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Item A Two-Stage Approach Integrating Provisional Biomaterial-Mediated Stabilization Followed by a Definitive Treatment for Managing Volumetric Muscle Loss Injuries(MDPI, 2024-06-06) Clark, Andrew R.; Kulwatno, Jonathan; Kanovka, Sergey S.; Klarmann, George J.; Hernandez, Claudia E.; Natoli, Roman M.; McKinley, Todd O.; Potter, Benjamin K.; Dearth, Christopher L.; Goldman, Stephen M.; Orthopaedic Surgery, School of MedicineTreatment of volumetric muscle loss (VML) faces challenges due to its unique pathobiology and lower priority in severe musculoskeletal injury management. Consequently, a need exists for multi-stage VML treatment strategies to accommodate delayed interventions owing to comorbidity management or prolonged casualty care in combat settings. To this end, polyvinyl alcohol (PVA) was used at concentrations of 5%, 7.5%, and 10% to generate provisional muscle void fillers (MVFs) of varying stiffness values (1.125 kPa, 3.700 kPa, and 7.699 kPa) to stabilize VML injuries as part of a two-stage approach. These were implanted into a rat model for a duration of 4 weeks, then explanted and either left untreated (control) or treated through minced muscle grafting (MMG). Additional benchmarks included acute MMG and unrepaired groups. At the MVF explant, the 7.5% PVA group exhibited superior neuromuscular function compared to the 5% and 10% PVA groups, the least fibrosis, and the largest median myofiber size among all groups at the 12-week endpoint. Despite the 7.5% PVA’s superiority amongst the two-stage treatment groups, neuromuscular function was neither improved nor impaired relative to acute treatment benchmarks. This suggests that the future success of a two-stage VML treatment strategy will necessitate a more effective definitive intervention.Item Ethics of Gene Therapy in the Military: Promise and Potential Problems(Elsevier, 2020-04-08) Schwartz, Peter H.; Medicine, School of MedicineItem In situ forming biomaterials as muscle void fillers for the provisional treatment of volumetric muscle loss injuries(Elsevier, 2023-09-02) Clark, Andrew; Kulwatno, Jonathan; Kanovka, Sergey S.; McKinley, Todd O.; Potter, Benjamin K.; Goldman, Stephen M.; Dearth, Christopher L.; Orthopaedic Surgery, School of MedicineVolumetric muscle loss (VML) represents a devastating extremity injury which leads to chronic functional deficits and disability and is unrecoverable through normal healing pathways. When left untreated, the VML pathophysiology creates many challenges towards successful treatment, such as altered residual muscle architecture, excessive fibrosis, and contracture(s). As such, innovative approaches and technologies are needed to prevent or reverse these adverse sequelae. Development of a rationally designed biomaterial technology which is intended to be acutely placed within a VML defect – i.e., to serve as a muscle void filler (MVF) by maintaining the VML defect – could address this clinical unmet need by preventing these adverse sequelae as well as enabling multi-staged treatment approaches. To that end, three biomaterials were evaluated for their ability to serve as a provisional MVF treatment intended to stabilize a VML defect in a rat model for an extended period (28 days): polyvinyl alcohol (PVA), hyaluronic acid and polyethylene glycol combination (HA + PEG), and silicone, a clinically used soft tissue void filler. HA + PEG biomaterial showed signs of deformation, while both PVA and silicone did not. There were no differences between treatment groups for their effects on adjacent muscle fiber count and size distribution. Not surprisingly, silicone elicited robust fibrotic response resulting in a fibrotic barrier with a large infiltration of macrophages, a response not seen with either the PVA or HA + PEG. Taken together, PVA was found to be the best material to be used as a provisional MVF for maintaining VML defect volume while minimizing adverse effects on the surrounding muscle.Item Patient Perception of Physician Attire in a Military Ophthalmology Clinic(Cureus, 2021-01-04) Scheive, Melanie; Gillis, John, II.; Gillis, Sarah; Legault, Gary L.; Ophthalmology, School of MedicineThe purpose of this study is to investigate patient preferences of physician attire in an outpatient military ophthalmology clinic to determine how these preferences affect patients' perceptions of physician competence and their overall clinical experience. Materials and methods This study is a prospective survey administered to patients at the ophthalmology clinic at Brooke Army Medical Center. USA. Patients who were willing to participate in a volunteer survey were included in this study. Demographic information and survey questions were utilized in this study along with words and pictures for patients to select a preference in physician attire in the clinic setting (scrubs, military uniform, or civilian professional attire) and surgical setting (surgical cap or a surgical bouffant). The survey asks patients if physician attire impacts patient confidence in physician abilities (yes or no) and if surgeon attire impacts the likelihood of the patient taking the surgeon's advice (yes or no). Results The demographic distribution includes 57-77 years old participants (53%), females (61%), retirees (49%), and dependent spouses (40%). The racial distribution includes 46% - Caucasian, 20% - African American, 22% - Hispanic, 6 - % Asian, and 6% - other. Most patient appointment types were established follow-up (77%) with only 12% new and 11% walk-in. The survey results (N=308) indicate that most patients (64%) did not have a preference in physician clinical attire, while 22% preferred scrubs, 11% preferred military uniform, and 3% preferred civilian attire. Most patients (66%) did not have a preference for surgical headwear, while 27% preferred the surgical cap, and 7% preferred the surgical bouffant. Only 9% of the patients surveyed indicated that physician attire impacted their confidence in their physician's ability, and 12% reported that attire impacted the likelihood of taking advice. Conclusions Most patients in an outpatient military ophthalmology clinic do not have a preference for physician attire or surgical headwear when surveyed. The majority of patients did not feel physician attire impacted their perception of physician's ability or their likelihood of taking advice. When indicating a preference, patients tended to prefer scrubs to outpatient civilian attire or military attire and trended towards preferring surgical cap over surgical bouffant for headwear.Item Veterans Hospital Administration Telehealth Utilization for Recreation and Creative Arts Therapies: A Brief Report(Liebert, 2021-08) Story, Kristin M.; Flanagan, Mindy E.; Brown, Heather A.; Robb, Sheri L.; Damush, Teresa M.; Otto, David; Medicine, School of MedicineBackground: A brief query was fielded to Veterans Health Administration (VHA) facilities across the United States to provide an initial assessment of recreation therapy (RT) and creative arts therapy (CAT) telehealth utilization. Methods: To develop an understanding of barriers and identify potential solutions for better delivery of services, a cross-sectional survey was deployed to points of contact at 136 VHA facilities. The survey included questions across five areas: staff, infrastructure, barriers to use, training, and interventions being deployed. Descriptive statistics were calculated, and a thematic analysis of qualitative responses was conducted. Results: The most frequent themes from aggregated responses indicated a need for hands-on training, reliable telehealth equipment, and accessible training and tools for Veteran patients who want to use telehealth services. Conclusion: Telehealth delivery of RT/CAT has increased services to Veteran patient populations; however, equipment and training are needed to expand consistent delivery to enhance patient reach across a national health care system.