre- and post-training. These surveys assessed attitudes and programme acceptability. Analyses included 74 soldiers who provided complete survey responses.Results: ReSTART training received high ratings in terms of usefulness, relevance, and importance in managing ASRs. From pre- to post-training, respondents had significant increases in positive attitudes towards ASR management and confidence in handling ASRs personally, and at the unit level; decreases in stigma-related attitudes associated with ASRs; and increased perception of leadership emphasizing ASR management.Conclusions: ReSTART training shows potential as an effective tool when preparing soldiers to manage ASRs in high-risk environments, enhancing military units' capacity to support each other and effectively respond to stress-induced functional disruptions. This study adds evidence supporting the utility of peer-based ASR management in operational settings and highlights the need for broader implementation and systematic evaluation.

This study is the first study outside the US and Israeli context to systematically evaluate the feasibility of peer-based interventions for Acute Stress Reactions (ASRs) during combat.Results show that a novel Norwegian Armed Forces training programme, called ReSTART, is strongly endorsed as a means to prepare soldiers for managing ASRs.The study also demonstrates that completing ReSTART training positively impacts changes in self-confidence in ASR management, confidence in others' ability to manage ASRs, perceptions of leadership emphasis of ASR management, and stigma related to ASRs.This investigation represents the first investigation of how suitable training for peer-based ASR interventions is for inexperienced conscripted soldiers. Findings show that overall, ReSTART training has high suitability for both professional soldiers and conscripts with less than 6 months of service.Findings demonstrate the utility of peer-based interventions like ReSTART in European militaries. Moreover, the study has implications for preparing inexperienced recruits such as newly mobilized Ukrainian soldiers currently being trained by NATO partners.

The association between perceived social support and mental health in combat-injured and uninjured male UK (ex-)military personnel: A cross-sectional study.

Social support is a key determinant of mental health across multiple populations and contexts. Little is known about social support among UK (ex-)military personnel, especially those with combat injuries following deployment to Afghanistan. This study aimed to investigate the level of perceived social support and its associations with mental health among injured and uninjured UK (ex-)military personnel. An analysis of baseline data from the Armed Services Trauma Rehabilitation Outcome (ADVANCE) prospective cohort study was performed. A representative sample of male UK combat-injured personnel was compared with a frequency-matched sample of uninjured personnel. Validated questionnaires were completed including the Multidimensional Scale of Perceived Social Support (MSPSS). MSPSS score was transformed using linear splines with a knot at ≥ 55. Multivariable logistic regression analyses examined associations between perceived social support and mental health. In total, 521 combat-injured participants (137 with amputations) and 515 uninjured participants were included. Median MSPSS score was 65 (interquartile range [IQR] 54-74). Injured and uninjured participants reported similar MSPSS scores, as did those injured with amputations, and non-amputation injured participants. For each one unit increase in MSPSS score (for scores ≥55), the odds of post-traumatic stress disorder decreased (adjusted odds ratio [AOR] 0.93, 95% confidence interval [CI] 0.91 to 0.96). No such association was found with MSPSS scores below 55 (AOR 0.99, 95% CI 0.97 to 1.01). Similar results were observed for depression and anxiety. Perceived social support may be a target for intervention within this population, irrespective of injury status.

Evaluation of Mean Shift, ComBat, and CycleGAN for Harmonizing Brain Connectivity Matrices Across Sites.

Connectivity matrices derived from diffusion MRI (dMRI) provide an interpretable and generalizable way of understanding the human brain connectome. However, dMRI suffers from inter-site and between-scanner variation, which impedes analysis across datasets to improve robustness and reproducibility of results. To evaluate different harmonization approaches on connectivity matrices, we compared graph measures derived from these matrices before and after applying three harmonization techniques: mean shift, ComBat, and CycleGAN. The sample comprises 168 age-matched, sex-matched normal subjects from two studies: the Vanderbilt Memory and Aging Project (VMAP) and the Biomarkers of Cognitive Decline Among Normal Individuals (BIOCARD). First, we plotted the graph measures and used coefficient of variation (CoV) and the Mann-Whitney U test to evaluate different methods' effectiveness in removing site effects on the matrices and the derived graph measures. ComBat effectively eliminated site effects for global efficiency and modularity and outperformed the other two methods. However, all methods exhibited poor performance when harmonizing average betweenness centrality. Second, we tested whether our harmonization methods preserved correlations between age and graph measures. All methods except for CycleGAN in one direction improved correlations between age and global efficiency and between age and modularity from insignificant to significant with p-values less than 0.05.

Lessons learned from the war in Ukraine for the anesthesiologist and intensivist: A scoping review.

BACKGROUND: The war in Ukraine provides purposefully anesthesiologists and intensivists with important data for improving the management of trauma patients. This scoping review aims to investigate the specific management of war-related trauma patients, during the war in Ukraine, through an objective and comprehensive analysis. METHODS: A comprehensive search of the Embase, Medline, and Open Grey databases from 2014 to February 2024 yielded studies focusing on anesthesia and surgery. These studies were assessed by PRISMA and STROBE criteria and needed to discuss anesthesiology and surgical procedures. RESULTS: Of the 519 studies identified, 21 were included, with a low overall level of evidence. The studies covered 11,622 patients and 2470 surgical procedures. Most patients were Ukrainian men, 25-63 years old, who had sustained severe injuries from high-energy weapons, such as multiple rocket systems and combat drones. These injuries included major abdominal, facial, and extremity traumas. The surgical procedures varied from initial debridement to complex reconstructions. Anesthesia management faced significant challenges, including resource scarcity and the need for quick adaptability. Evacuations of casualties were lengthy, complex, and often involved rail transportation. Hemorrhage control with tourniquets was critical but associated with many complications. The very frequent presence of multi-resistant organisms required dedicated preventive measures and appropriated treatments. The need for qualified human resources underscored the importance of civilian-military cooperation. CONCLUSION: This scoping review provides original and relevant insights on the lessons learned from the ongoing war in Ukraine, which could be useful for anesthesiologists and intensivists.

Non-therapeutic laparotomies in military trauma (2009-2014).

BACKGROUND: Combat casualties are frequently injured in austere settings where modern imaging modalities are unavailable. Exploratory laparotomies are often performed in these settings when there is suspicion for intra-abdominal injury. Prior studies of combat casualties reported non-therapeutic laparotomy (NTL) rates as high as 32%. Given improvements in combat casualty care over time, we evaluated NTLs performed during later years of the wars in Iraq and Afghanistan. METHODS: Military personnel with combat-related injuries (6/1/2009-12/31/2014) who underwent exploratory laparotomy based on concern for abdominal injury (i.e. not performed for proximal vascular control or fecal diversion) and were evacuated to Landstuhl Regional Medical Center (Germany) before being transferred to participating U.S. military hospitals were assessed. An NTL was defined as a negative laparotomy without substantial intra-abdominal injuries requiring repair. Characteristics, indications for laparotomy, operative findings, and outcomes were examined. RESULTS: Among 244 patients who underwent laparotomies, 41 (16.8%) had NTLs and 203 (83.2%) had therapeutic laparotomies (i.e. positive findings). Patients with NTLs had more computed tomography scans concerning for injury (48.8% vs 27.1%; p = 0.006), less penetrating injury mechanisms (43.9% vs 71.9%; p < 0.001), and lower Injury Severity Scores (26 vs 33; p = 0.003) compared to patients with therapeutic laparotomies. Patients with NTLs were also less likely to be admitted to the intensive care unit (70.7 vs 89.2% for patients with therapeutic laparotomies; p = 0.007). No patients with NTLs developed abdominal surgical site infections (SSI) compared to 16.7% of patients with therapeutic laparotomies (p = 0.002). There was no significant difference in mortality between the groups (p = 0.198). CONCLUSIONS: Our proportion of NTLs was lower than reported from earlier years during the wars in Iraq and Afghanistan. No infectious complications from NTLs (i.e. abdominal SSIs) were identified. Nevertheless, surgeons should continue to have a low threshold for exploratory laparotomy in military patients in austere settings with concern for intra-abdominal injury.

Effects of 12 weeks of functional training vs. Muay Thai on cardiac autonomic modulation and hemodynamic parameters in older adults: a randomized clinical trial.

BACKGROUND: The elevated blood pressure (BP) and lower cardiac autonomic modulation (CAM) are associated with higher morbidity mortality risk among older adults. Although exercise is an important intervention for cardiovascular promotion, it is unclear whether combat sports training could benefit cardiovascular outcomes as much as autonomic in this population. This study compared the effects of 12 weeks of Muay Thai (MT) training against functional training (FT) on CAM and hemodynamic parameters in older adults. METHODS: The sample consisted of 50 older adults (41 women; 66.0 ± 5.3 years old), who were equaly randomized into FT (n = 25) and MT (n = 25) intervention groups. CAM was measured by 30-min rest heart rate variability. Systolic blood pressure (SBP), diastolic blood pressure (DBP) and resting heart rate (RHR) were measured using an automatic oscillometric device. Pulse pressure (PP) and the double product (DP) were also calculated. The interventions were carried out three times a week, with 60-min length per session, during 12 consecutive weeks. The intensity of the interventions was measured using the subjective perception of exertion scale and by accelerometer. Two-factor repeated measures analysis of covariance was used for groups comparison, considering intervention group and body mass as factors. The 95% confidence interval of the difference (95%CIdif) was also calculated and the effect size was measured using partial eta squared (η2p). RESULTS: CAM indices did not show significant changes across moments and intervention groups. In hemodynamic parameters, only in DBP was there an effect of the moment (F1,39 = 8.206; P = 0.007; η2p = 0.174, large) and interaction effect between group*moment (F1,39 = 7.950; P = 0.008; η2p = 0.169, large). Specifically, the MT group at the post-training moment showed lower DBP (P = 0.010; 95%CIdif = -13.3; -1.89) in relation to the FT group. Furthermore, the MT group showed a decrease in DBP during training (P = 0.002; 95%CIdif = -10.3; -2.6). Also, an increase in training intensity was also found over the 12 weeks in FT, with no difference between the groups. CONCLUSION: After 12 weeks of MT practice there was a reduction in DBP compared to FT in older adults. TRIAL REGISTRATION: NCT03919968 Registration date: 01/02/2019.

Boxing Punch Detection with Single Static Camera.

Computer vision in sports analytics is gaining in popularity. Monitoring players' performance using cameras is more flexible and does not interfere with player equipment compared to systems using sensors. This provides a wide set of opportunities for computer vision systems that help coaches, reporters, and audiences. This paper provides an introduction to the problem of measuring boxers' performance, with a comprehensive survey of approaches in current science. The main goal of the paper is to provide a system to automatically detect punches in Olympic boxing using a single static camera. The authors use Euclidean distance to measure the distance between boxers and convolutional neural networks to classify footage frames. In order to improve classification performance, we provide and test three approaches to manipulating the images prior to fitting the classifier. The proposed solution achieves 95% balanced accuracy, 49% F1 score for frames with punches, and 97% for frames without punches. Finally, we present a working system for analyses of a boxing scene that marks boxers and labelled frames with detected clashes and punches.