A Distinct Metabolite Signature in Military Personnel Exposed to Repetitive Low-Level Blasts.

Military Breachers and Range Staff (MBRS) are subjected to repeated sub-concussive blasts, and they often report symptoms that are consistent with a mild traumatic brain injury (mTBI). Biomarkers of blast injury would potentially aid blast injury diagnosis, surveillance and avoidance. Our objective was to identify plasma metabolite biomarkers in military personnel that were exposed to repeated low-level or sub-concussive blast overpressure. A total of 37 military members were enrolled (18 MBRS and 19 controls), with MBRS having participated in 8-20 breaching courses per year, with a maximum exposure of 6 blasts per day. The two cohorts were similar except that the number of blast exposures were significantly higher in the MBRS, and the MBRS cohort suffered significantly more post-concussive symptoms and poorer health on assessment. Metabolomics profiling demonstrated significant differences between groups with 74% MBRS classification accuracy (CA). Feature reduction identified 6 metabolites that resulted in a MBRS CA of 98%, and included acetic acid (23.7%), formate (22.6%), creatine (14.8%), acetone (14.2%), methanol (12,7%), and glutamic acid (12.0%). All 6 metabolites were examined with individual receiver operating characteristic (ROC) curve analyses and demonstrated areas-under-the-curve (AUCs) of 0.82-0.91 (P ≤ 0.001) for MBRS status. Several parsimonious combinations of three metabolites increased accuracy of ROC curve analyses to AUCs of 1.00 (P < 0.001), while a combination of volatile organic compounds (VOCs; acetic acid, acetone and methanol) yielded an AUC of 0.98 (P < 0.001). Candidate biomarkers for chronic blast exposure were identified, and if validated in a larger cohort, may aid surveillance and care of military personnel. Future point-of-care screening could be developed that measures VOCs from breath, with definitive diagnoses confirmed with plasma metabolomics profiling.

Repeated Occupational Exposure to Low-level Blast in the Canadian Armed Forces: Effects on Hearing, Balance, and Ataxia.

INTRODUCTION: Recently, there has been increasing concern about the adverse health effects of long-term occupational exposure to low-level blast in military personnel. Occupational blast exposure occurs routinely in garrison through use of armaments and controlled blast detonations. In the current study, we focused on a population of breaching instructors and range staff. Breaching is a tactical technique that is used to gain entry into closed spaces, often through the use of explosives. MATERIALS AND METHODS: Initial measurements of blast overpressure collected during breaching courses found that up to 10% of the blasts for range staff and up to 32% of the blasts for instructors exceeded the recommended 3 psi exposure limit. Using a cross-sectional design, we used tests of balance, ataxia, and hearing to compare a sample of breachers (n = 19) to age-and sex-matched military controls (n = 19). RESULTS: There were no significant differences between the two groups on the balance and ataxia tests, although the average scores of both groups were lower than would be expected in a normative population. The prevalence of hearing loss was low in the breacher group (4 of 19), and hearing thresholds were not significantly different from the controls. However, the prevalence of self-reported tinnitus was significantly higher in the breacher group (12 of 19) compared with the controls (4 of 19), and all breachers who were identified as having hearing loss also reported tinnitus. CONCLUSIONS: Our results suggest that basic tests of balance, ataxia, and hearing on their own were not sensitive to the effects of long-term occupational exposure to low-level blast. Some of the blast exposure levels exceeded limits, and there was a significant association of exposure with tinnitus. Future studies should supplement with additional information including exposure history and functional hearing assessments. These findings should be considered in the design of future acute and longitudinal studies of low-level blast exposure.

Blast in Context: The Neuropsychological and Neurocognitive Effects of Long-Term Occupational Exposure to Repeated Low-Level Explosives on Canadian Armed Forces' Breaching Instructors and Range Staff.

Currently, there is strong interest within the military to better understand the effects of long-term occupational exposure to repeated low-level blast on health and performance. To gain traction on the chronic sequelae of blast, we focused on breaching-a tactical technique for gaining entry into closed/blocked spaces by placing explosives and maintaining a calculated safe distance from the detonation. Using a cross-sectional design, we compared the neuropsychological and neurocognitive profiles of breaching instructors and range staff to sex- and age-matched Canadian Armed Forces (CAF) controls. Univariate tests demonstrated that breaching was associated with greater post-concussive symptoms (Rivermead Post Concussion Symptoms Questionnaire) and lower levels of energy (RAND SF-36). In addition, breaching instructors and range staff were slower on a test that requires moving and thinking simultaneously (i.e., cognitive-motor integration). Next, using a multivariate approach, we explored the impact of other possible sources of injury, including concussion and prior war-zone deployment on the same outcomes. Concussion history was associated with higher post-concussive scores and musculoskeletal problems, whereas deployment was associated with higher post-concussive scores, but lower energy and greater PTSD symptomatology (using PCL-5). Our results indicate that although breaching, concussion, and deployment were similarly correlated with greater post-concussive symptoms, concussion history appears to be uniquely associated with altered musculoskeletal function, whereas deployment history appears to be uniquely associated with lower energy and risk of PTSD. We argue that the broader injury context must, therefore, be considered when studying the impact of repetitive low-level explosives on health and performance in military members.

Influence of impulse noise on noise dosimetry measurements on the International Space Station.

Objective: Acoustic dosimetry (AD) data collected on the International Space Station (ISS) were analysed to investigate the impact of impulse noise on crew noise exposure.Design: The noise exposure during work (LAeq16h) and sleep (LAeq8h) time, and the number of impulses >115 dB peak that occurred during each measurement activity, were calculated from the AD data. Two parametric studies were used to estimate the effect of 1) impulses in the original data set, and 2) hypothetical impulses of different levels, durations and quantities on LAeq16h.Study sample: Twelve sets of AD data collected on the ISS from November 2017 to October 2018.Results: The ISS work time noise limit (72 dBA) was exceeded in four of the 12 data sets. In three of those, there were over 100 impulses >115 dB peak and the number of impulses was significantly correlated with LAeq16h. However, the impulses only caused a meaningful increase in LAeq16h when the number of occurrences was large (>50), or when both the level and duration of the impulses were large.Conclusions: Continued monitoring of impulse noise data is recommended to facilitate the investigation of exceedances or abnormalities in future AD data acquired on the ISS.

Task switching following 24 h of total sleep deprivation: a functional MRI study.

Task switching is a ubiquitous feature of many human activities that involve multitasking. In addition, owing to occupational demands, many individuals are required to engage in task switching under various levels of sleep deprivation, such as those who work in military and medical contexts. Nevertheless, little is known about the effects that sleep loss has on the neural bases of task switching. To address this shortcoming, we administered a cued switching task to participants following a night of normal sleep and also following a night of total sleep deprivation - in counterbalanced order. The behavioral results demonstrated a cost (i.e. longer reaction time) both as a function of sleep deprivation and task switching. Sleep deprivation resulted in greater activation in the frontoparietal network, whereas task switching was correlated with greater activation in the thalamus and superior temporal gyrus. However, despite increases in fatigue and sleepiness and a reduction in cognitive effectiveness (computed from actigraphic data), the reaction time cost associated with switching (i.e. switch cost) was not exacerbated by sleep deprivation. The results are discussed in terms of the involvement of executive functions in mitigating the effects of sleep deprivation on task switching.

Transfer of training from one working memory task to another: behavioural and neural evidence.

N-back working memory (WM) tasks necessitate the maintenance and updating of dynamic rehearsal sets during performance. The delayed matching-to-sample (dMTS) task is another WM task, which in turn involves the encoding, maintenance, and retrieval of stimulus representations in sequential order. Because both n-back and dMTS engage WM function, we hypothesized that compared to a control task not taxing WM, training on the n-back task would be associated with better performance on dMTS by virtue of training a shared mental capacity. We tested this hypothesis by randomly assigning subjects (N = 43) to train on either the n-back (including 2-back and 3-back levels) or an active control task. Following training, dMTS was administered in the fMRI scanner. The n-back group performed marginally better than the active control group on dMTS. In addition, although the n-back group improved more on the less difficult 2-back level than the more difficult 3-back level across training sessions, it was improvement on the 3-back level that accounted for 21% of the variance in dMTS performance. For the control group, improvement in training across sessions was unrelated to dMTS performance. At the neural level, greater activation in the left inferior frontal gyrus, right posterior parietal cortex, and the cerebellum distinguished the n-back group from the control group in the maintenance phase of dMTS. Degree of improvement on the 3-back level across training sessions was correlated with activation in right lateral prefrontal and motor cortices in the maintenance phase of dMTS. Our results suggest that although n-back training is more likely to improve performance in easier blocks, it is improvement in more difficult blocks that is predictive of performance on a target task drawing on WM. In addition, the extent to which training on a task can transfer to another task is likely due to the engagement of shared cognitive capacities and underlying neural substrates-in this case WM.

Review of weapon noise measurement and damage risk criteria: considerations for auditory protection and performance.

Noise-induced hearing loss resulting from weapon noise exposure has been studied for decades. A summary of recent work in weapon noise signal analysis, current knowledge of hearing damage risk criteria, and auditory performance in impulse noise is presented. Most of the currently used damage risk criteria are based on data that cannot be replicated or verified. There is a need to address the effects of combined noise exposures, from similar or different weapons and continuous background noise, in future noise exposure regulations. Advancements in hearing protection technology have expanded the options available to soldiers. Individual selection of hearing protection devices that are best suited to the type of exposure, the auditory task requirements, and hearing status of the user could help to facilitate their use. However, hearing protection devices affect auditory performance, which in turn affects situational awareness in the field. This includes communication capability and the localization and identification of threats. Laboratory training using high-fidelity weapon noise recordings has the potential to improve the auditory performance of soldiers in the field, providing a low-cost tool to enhance readiness for combat.

Strategies to combat auditory overload during vehicular command and control.

Strategies to combat auditory overload were studied. Normal-hearing males were tested in a sound isolated room in a mock-up of a military land vehicle. Two tasks were presented concurrently, in quiet and vehicle noise. For Task 1 dichotic phrases were delivered over a communications headset. Participants encoded only those beginning with a preassigned call sign (Baron or Charlie). For Task 2, they agreed or disagreed with simple equations presented either over loudspeakers, as text on the laptop monitor, in both the audio and the visual modalities, or not at all. Accuracy was significantly better by 20% on Task 2 when the equations were presented visually or audiovisually. Scores were at least 78% correct for dichotic phrases presented over the headset, with a right ear advantage of 7%, given the 5 dB speech-to-noise ratio. The left ear disadvantage was particularly apparent in noise, where the interaural difference was 12%. Relatively lower scores in the left ear, in noise, were observed for phrases beginning with Charlie. These findings underscore the benefit of delivering higher priority communications to the dominant ear, the importance of selecting speech sounds that are resilient to noise masking, and the advantage of using text in cases of degraded audio.

The effects of a single night of sleep deprivation on fluency and prefrontal cortex function during divergent thinking.

The dorsal and ventral aspects of the prefrontal cortex (PFC) are the two regions most consistently recruited in divergent thinking tasks. Given that frontal tasks have been shown to be vulnerable to sleep loss, we explored the impact of a single night of sleep deprivation on fluency (i.e., number of generated responses) and PFC function during divergent thinking. Participants underwent functional magnetic resonance imaging scanning twice while engaged in the Alternate Uses Task (AUT) - once following a single night of sleep deprivation and once following a night of normal sleep. They also wore wrist activity monitors, which enabled us to quantify daily sleep and model cognitive effectiveness. The intervention was effective, producing greater levels of fatigue and sleepiness. Modeled cognitive effectiveness and fluency were impaired following sleep deprivation, and sleep deprivation was associated with greater activation in the left inferior frontal gyrus (IFG) during AUT. The results suggest that an intervention known to temporarily compromise frontal function can impair fluency, and that this effect is instantiated in the form of an increased hemodynamic response in the left IFG.

Right inferior frontal gyrus activation as a neural marker of successful lying.

There is evidence to suggest that successful lying necessitates cognitive effort. We tested this hypothesis by instructing participants to lie or tell the truth under conditions of high and low working memory (WM) load. The task required participants to register a response on 80 trials of identical structure within a 2 (WM Load: high, low) × 2 (Instruction: truth or lie) repeated-measures design. Participants were less accurate and responded more slowly when WM load was high, and also when they lied. High WM load activated the fronto-parietal WM network including dorsolateral prefrontal cortex (PFC), middle frontal gyrus, precuneus, and intraparietal cortex. Lying activated areas previously shown to underlie deception, including middle and superior frontal gyrus and precuneus. Critically, successful lying in the high vs. low WM load condition was associated with longer response latency, and it activated the right inferior frontal gyrus-a key brain region regulating inhibition. The same pattern of activation in the inferior frontal gyrus was absent when participants told the truth. These findings demonstrate that lying under high cognitive load places a burden on inhibition, and that the right inferior frontal gyrus may provide a neural marker for successful lying.

Negative valence can evoke a liberal response bias in syllogistic reasoning.

Recently, studies have demonstrated that negative valence reduces the magnitude of the belief-bias effect in syllogistic reasoning. This effect has been localized in the reasoning stage, in the form of increased deliberation on trials where validity and conclusion believability are incongruent. Here, using signal detection theory, we show that the attenuation of belief bias observed when valence was negative can also be evoked by a liberal response bias at the decision stage. Indeed, when valence was negative participants adopted a more liberal criterion for judging syllogisms as "valid," and were overconfident in their judgments. They also displayed less sensitivity in distinguishing between valid and invalid syllogisms. Our findings dovetail with recent evidence from memory research suggesting that negative valence can evoke a liberal response bias without improving performance. Our novel contribution is the demonstration that the attenuating effect of negative valence on belief bias can take multiples routes--by influencing the decision stage as was the case here, the reasoning stage as has been demonstrated elsewhere, and potentially both stages.

Divided listening in noise in a mock-up of a military command post.

This study investigated divided listening in noise in a mock-up of a vehicular command post. The effects of background noise from the vehicle, unattended speech of coworkers on speech understanding, and a visual cue that directed attention to the message source were examined. Sixteen normal-hearing males participated in sixteen listening conditions, defined by combinations of the absence/presence of vehicle and speech babble noises, availability of a vision cue, and number of channels (2 or 3, diotic or dichotic, and loudspeakers) over which concurrent series of call sign, color, and number phrases were presented. All wore a communications headset with integrated hearing protection. A computer keyboard was used to encode phrases beginning with an assigned call sign. Subjects achieved close to 100% correct phrase identification when presented over the headset (with or without vehicle noise) or over the loudspeakers, without vehicle noise. In contrast, the percentage correct phrase identification was significantly less by 30 to 35% when presented over loudspeakers with vehicle noise. Vehicle noise combined with babble noise decreased the accuracy by an additional 12% for dichotic listening. Vision cues increased phrase identification accuracy by 7% for diotic listening. Outcomes could be explained by the at-ear energy spectra of the speech and noise.

Speech understanding in noise with integrated in-ear and muff-style hearing protection systems.

Integrated hearing protection systems are designed to enhance free field and radio communications during military operations while protecting against the damaging effects of high-level noise exposure. A study was conducted to compare the effect of increasing the radio volume on the intelligibility of speech over the radios of two candidate systems, in-ear and muff-style, in 85-dBA speech babble noise presented free field. Twenty normal-hearing, English-fluent subjects, half male and half female, were tested in same gender pairs. Alternating as talker and listener, their task was to discriminate consonant-vowel-consonant syllables that contrasted either the initial or final consonant. Percent correct consonant discrimination increased with increases in the radio volume. At the highest volume, subjects achieved 79% with the in-ear device but only 69% with the muff-style device, averaged across the gender of listener/talker pairs and consonant position. Although there was no main effect of gender, female listener/talkers showed a 10% advantage for the final consonant and male listener/talkers showed a 1% advantage for the initial consonant. These results indicate that normal hearing users can achieve reasonably high radio communication scores with integrated in-ear hearing protection in moderately high-level noise that provides both energetic and informational masking. The adequacy of the range of available radio volumes for users with hearing loss has yet to be determined.

Various anti-motion sickness drugs and core body temperature changes.

INTRODUCTION: Blood flow changes and inactivity associated with motion sickness appear to exacerbate the rate of core temperature decrease during subsequent body cooling. We investigated the effects of various classes of anti-motion sickness drugs on core temperature changes. METHODS: There were 12 healthy male and female subjects (20-35 yr old) who were given selected classes of anti-motion sickness drugs prior to vestibular Coriolis cross coupling induced by graded yaw rotation and periodic pitch-forward head movements in the sagittal plane. All subjects were then immersed in water at 18 degrees C for a maximum of 90 min or until their core temperature reached 35 degrees C. Double-blind randomized trials were administered, including a placebo, a non-immersion control with no drug, and six anti-motion sickness drugs: meclizine, dimenhydrinate, chlorpheniramine, promethazine + dexamphetamine, promethazine + caffeine, and scopolamine + dexamphetamine. A 7-d washout period was observed between trials. Core temperature and the severity of sickness were monitored throughout each trial. RESULTS: A repeated measures design was performed on the severity of sickness and core temperature changes prior to motion provocation, immediately after the motion sickness end point, and throughout the period of cold-water immersion. The most effective anti-motion sickness drugs, promethazine + dexamphetamine (with a sickness score/duration of 0.65 +/- 0.17) and scopolamine + dexamphetamine (with a sickness score/duration of 0.79 +/- 0.17), significantly attenuated the decrease in core temperature. The effect of this attenuation was lower in less effective drugs. CONCLUSION: Our results suggest that the two most effective anti-motion sickness drugs are also the most effective in attenuating the rate of core temperature decrease.

Hearing, communication and cognition in low-frequency noise from armoured vehicles.

An experiment was performed to study auditory perception and cognitive function in the presence of low-frequency dominant armoured vehicle noise (LAV III). Thirty-six normal hearing subjects were assigned to one of three noise backgrounds: Quiet, pink noise and vehicle noise. The pink and vehicle noise were presented at 80 dBA. Each subject performed an auditory detection test, modified rhyme test (MRT) and cognitive test battery for three different ear conditions: Unoccluded and fitted with an active noise reduction (ANR) headset in passive and ANR modes. Auditory detection was measured at six 1/3 octave band frequencies from 0.25 to 8 kHz. The cognitive test battery consisted of two subjective questionnaires and five performance tasks. The earmuff, both in the conventional and ANR modes, did not significantly affect detection thresholds at any frequency in the pink and vehicle noise backgrounds. For the MRT, there were no significant differences between the speech levels required for 60% correct responses for three ear conditions in the pink and vehicle noise backgrounds. A small but significant (4 dB) increase in speech level was required in pink noise as compared to vehicle noise. For the serial reaction time task, the mean response time in the vehicle noise background (751 ms) was significantly higher than in pink noise and quiet (709 and 651 ms, respectively). The mean response time in the pink noise background was also significantly higher than in quiet. Thus, the presence of noise, especially low-frequency noise, had a negative effect on reaction time.

Measurement of noise and vibration in Canadian forces armoured vehicles.

Noise and whole-body vibration measurements were made in the following Canadian Forces vehicles: LAV III, Bison and M113A2 ADATS (air defence anti-tank system). Measurements were made at different crew positions while the vehicles were driven at different speeds over rough terrain and paved roads. The participants completed a questionnaire at the end of each measurement session on their reactions to the noise and vibration. Noise levels were as high as 115 dBA in the ADATS, 102 dBA in the Bison and 96 dBA in the LAV III, exceeding the Canada Labour Code exposure limit of 87 dBA for 8 h(1)). A communications headset was found to be sufficient to reduce the noise exposure to safe levels in most cases. The vector sum vibration magnitudes for the LAV III and Bison were relatively low during highway driving (0.3 m/s(2) for both vehicles) compared to rough terrain (0.71 and 1.36 m/s(2), respectively). The ADATS vibration increased with driving speed (0.62 m/s(2) at 8 km/h and 1.26 m/s(2) at 32 km/h). The questionnaire responses indicated that half the crewmembers had difficulty communicating in vehicle noise, but were generally unaffected physically by vibration. The latter result may have been due to the relatively short exposure duration.