Injuries and Factors Associated with Injuries Among U.S. Army Band Musicians.

The Department of Defense is the largest employer of full-time musicians. In the U.S. military, many musicians experience unique occupational exposures such as extended periods of standing, sitting, and marching for rehearsals and performances, static and non-neutral postures, and a variety of repetitive motions while playing instruments. These exposures are in addition to physical training and fitness standards required of U.S. Army soldiers. METHODS: An electronic survey was administered to active-duty U.S. Army Band musicians. The survey collected demographics, personal characteristics, Army Physical Fitness Test performance, occupational demands, health behaviors, and injuries from October 2017 to December 2018. Survey responses were combined with medical and physical fitness performance records. Descriptive statistics were reported and factors associated with injuries were investigated. RESULTS: There were 465 Army Band members in this population, with approximately half (49%) completing the survey. Most survey respondents (81%) reported an injury in the past year, which they predominantly attributed to overuse (54%). Leading reported activities resulting in injury included running for physical training (21%), repetitive movements while playing an instrument (11%), and standing while playing (11%). A majority of survey respondents (60%) also had a medical encounter for an injury. Factors significantly associated with injury among men were lower aerobic fitness and higher body fat percentage; additional unadjusted factors associated with injury among all Army Band soldiers included female sex, older age, and longer periods of marching and standing while playing. CONCLUSIONS: Injury prevention initiatives for Army Band musicians should focus on the reduction of overuse and repetitive motion injuries. Suggested prevention strategies include balanced physical training, ergonomic adjustments, rehearsal breaks, and leadership support for injury prevention efforts.

The National Hospital Care Survey Is a Unique Source of Data on Rare Diseases.

OBJECTIVES: This study aims to demonstrate the usefulness of the National Hospital Care Survey (NHCS) for studying rare diseases. METHODS: NHCS contains data on millions of hospital patients from participating US hospitals, including diagnoses coded using 10th revision of International Classification of Diseases, Clinical Modification, making it likely that some of the patients have a diagnosed rare disease. The data for 2016 are unweighted and are not nationally representative. The Orphanet Nomenclature Pack lists 877 10th revision of the International Classification of Diseases codes that correspond to 536 rare diseases. Using Orphanet Nomenclature Pack, we identified NHCS patients with diagnosed rare diseases. We demonstrate the usefulness of NHCS for studying rare diseases by reporting, for each rare disease, the number of patients in NHCS with the disease, the average number of hospital encounters per patient, the average length of hospital stay, and the percent of patients who died either in-hospital or within 90 days after discharge. RESULTS: In just 1 year of NHCS, we identified hundreds of rare diseases with ≥30 patients each (313 rare diseases in the inpatient setting and 273 in the emergency department setting). Although 10th revision of the International Classification of Diseases, Clinical Modification codes identify a small percent of known rare diseases, 12.9% of inpatient patients and 3.4% of emergency department patients had a diagnosed rare disease. CONCLUSIONS: NHCS is a rich source of administrative and electronic health record data on hospital patients with rare diseases, providing unique variables and observations on many patients. Although the percent of patients with each rare disease is low, a large percent of hospital patients has a rare disease.

Seasonal Trends for Environmental Illness Incidence in the U.S. Army.

INTRODUCTION: The incidence of and risk factors for exertional heat illness (EHI) and cold weather injury (CWI) in the U.S. Army have been well documented. The "heat season", when the risk of EHI is highest and application of risk mitigation procedures is mandatory, has been arbitrarily defined as May 1 through September 30, while the "cold season" is understood to occur from October 1 to April 30 each year. The proportions of EHI and CWI that occur outside of the traditional heat and cold seasons are unknown. Additionally, it is unknown if either of the seasonal definitions are appropriate. The primary purpose of this study was to determine the proportion of EHI and of CWI that occur within the commonly accepted seasonal definitions. We also report the location-specific variability, seasonal definitions, and the demographic characteristics of the populations. METHODS: The U.S. Army installations with the highest frequency of EHI and of CWI from 2008 to 2013 were identified and used for analysis. In total there were 15 installations included in the study, with five installations used for analysis in both the EHI and CWI projects. In- and out-patient EHI and CWI data (ICD-9-CM codes 992.0 to 992.9 and ICD codes 991.0 to 991.9, respectively) were obtained from the Defense Medical Surveillance System. Installation-specific denominator data were obtained from the Defense Manpower Data Center, and incidence rates were calculated by week, for each installation. Segmental (piecewise) regression analysis was used to determine the start and end of the heat and cold seasons. RESULTS: Our analysis indicates that the heat season starts around April 22 and ends around September 9. The cold season starts on October 3 and ends on March 24. The majority (n = 6,445, 82.3%) of EHIs were diagnosed during the "heat season" of May 1 to September 30, while 10.3% occurred before the heat season started (January1 to April 30) and 7.3% occurred after the heat season ended (October 1 to December 31). Similar to EHI, 90.5% of all CWIs occurred within the traditionally defined cold season, while 5.7% occurred before and 3.8% occurred after the cold season. The locations with the greatest EHI frequency were Ft Bragg (n = 2,129), Ft Benning (n = 1,560), and Ft Jackson (n = 1,538). The bases with the largest proportion of CWI in this sample were Ft Bragg (17.8%), Ft Wainwright (17.2%), and Ft Jackson (12.7%). There were considerable inter-installation differences for the start and end dates of the respective seasons. CONCLUSIONS: The present study indicates that the traditional heat season definition should be revised to begin ∼3 weeks earlier than the current date of May 1; our data indicate that the current cold season definition is appropriate. Inter-installation variability in the start of the cold season was much larger than that for the heat season. Exertional heat illnesses are a year-round problem, with ∼17% of all cases occurring during non-summer months, when environmental heat strain and vigilance are lower. This suggests that EHI mitigation policies and procedures require greater year-round emphasis, particularly at certain locations.

Factors associated with medical problems among young non-deployed U.S. military working dogs.

The goals of this project were to quantify medical problems among a population of Military Working Dogs (MWDs) and analyze factors associated with common medical conditions. Medical conditions recorded in veterinary Master Problem List (MPL) entries for 774 young, non-deployed, active MWDs were categorized and combined with demographic information to analyze risk factors. Most dogs were male (74%), German Shepherd (39%) or Belgian Malinois (31%) breeds, certified in Explosive Detection (60%), and had a dark coat color (83%). Ages ranged from one to six years, with an average of 2.6 years (± 0.5 years). Eighty-three percent of dogs had a non-surgical medical problem in their record. The most common non-surgical medical problems were dermatologic (25% of MPL entries), alimentary (21%), dental (15%), soft-tissue injury (10%), and musculoskeletal conditions (4%). Factors associated with each medical condition were breed (Odds Ratios 1.96-8.24), sex and spay/neuter status (ORs 1.78-5.77), occupational duty certification (ORs 2.65-3.62), military command location (ORs 2.32-7.44), and military branch (OR 5.16). As MWDs are a valuable asset for the Department of Defense, training and work conditions for the identified at-risk groups of MWDs should be further assessed to maximize their operational capabilities and assess the potential to serve as sentinel indicators for human diseases. Improved understanding of the most common medical problems affecting MWDs, and the identification of factors associated with these conditions, can help drive changes in their preventive care.

Factors associated with motorcycle traffic crash fatalities among active duty U.S. Army personnel.

OBJECTIVE: Research on factors associated with motorcycle fatalities among active duty U.S. Army personnel is limited. This analysis describes motorcycle crash-related injuries from 1995 through 2014 and assesses the effect of alcohol use and helmet use on the risk of fatal injury among active duty U.S. Army motorcycle operators involved in a traffic crash, controlling for other factors shown to be potentially associated with fatality in this population. METHODS: Demographics, crash information, and injury data were obtained from safety reports maintained in the Army Safety Management Information System. Traffic crashes were defined as crashes occurring on a paved public or private roadway or parking area, including those on a U.S. Army installation. Analysis was limited to motorcycle operators. Odds ratios (ORs) and 95% confidence intervals (95% CIs) from a multivariable analysis estimated the effect of alcohol use and helmet use on the risk of a fatal injury given a crash occurred, controlling for operator and crash characteristics. RESULTS: Of the 2,852 motorcycle traffic crashes, most involved men (97%), operators aged 20-29 years of age (60%), and operators who wore helmets (95%) and did not use alcohol (92%). Two thirds of reported crashes resulted in injuries requiring a lost workday; 17% resulted in fatality. Controlling for operator and crash characteristics, motorcycle traffic crashes involving operators who had used alcohol had a 3.1 times higher odds of fatality than those who did not use alcohol (OR =3.14; 95% CI, 2.17-4.53). Operators who did not wear a helmet had 1.9 times higher odds of fatality than those who did wear a helmet (OR =1.89; 95% CI, 1.24-2.89). CONCLUSIONS: Among U.S. Army motorcycle operators, alcohol use and not wearing a helmet increased the odds of fatality, given that a crash occurred, and additional modifiable risk factors were identified. Results will help inform U.S. Army motorcycle policies and training.

Injury Mechanisms, Activities, and Limited Work Days in US Army Infantry Units.

Injuries are a leading health and readiness concern for the US Army. For effective prevention planning, details concerning circumstances associated with injuries are needed. Over 5,000 Soldiers were surveyed to collect demographic and injury details (type, body part, mechanism, activity, limited duty days); 874 reported an injury within 6 months of survey administration. The greatest proportion of limited duty time was associated with knee (19.2%), ankle (14.8%), and lower back injuries (12.9%). Overexertion was the leading injury mechanism (43.9%), followed by falls, jumps, trips, and slips (35.2%), which accounted for the highest average limited duty days per injury (42±43 days). Running was the leading activity associated overexertion injuries (39.3%) and falls (30.5%). Running also accounted for the greatest total limited duty days (5,844 days, 29.8%). For Army infantry units, results suggested a focus of prevention activities on running-related injuries resulting in overexertion or falls. Healthcare providers can facilitate injury prevention with contributions to initiatives providing details on injury mechanisms and activities associated with injuries.

Associations of age, aerobic fitness, and body mass index with injury in an operational Army brigade.

OBJECTIVES: To investigate the effects of age, aerobic fitness, and body mass index (BMI) on injury risk in operational Army soldiers. DESIGN: Retrospective cohort study. METHODS: Male soldiers from an operational Army brigade were administered electronic surveys regarding personal characteristics, physical fitness, and injuries occurring over the last 12 months. Injury risks were stratified by age, 2-mile run time, and BMI. Analyses included descriptive incidence, a Mantel-Haenszel χ2 test to determine trends, a multivariable logistic regression to determine factors associated with injury, and a one-way analysis of variance (ANOVA). RESULTS: Forty-seventy percent of 1099 respondents reported at least one injury. A linear trend showed that as age, 2-mile run time, and BMI increased, so did injury risk (p<0.01). When controlling for BMI, the most significant independent injury risk factors were older age (odd ratio (OR) 30years-35years/≤24years=1.25, 95%CI: 1.08-2.32), (OR≥36years/≤24years=2.05, 95%CI: 1.36-3.10), and slow run times (OR≥15.9min/≤13.9min=1.91, 95%CI: 1.28-2.85). An ANOVA showed that both run times and BMI increased with age. CONCLUSIONS: The stratified analysis and the multivariable logistic regression suggested that older age and poor aerobic fitness are stronger predictors of injury than BMI.

The IntXO-PSL Recombination System Is a Key Component of the Second Maintenance System for Bacillus anthracis Plasmid pXO1.

UNLABELLED: We previously identified three noncontiguous regions on Bacillus anthracis plasmid pXO1 that comprise a system for accurate plasmid partitioning and maintenance. However, deletion of these regions did not decrease retention of certain shortened pXO1 plasmids during vegetative growth. Using two genetic tools developed for DNA manipulation in B. anthracis (the Cre-loxP and Flp-FRT systems), we found two other noncontiguous pXO1 regions that together are sufficient for plasmid stability. This second pXO1 maintenance system includes the tubZ and tubR genes, characteristic of a type III partitioning system, and the IntXO recombinase gene (GBAA_RS29165), encoding a tyrosine recombinase, along with its adjacent 37-bp perfect stem-loop (PSL) target. Insertion of either the tubZ and tubR genes or the IntXO-PSL system into an unstable mini-pXO1 plasmid did not restore plasmid stability. The need for the two components of the second pXO1 maintenance system follows from the sequential roles of IntXO-PSL in generating monomeric circular daughter pXO1 molecules (thereby presumably preventing dimer catastrophe) and of TubZ/TubR in partitioning the monomers during cell division. We show that the IntXO recombinase deletes DNA regions located between two PSL sites in a manner similar to the actions of the Cre-loxP and Flp-FRT systems. IMPORTANCE: Tyrosine recombinases catalyze cutting and joining reactions between short specific DNA sequences. Three types of reactions occur: integration and excision of DNA segments, inversion of DNA segments, and separation of monomeric forms from replicating circular DNA molecules. Here we show that the newly discovered site-specific IntXO-PSL recombinase system that contributes to the maintenance of the B. anthracis plasmid pXO1 can be used for genome engineering in a manner similar to that of the Cre-loxP or Flp-FRT system.

Identification of three noncontiguous regions on Bacillus anthracis plasmid pXO1 that are important for its maintenance.

Bacillus anthracis pXO1 minireplicon (MR) plasmid consisting of open reading frames (ORFs) GBAA_pXO1_0020 to GBAA_pXO1_0023 is not stably maintained in B. anthracis, whereas the full-size parent pXO1 plasmid (having 181,677 bp and 217 ORFs) is extremely stable under the same growth conditions. Two genetic tools developed for DNA manipulation in B. anthracis (Cre-loxP and Flp-FRT systems) were used to identify pXO1 regions important for plasmid stability. We localized a large segment of pXO1 that enables stable plasmid maintenance during vegetative growth. Further genetic analysis identified three genes that are necessary for pXO1 maintenance: amsP (GBAA_pXO1_0069), minP (GBAA_pXO1_0082), and sojP (GBAA_pXO1_0084). Analysis of conserved domains in the corresponding proteins indicated that only AmsP (activator of maintenance system of pXO1) is predicted to bind DNA, due to its strong helix-turn-helix domain. Two conserved domains were found in the MinP protein (Min protein from pXO1): an N-terminal domain having some similarity to the B. anthracis septum site-determining protein MinD and a C-terminal domain that resembles a baculovirus single-stranded-DNA-binding protein. The SojP protein (Soj from pXO1) contains putative Walker box motifs and belongs to the ParA family of ATPases. No sequences encoding other components of type I plasmid partition systems, namely, cis-acting centromere parS and its binding ParB protein, were identified within the pXO1 genome. A model describing the role of the MinP protein in pXO1 distribution between daughter cells is proposed.

Iminobiotin binding induces large fluorescent enhancements in avidin and streptavidin fluorescent conjugates and exhibits diverging pH-dependent binding affinities.

The pH-dependent binding affinity of either avidin or streptavidin for iminobiotin has been utilized in studies ranging from affinity binding chromatography to dynamic force spectroscopy. Regardless of which protein is used, the logarithmic dependence of the equilibrium dissociation constant (K(d)) on pH is assumed conserved. However a discrepancy has emerged from a number of studies which have shown the binding affinity of streptavidin for iminobiotin in solution to be unexpectedly low, with the K(d) at values usually associated with non-specific binding even at strongly basic pH levels. In this work we have utilized a Bodipy fluorescent conjugate of avidin and an Oregon Green fluorescent conjugate of streptavidin to determine the K(d) of the complexes in solution in the pH range of 7.0 to 10.7. The study was made possible by the remarkable fluorescent enhancement of the two fluorescent conjugates (greater than 10 fold) upon saturation with iminobiotin. The streptavidin-iminobiotin interaction exhibited almost no pH dependence over the range studied, with K(d) consistently on the order of 10(-5) M. In contrast, under identical experimental conditions the avidin-iminobiotin interaction exhibited the expected logarithmic dependence on pH. We discuss the possible origins for why these two closely related proteins would diverge in their binding affinities for iminobiotin as a function of pH.