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Article ; Online: Analysis of the U.S. Military Trauma System in Accordance With Doctrinal Levels of Warfare.

Baker, Jay B / Keenan, Sean / Duquette-Frame, Teresa A / Kotwal, Russ / Harvey, Andrew S / Cap, Andrew P / Shackelford, Stacy A / Gurney, Jennifer M

Military medicine

2023

Abstract: Introduction: In recent conflicts, the Joint Theater Trauma System (JTTS) led the systematic approach to improve battlefield trauma care, substantially contributing to the unprecedented survival of combat casualties. The Joint Trauma System (JTS) was ... ...

Abstract	Introduction: In recent conflicts, the Joint Theater Trauma System (JTTS) led the systematic approach to improve battlefield trauma care, substantially contributing to the unprecedented survival of combat casualties. The Joint Trauma System (JTS) was codified in 2016 to preserve the lessons learned and functions of the JTTS, including the Department of Defense Trauma Registry. Concurrently, Combatant Commands (CCMD) were directed to establish CCMD Trauma Systems (CTS) "modeled after the JTTS" and to maintain a baseline of core functions intended to rapidly scale as needed. The complex nature of both CCMDs and the military trauma system has challenged the full implementation of the CTS. Analyzing the historical experiences of the JTTS, JTS, and CTS within a military doctrinal framework might enable the further success of the military trauma system. Methods: The strategic, operational, and tactical levels of warfare, in accordance with Joint Publication 1-0, Doctrine of the Armed Forces of the United States, and Joint Publication 3-0, Joint Operations, established the analytic framework for this study. The literature regarding the JTTS, CTS, and JTS was reviewed for relevant information concerning organizational structure and functions of trauma system performance improvement (PI) capabilities. A comprehensive analysis was performed using a thematic approach to evaluating descriptive data contained within the collected data set. Deployed trauma system PI tasks, functions, and responsibilities were identified, defined, and correlated according to the respective levels of warfare. Results: The comprehensive analysis revealed both discrete and overlapping tasks, functions, and responsibilities of the trauma system PI capabilities at each of the three levels of warfare. Strategic-level actions were categorized according to 12 distinct themes: reduce mortality; strategic reporting; centralized trauma registry; strategic communications; centralized organization; direct support to CCMDs; Department of Defense policy and doctrine; strategic-level PI; clinical practice guidelines; training and readiness standards; force structure, standardization, and interoperability; and research and development. Operational-level actions were categorized according to seven distinct themes: theater trauma system policies and requirements; theater trauma system leadership; stakeholder coordination; theater communication; theater standards for readiness and skill sustainment; trauma system planning; and medical logistics support. Tactical-level actions were categorized according to seven distinct themes: trauma system personnel; PI; documentation enforcement and patient care data collection; tactical planning recommendations for employing medical assets; research support; communication and reporting; and training and skills sustainment. Conclusion: The deployed U.S. military trauma system requires a robust PI capability to optimize combat casualty care. Policy updates, a joint military trauma system doctrine, and force design updates are necessary for deployed military trauma system PI capabilities to function optimally across all levels of warfare.
Language	English
Publishing date	2023-02-25
Publishing country	England
Document type	Journal Article
ZDB-ID	391061-1
ISSN	1930-613X ; 0026-4075
ISSN (online)	1930-613X
ISSN	0026-4075
DOI	10.1093/milmed/usad053
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Article: Noninvasive ventilation in acute lung injury: caution is good, more evidence is better.

Keenan, Sean P

Respiratory care

2010 Volume 55, Issue 12, Page(s) 1757–1759

MeSH term(s)	Acute Lung Injury/therapy ; Clinical Protocols ; Humans ; Positive-Pressure Respiration ; Respiratory Distress Syndrome, Adult/therapy ; Treatment Outcome
Language	English
Publishing date	2010-12
Publishing country	United States
Document type	Comment ; Editorial
ZDB-ID	603252-7
ISSN	0020-1324 ; 0098-9142
ISSN	0020-1324 ; 0098-9142
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Article: Surgeon anterior cruciate ligament reconstruction volume and rates of concomitant meniscus repair.

Dadoo, Sahil / Meredith, Sean J / Keeling, Laura E / Hughes, Jonathan D / Keenan, Christopher / Viecelli, Mark / Irrgang, James J / Lesniak, Bryson P / Musahl, Volker

Journal of experimental orthopaedics

2023 Volume 10, Issue 1, Page(s) 61

Abstract: ... vs 10.7%, p < 0.001). Binary logistic regression indicated 4.15 times higher odds of meniscus repair ... repair among low-volume surgeons (6.7% vs 3.4%, p = 0.047), but not high-volume surgeons (7.0% vs 4.3%, p ... vs 118.3 min, p = 0.003) and meniscectomy (100.6 vs 95.9 min, p = 0.003).: Conclusions: Data ...

Abstract	Purpose: The purpose of this study was to assess the effect of surgeon anterior cruciate ligament reconstruction (ACLR) volume on rates of ACLR with concomitant meniscus repair versus meniscectomy and subsequent meniscus surgeries. Methods: A retrospective review was conducted from a database of all ACLR performed between 2015 and 2020 at a large integrated health care system. Surgeon volume was categorized as < 35 ACLR per year (low-volume), and ≥ 35 ACLR per year (high-volume). Rates of concomitant meniscus repair and meniscectomy were compared between low-volume and high-volume surgeons. Subgroup analyses compared the rates of subsequent meniscus surgery and procedure time based on surgeon volume and meniscus procedure type. Results: A total of 3,911 patients undergoing ACLR were included. High-volume surgeons performed concomitant meniscus repair statistically significantly more often than low-volume surgeons (32.0% vs 10.7%, p < 0.001). Binary logistic regression indicated 4.15 times higher odds of meniscus repair among high-volume surgeons. Subsequent meniscus surgery occurred more commonly following ACLR with meniscus repair among low-volume surgeons (6.7% vs 3.4%, p = 0.047), but not high-volume surgeons (7.0% vs 4.3%, p = 0.079). Low-volume surgeons also had longer procedure times for concomitant meniscus repair (129.9 vs 118.3 min, p = 0.003) and meniscectomy (100.6 vs 95.9 min, p = 0.003). Conclusions: Data from this study shows that surgeons with lower volume of ACLR select meniscus resection statistically significantly more often than higher-volume surgeons. However, an abundance of literature is available to show that meniscus loss negatively affects the development of post-traumatic osteoarthritis in patients Therefore, as demonstrated in this study by high-volume surgeons, the meniscus should be repaired and protected whenever possible. Level of evidence: III.
Language	English
Publishing date	2023-06-08
Publishing country	Germany
Document type	Journal Article
ZDB-ID	2780021-0
ISSN	2197-1153
ISSN	2197-1153
DOI	10.1186/s40634-023-00626-8
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Article ; Online: Guideline for laboratory diagnosis and monitoring of von Willebrand disease: A joint guideline from the United Kingdom Haemophilia Centre Doctors' Organisation and the British Society for Haematology.

Platton, Sean / Baker, Peter / Bowyer, Annette / Keenan, Catriona / Lawrence, Caroline / Lester, Will / Riddell, Anne / Sutherland, Megan

British journal of haematology

2024

Language	English
Publishing date	2024-03-26
Publishing country	England
Document type	Journal Article
ZDB-ID	80077-6
ISSN	1365-2141 ; 0007-1048
ISSN (online)	1365-2141
ISSN	0007-1048
DOI	10.1111/bjh.19385
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Article ; Online: Integrating assemblage structure and habitat mapping data into the design of a multispecies reef fish survey

Switzer, Theodore S. / Keenan, Sean F. / Thompson, Kevin A. / Shea, Colin P. / Knapp, Anthony R. / Campbell, Matthew D. / Noble, Brandi / Gardner, Chris / Christman, Mary C.

Marine and Coastal Fisheries. 2023 Aug., v. 15, no. 4 p.e10245-

2023

Abstract: OBJECTIVE: Since 2010, three spatially disjunct reef fish video surveys have provided fishery‐independent data critical to the assessment and management of reef fishes in the Gulf of Mexico. Although analytical approaches have recently been developed to ... ...

Abstract	OBJECTIVE: Since 2010, three spatially disjunct reef fish video surveys have provided fishery‐independent data critical to the assessment and management of reef fishes in the Gulf of Mexico. Although analytical approaches have recently been developed to integrate data from these surveys into a single measure of relative abundance and size composition, a more parsimonious approach would be to integrate survey efforts under a single Gulf‐wide survey design. Accordingly, we conducted a retrospective analysis of historical video‐ and habitat‐mapping data to develop a novel stratified random sampling design for conducting surveys of natural and artificial reef habitats. METHODS: We conducted a series of classification and regression tree analyses to delineate both spatial and habitat strata, and conducted simulations to assess the performance of an optimized survey design. RESULT: Spatially, classification and regression tree results identified three depth strata (10–25 m, >25–50 m, >50–180 m) and three regional strata (north‐central Gulf, Big Bend, southwest Florida) in the eastern Gulf. For both natural and artificial reefs, habitat strata were delineated based on a combination of relative relief (low, medium, high) and size of the individual reef feature, although reef scale differed markedly between natural (<100 m², 100–1000 m², >1000 m²) and artificial habitats (<25 m², 25–100 m², >100 m²). To optimize effort among sampling strata, effort was allocated proportionally based on a combination of habitat availability and managed‐species richness for each stratum. Simulation results indicated that relative median biases were <10% and relative median absolute deviations <30% on estimates of abundance for most species examined on natural reefs under the optimal design, except Greater Amberjack Seriola dumerili. These measures of bias and imprecision were similar or higher for most species simulated using simple random and stratified random survey designs. Estimated relative median bias and relative median absolute deviations were notably higher for artificial reef surveys. CONCLUSION: Based on these results, survey efforts were integrated as the Gulf Fishery Independent Survey of Habitat and Ecosystem Resources (G‐FISHER) in 2020.
Keywords	Seriola dumerili ; artificial reefs ; ecosystems ; fish ; fisheries ; habitats ; regression analysis ; retrospective studies ; surveys ; Florida ; Gulf of Mexico
Language	English
Dates of publication	2023-08
Publishing place	John Wiley & Sons, Ltd
Document type	Article ; Online
Note	JOURNAL ARTICLE
ZDB-ID	2483227-3
ISSN	1942-5120
ISSN	1942-5120
DOI	10.1002/mcf2.10245
Database	NAL-Catalogue (AGRICOLA)

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Article ; Online: A blood biomarker of the pace of aging is associated with brain structure: replication across three cohorts.

Neurobiology of aging

2024 Volume 136, Page(s) 23–33

Abstract: Biological aging is the correlated decline of multi-organ system integrity central to the etiology of many age-related diseases. A novel epigenetic measure of biological aging, DunedinPACE, is associated with cognitive dysfunction, incident dementia, and ...

Abstract	Biological aging is the correlated decline of multi-organ system integrity central to the etiology of many age-related diseases. A novel epigenetic measure of biological aging, DunedinPACE, is associated with cognitive dysfunction, incident dementia, and mortality. Here, we tested for associations between DunedinPACE and structural MRI phenotypes in three datasets spanning midlife to advanced age: the Dunedin Study (age=45 years), the Framingham Heart Study Offspring Cohort (mean age=63 years), and the Alzheimer's Disease Neuroimaging Initiative (mean age=75 years). We also tested four additional epigenetic measures of aging: the Horvath clock, the Hannum clock, PhenoAge, and GrimAge. Across all datasets (total N observations=3380; total N individuals=2322), faster DunedinPACE was associated with lower total brain volume, lower hippocampal volume, greater burden of white matter microlesions, and thinner cortex. Across all measures, DunedinPACE and GrimAge had the strongest and most consistent associations with brain phenotypes. Our findings suggest that single timepoint measures of multi-organ decline such as DunedinPACE could be useful for gauging nervous system health.
MeSH term(s)	Humans ; Aged ; Brain/pathology ; Aging/genetics ; Alzheimer Disease/genetics ; Cognitive Dysfunction/pathology ; Biomarkers ; Epigenesis, Genetic
Chemical Substances	Biomarkers
Language	English
Publishing date	2024-01-24
Publishing country	United States
Document type	Journal Article
ZDB-ID	604505-4
ISSN	1558-1497 ; 0197-4580
ISSN (online)	1558-1497
ISSN	0197-4580
DOI	10.1016/j.neurobiolaging.2024.01.008
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Article ; Online: Noninvasive ventilation: trying to minimize harm?

Keenan, Sean P

Critical care medicine

2008 Volume 36, Issue 10, Page(s) 2937–2939

MeSH term(s)	Critical Care/methods ; Critical Illness/mortality ; Critical Illness/therapy ; Female ; Hematologic Neoplasms/complications ; Hematologic Neoplasms/diagnosis ; Humans ; Male ; Positive-Pressure Respiration/methods ; Positive-Pressure Respiration/mortality ; Respiratory Distress Syndrome, Adult/etiology ; Respiratory Distress Syndrome, Adult/mortality ; Respiratory Distress Syndrome, Adult/therapy ; Risk Assessment ; Sensitivity and Specificity ; Survival Analysis
Language	English
Publishing date	2008-10
Publishing country	United States
Document type	Comment ; Editorial
ZDB-ID	197890-1
ISSN	1530-0293 ; 0090-3493
ISSN (online)	1530-0293
ISSN	0090-3493
DOI	10.1097/CCM.0b013e31818721c5
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Article ; Online: Noninvasive positive pressure ventilation for patients with acute hypoxemic respiratory failure?

Keenan, Sean P

Expert review of respiratory medicine

2008 Volume 2, Issue 1, Page(s) 55–62

Abstract: The re-emergence of noninvasive positive pressure ventilation (NIV) represents perhaps the single greatest advance in mechanical ventilation over the last 20 years. Clear benefit has been demonstrated for patients with respiratory failure in the setting ... ...

Abstract	The re-emergence of noninvasive positive pressure ventilation (NIV) represents perhaps the single greatest advance in mechanical ventilation over the last 20 years. Clear benefit has been demonstrated for patients with respiratory failure in the setting of acute exacerbations of chronic obstructive pulmonary disease and cardiogenic pulmonary edema. While there are advocates for the use of NIV in patients presenting with acute hypoxemic respiratory failure not due to cardiogenic pulmonary edema, benefit for these patients is less clear. This article reviews briefly the heterogeneity of hypoxemic respiratory failure and looks at the current evidence to support NIV in this setting in some depth. Presently, there is little evidence to support the use of NIV for patients presenting with hypoxemic respiratory failure who fulfill the American and European Consensus Conference definition of acute lung injury or acute respiratory distress syndrome, other than in patients with high risk for death if endotracheally intubated (immunocompromised patients, postlung resection acute respiratory distress syndrome). As there are reasonable rationales for both benefit and harm, there is a need for a large, multicenter, randomized, controlled trial to clarify whether NIV offers benefit in terms of a reduced need for endotracheal intubation, length of stay and hospital mortality.
Language	English
Publishing date	2008-02
Publishing country	England
Document type	Journal Article
ZDB-ID	2479146-5
ISSN	1747-6356 ; 1747-6348
ISSN (online)	1747-6356
ISSN	1747-6348
DOI	10.1586/17476348.2.1.55
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Article: Moving beyond numbers ... the next step forward in improving patient care.

Keenan, Sean P

Critical care medicine

2007 Volume 35, Issue 3, Page(s) 960–961

MeSH term(s)	Attitude of Health Personnel ; Continuous Positive Airway Pressure ; Guideline Adherence ; Humans ; Intensive Care Units ; Medical Audit ; Patient Care Team ; Practice Guidelines as Topic ; Quality Assurance, Health Care ; Sampling Studies
Language	English
Publishing date	2007-03
Publishing country	United States
Document type	Comment ; Editorial
ZDB-ID	197890-1
ISSN	1530-0293 ; 0090-3493
ISSN (online)	1530-0293
ISSN	0090-3493
DOI	10.1097/01.ccm.0000257360.65311.2e
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Article: Streptokinase did not reduce mortality or need for surgical drainage in pleural infection.

Keenan, Sean P

ACP journal club

2005 Volume 143, Issue 2, Page(s) 40

Language	English
Publishing date	2005-09
Publishing country	United States
Document type	Comment ; Journal Article
ZDB-ID	1061215-4
ISSN	1539-8560 ; 1056-8751
ISSN (online)	1539-8560
ISSN	1056-8751
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