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Clinical case definitions describe the criteria for diagnosing TBI and provide an important background for evaluating epidemiologic case definitions. Two clinical indicators, the occurrence of impairment of consciousness [also ref...
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Clinical case definitions describe the criteria for diagnosing TBI and provide an important background for evaluating epidemiologic case definitions. Two clinical indicators, the occurrence of impairment of consciousness [also referred to as alteration of consciousness (AOC), including loss of consciousness (LOC)] and post-traumatic amnesia (PTA), are the indicators most commonly used to assess acute brain injury severity and thus figure prominently in TBI clinical case definitions. The Glasgow Coma Scale (GCS) is the most widely used tool for assessing impaired consciousness (Teasdale and Jennett 1974) (Table 4.1)
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G-induced loss of consciousness (GLOC), first experienced at least 65 years ago, is still killing pilots. Second only to spatial disorientation as the number one human factors problem facing the Tactical Air Force, GLOC remains a ...
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G-induced loss of consciousness (GLOC), first experienced at least 65 years ago, is still killing pilots. Second only to spatial disorientation as the number one human factors problem facing the Tactical Air Force, GLOC remains a killer of both Air Force and Navy pilots. Various loss-of-consciousness research efforts in the Air Force and Navy have been initiated, but no loss-of-consciousness monitoring system (LOCOMS) has been developed for integration into modern fighter aircraft. One of the development problems is that such a LOCOMS should be invisible to the pilot and not require the donning of electrodes or special sensors that require the attention of the pilot, who will have other priorities to attend to. Taking advantage of technology originally developed for the hospital environment, the Harry G. Armstrong Aerospace Medical Research Laboratory at Wright-Patterson AFB has developed an integrated arterial oxygen saturation monitor oxygen mask system that monitors the % SaO2, pulse rate and pulse waveform of the pilot, even under 9 G . This paper describes the development and evaluation of the smart mask.
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Our primary aims have been to determine whether frontal WM microstructural integrity accounts for disparate cognitive outcomes in executive function following mild TBI (mTBI) and to determine if injury severity, as measured by los...
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Our primary aims have been to determine whether frontal WM microstructural integrity accounts for disparate cognitive outcomes in executive function following mild TBI (mTBI) and to determine if injury severity, as measured by loss of consciousness (LOC), is related to neuropsychological outcome and WM microstructural integrity. We examined a subgroup of mTBI participants with executive dysfunction and compared them to a group with intact executive functioning on DTI measures. Results showed that those with executive dysfunction showed significantly decreased fractional anisotropy (FA) values in the anterior corpus callosum as well as in the cingulum and prefrontal white matter regions. Additionally, across the entire sample, we have found that white matter integrity is strongly associated with performance on executive function measures. Finally, those participants with LOC revealed a higher proportion of executive impairment and a similar regional pattern of decreased FA, with additional group differences in the splenium of the corpus callosum.
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Background: An important medical concern of the Iraq war is the potential long-term effect of mild traumatic brain injury, or concussion, particularly from blast explosions. However, the epidemiology of combat-related mild traumat...
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Background: An important medical concern of the Iraq war is the potential long-term effect of mild traumatic brain injury, or concussion, particularly from blast explosions. However, the epidemiology of combat-related mild traumatic brain injury is poorly understood. Methods: We surveyed 2525 U.S. Army infantry soldiers 3 to 4 months after their return from a year-long deployment to Iraq. Validated clinical instruments were used to compare soldiers reporting mild traumatic brain injury, defined as an injury with loss of consciousness or altered mental status (e.g., dazed or confused), with soldiers who reported other injuries. Results: Of 2525 soldiers, 124 (4.9%) reported injuries with loss of consciousness, 260 (10.3%) reported injuries with altered mental status, and 435 (17.2%) reported other injuries during deployment. Of those reporting loss of consciousness, 43.9% met criteria for post-traumatic stress disorder (PTSD), as compared with 27.3% of those reporting altered mental status, 16.2% with other injuries, and 9.1% with no injury. Soldiers with mild traumatic brain injury, primarily those who had loss of consciousness, were significantly more likely to report poor general health, missed workdays, medical visits, and a high number of somatic and postconcussive symptoms than were soldiers with other injuries. However, after adjustment for PTSD and depression, mild traumatic brain injury was no longer significantly associated with these physical health outcomes or symptoms, except for headache. Conclusions: Mild traumatic brain injury (i.e., concussion) occurring among soldiers deployed in Iraq is strongly associated with PTSD and physical health problems 3 to 4 months after the soldiers return home. PTSD and depression are important mediators of the relationship between mild traumatic brain injury and physical health problems.
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The approach to aircraft autorecovery demands consideration of many aspects of fighter aircraft operations and aircrew requirements. Autorecovery may include only aircraft attitude monitoring or it may also include consideration o...
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The approach to aircraft autorecovery demands consideration of many aspects of fighter aircraft operations and aircrew requirements. Autorecovery may include only aircraft attitude monitoring or it may also include consideration of the aircrew. A knowledge of the kinetics of +Gz-induced loss of consciousness (G-LOC) allows early development of an inexpensive, non-encumbering, indirect method for G-LOC warning which may be followed by autorecovery if necessary. This indirect method has specific advantage for aerial combat training. Integration of an indirect monitoring system with the ground collision avoidance system currently being developed has the potential for earlier aircraft recovery. A suggested algorithm based on G-LOC physiology is given. Development of indirect monitoring systems provides valuable insight into future development of more sophisticated direct physiologic monitoring technology. It is currently not clear that the ability to reliably detect G-LOC with direct monitoring will automatically benefit aircrew during aerial combat. Keywords: Flight control systems; Acceleration tolerance; Autorecovery; Unconsciousness; Fighter aircraft G-LOC. (KT)
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Assessment of acute mild traumatic brain injury (mTBI) symptoms after a combat blast could aid diagnosis and guide follow-up care. This study s purposes were to document acute mTBI symptoms following a combat blast and to examine ...
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Assessment of acute mild traumatic brain injury (mTBI) symptoms after a combat blast could aid diagnosis and guide follow-up care. This study s purposes were to document acute mTBI symptoms following a combat blast and to examine associations between acute symptoms and mental health and service discharge outcomes. A retrospective cohort study was conducted of 1656 service personnel who experienced a combat blast-related mTBI in Iraq. Acute mTBI symptoms were ascertained from point-of-injury medical records. The associations between acute symptoms and posttraumatic stress disorder (PTSD), postconcussion syndrome (PCS), and type of service discharge were examined. Disability discharge occurred in 11%, while 36% had a non-disability discharge and 52% had no recorded discharge. A PTSD and PCS diagnosis was made in 19% and 15% of the sample, respectively. The most common acute mTBI symptoms were headache (62.8%), loss of consciousness (LOC) (34.5%), and tinnitus (33.2%). LOC was predictive of PTSD (odds ratio [OR] 1.54; 95% confidence interval [CI] 1.18, 2.00) and PCS (OR 2.08; 95% CI 1.56, 2.77), while altered mental status (OR 1.53; 95% CI 1.07, 2.17) and previous blast history (OR 1.83; 95% CI 1.15, 2.90) were also predictive of PCS. While no acute mTBI symptoms were associated with discharge outcomes, injury severity was associated with disability discharge. LOC after blast-related mTBI was associated with PTSD and PCS, and injury severity was predictive of disability discharge. The assessment of cognitive status immediately after a blast could assist in diagnosing mTBI and indicate a need for follow-up care.
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The DoD Inspector General (IG) conducted a review of the AlB for adherence to procedures set forth in Air Force Instruction (AFI) 51-503, 'Aerospace Accident Investigations.' This review was self-initiated and began on January 25,...
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The DoD Inspector General (IG) conducted a review of the AlB for adherence to procedures set forth in Air Force Instruction (AFI) 51-503, 'Aerospace Accident Investigations.' This review was self-initiated and began on January 25, 2012. Our assessment also determined if the AlB conclusions were supported by the evidence of record consistent with the standard of proof established by AFI 51-503. In conducting our review, we were especially mindful of the general consideration, as stated within the AFI, that conducting a thorough and timely investigation is a high priority for the Air Force, NoK the Next of Kin of deceased Air Force personnel, injured personnel, and the public.' We concluded that the AlB Statement of Opinion regarding the cause of the mishap was not supported by the facts within the AlB report consistent with the clear and convincing standard of proof established by AFI 51-503. Our conclusion was suppmied by five individual findings, and we recommended that the AlB report be reevaluated in light of our findings. On October 04, 2012, we provided a copy of our draft report to the Air Force for comment.
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Morphine and fentanyl are frequently used for analgesia after trauma, but there is debate over the advantages and disadvantages of these opioids. Among combat amputees, intravenous (IV) morphine (vs IV fentanyl) after injury was a...
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Morphine and fentanyl are frequently used for analgesia after trauma, but there is debate over the advantages and disadvantages of these opioids. Among combat amputees, intravenous (IV) morphine (vs IV fentanyl) after injury was associated with reduced likelihood of posttraumatic stress disorder (PTSD). The previous results were based on military health diagnoses over 2 yr post-injury. The present study followed psychological diagnoses of patients with amputation for 4 yr using military and Department of Veterans Affairs health data. In theater combat casualty records (n = 145) documented Glasgow Coma Scale (GCS) scores and/or morphine, fentanyl, or no opioid treatment within hours of injury. We found that (1) GCS scores were not significantly associated with PTSD; (2) longitudinal modeling using four (yearly) time points showed significantly reduced odds of PTSD for patients treated with morphine (vs fentanyl) across years (adjusted odds ratio = 0.40; 95% confidence interval = 0.17-0.94); (3) reduced PTSD prevalence for morphine (vs IV fentanyl; morphine = 25%, fentanyl = 59%, p less than 0.05) was significant, specifically among patients with traumatic brain injury during the first 2 yr post-injury; and (4) PTSD prevalence, but not other disorders (e.g., mood), increased between year 1 (PTSD = 18%) and years 2 through 4 post-injury (PTSD range = 30%-32%).
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