A machine learning framework to classify musculoskeletal injury risk groups in military service members.

Background: Musculoskeletal injuries (MSKIs) are endemic in military populations. Thus, it is essential to identify and mitigate MSKI risks. Time-to-event machine learning models utilizing self-reported questionnaires or existing data (e.g., electronic health records) may aid in creating efficient risk screening tools. Methods: A total of 4,222 U.S. Army Service members completed a self-report MSKI risk screen as part of their unit's standard in-processing. Additionally, participants' MSKI and demographic data were abstracted from electronic health record data. Survival machine learning models (Cox proportional hazard regression (COX), COX with splines, conditional inference trees, and random forest) were deployed to develop a predictive model on the training data (75%; n = 2,963) for MSKI risk over varying time horizons (30, 90, 180, and 365 days) and were evaluated on the testing data (25%; n = 987). Probability of predicted risk (0.00-1.00) from the final model stratified Service members into quartiles based on MSKI risk. Results: The COX model demonstrated the best model performance over the time horizons. The time-dependent area under the curve ranged from 0.73 to 0.70 at 30 and 180 days. The index prediction accuracy (IPA) was 12% better at 180 days than the IPA of the null model (0 variables). Within the COX model, "other" race, more self-reported pain items during the movement screens, female gender, and prior MSKI demonstrated the largest hazard ratios. When predicted probability was binned into quartiles, at 180 days, the highest risk bin had an MSKI incidence rate of 2,130.82 ± 171.15 per 1,000 person-years and incidence rate ratio of 4.74 (95% confidence interval: 3.44, 6.54) compared to the lowest risk bin. Conclusion: Self-reported questionnaires and existing data can be used to create a machine learning algorithm to identify Service members' MSKI risk profiles. Further research should develop more granular Service member-specific MSKI screening tools and create MSKI risk mitigation strategies based on these screenings.

Movement Clearing Screens for Service Member Musculoskeletal Injury Risk Identification.

CONTEXT: Pain during movement screens is a risk factor for musculoskeletal injury (MSKI). Movement screens often require specialized/clinical expertise and large amounts of time to administer. OBJECTIVE: Evaluate if self-reported pain 1) with movement clearing screens is a risk factor for any MSKI, 2) with movement clearing screens is a risk factor for body region-specific MSKIs, and 3) with a greater number of movement clearing screens progressively increases MSKI risk. DESIGN: Retrospective cohort study. SETTING: Field-based. PARTICIPANTS: Military Service members (n=4,222). MAIN OUTCOME MEASURES: Active-duty Service members self-reported pain during movement clearing screens (Shoulder Clearing, Spinal Extension, Squat-Jump-Land). MSKI data were abstracted up to 180-days post-screening. A Traffic Light Model grouped Service members if they self-reported pain during 0 (Green), 1 (Amber), 2 (Red), or 3 (Black) movement clearing screens. Cox proportional hazards models adjusted for age, gender, body mass index, and prior MSKI determined the relationships between pain during movement clearing screens with any and body region-specific MSKIs. RESULTS: Service members self-reporting pain during the Shoulder Clearing (adjusted-Hazard Ratio and 95% confidence interval (HRadj [95%CI]) =1.58 [1.37, 1.82]), Spinal Extension (HRadj=1.48 [1.28, 1.87]), or Squat- Jump-Land (HRadj=2.04 [1.79, 2.32]) tests were more likely to experience any MSKI compared to Service members reporting no pain. Service members with pain during the Shoulder Clearing (HRadj=3.28 [2.57, 4.19]), Spinal Extension (HRadj=2.80 [2.26, 3.49]), or Squat-Jump-Land (HRadj=2.07 [1.76, 2.43]) tests were more likely to experience an upper extremity, spine, back, and torso, or lower extremity MSKI, respectively, compared to Service members reporting no pain. The Amber (HRadj=1.69 [1.48, 1.93]), Red (HRadj=2.07 [1.73, 2.48]), and Black (HRadj=2.31 [1.81, 2.95]) cohorts were more likely to experience an MSKI compared to the Green cohort. CONCLUSIONS: Self-report movement clearing screens in combination with a Traffic Light Model provide clinician/non-clinician-friendly, expedient means to identify Service members at MSKI risk.

Allostatic Load Is Associated with Overuse Musculoskeletal Injury during US Marine Corps Officer Candidates School.

INTRODUCTION: Overuse musculoskeletal injuries (MSKIs) remain a significant medical challenge in military personnel undergoing military training courses; a further understanding of the biological process leading to overuse MSKI development and biological signatures for injury risk are warranted. The purpose of this study was to determine the association between overuse MSKI occurrence and physiological characteristics of allostatic load (AL) characterized as maladaptive biological responses to chronic stress measured by wearable devices in US Marine Corps officer candidates during a 10-week training course. METHODS: Devices recorded energy expenditure (EE), daytime heart rate (HR), sleeping HR, and sleep architecture (time and percent of deep, light, REM sleep, awake time, total sleep). Flux was calculated as the raw or absolute difference in the average value for that day or night and the day or night beforehand. Linear mixed-effect model analysis accounting for cardiorespiratory fitness assessed the association between overuse MSKI occurrence and device metrics (α = 0.05). RESULTS: Sixty-nine participants (23 females) were included. Twenty-one participants (eight females) sustained an overuse MSKI. Overuse MSKI occurrence in male participants was positively associated with daytime HR (ß = 5.316, p = 0.008), sleeping HR (ß = 2.708, p = 0.032), relative EE (ß = 8.968, p = 0.001), absolute flux in relative EE (ß = 2.994, p = 0.002), absolute EE (ß = 626.830, p = 0.001), and absolute flux in absolute EE (ß = 204.062, p = 0.004). Overuse MSKI occurrence in female participants was positively associated with relative EE (ß = 5.955, p = 0.026), deep sleep time (ß = 0.664, p < 0.001), %deep sleep (ß = 12.564, p < 0.001) and negatively associated with absolute flux in sleeping HR (ß = -0.660, p = 0.009). CONCLUSIONS: Overuse MSKI occurrences were associated with physiological characteristics of AL including chronically elevated HR and EE and greater time in restorative sleep stages, which may serve as biological signatures for overuse MSKI risk.

Correction to "Intra- and Inter-Molecular Charge Transfer Dynamics of Carbene-Metal-Amide Photosensitizers".

[This corrects the article DOI: 10.1021/acs.jpcc.4c01994.].

Intra- and Intermolecular Charge-Transfer Dynamics of Carbene-Metal-Amide Photosensitizers.

A series of steady-state and time-resolved spectroscopies were performed on a set of eight carbene-metal-amide (cMa) complexes, where M = Cu and Au, that have been used as photosensitizers for photosensitized electrocatalytic reactions. Using ps-to-ns and ns-to-ms transient absorption spectroscopies (psTA and nsTA, respectively), the excited-state kinetics from light absorption, intersystem crossing (ISC), and eventually intermolecular charge transfer were thoroughly characterized. Using time-correlated single photon counting (TCSPC) and psTA with a thermally activated delayed fluorescence (TADF) model, the variation in intersystem crossing (ISC), (S1 → T1) rates (∼3-120 × 109 s-1), and ΔEST values (73-115 meV) for these compounds were fully characterized, reflecting systematic changes to the carbene, carbazole, and metal. The psTA additionally revealed an early time relaxation (rate ∼0.2-0.8 × 1012 s-1) attributed to solvent relaxation and vibrational cooling. The nsTA experiments for a gold-based cMa complex demonstrated efficient intermolecular charge transfer from the excited cMa to an electron acceptor. Pulse radiolysis and bulk electrolysis experiments allowed us to identify the character of the transient excited states as ligand-ligand charge transfer as well as the spectroscopic signature of oxidized and reduced forms of the cMa photosensitizer.

Presence of phage-plasmids in multiple serovars of Salmonella enterica.

Evidence is accumulating in the literature that the horizontal spread of antimicrobial resistance (AMR) genes mediated by bacteriophages and bacteriophage-like plasmid (phage-plasmid) elements is much more common than previously envisioned. For instance, we recently identified and characterized a circular P1-like phage-plasmid harbouring a bla CTX-M-15 gene conferring extended-spectrum beta-lactamase (ESBL) resistance in Salmonella enterica serovar Typhi. As the prevalence and epidemiological relevance of such mechanisms has never been systematically assessed in Enterobacterales, in this study we carried out a follow-up retrospective analysis of UK Salmonella isolates previously sequenced as part of routine surveillance protocols between 2016 and 2021. Using a high-throughput bioinformatics pipeline we screened 47 784 isolates for the presence of the P1 lytic replication gene repL, identifying 226 positive isolates from 25 serovars and demonstrating that phage-plasmid elements are more frequent than previously thought. The affinity for phage-plasmids appears highly serovar-dependent, with several serovars being more likely hosts than others; most of the positive isolates (170/226) belonged to S. Typhimurium ST34 and ST19. The phage-plasmids ranged between 85.8 and 98.2 kb in size, with an average length of 92.1 kb; detailed analysis indicated a high amount of diversity in gene content and genomic architecture. In total, 132 phage-plasmids had the p0111 plasmid replication type, and 94 the IncY type; phylogenetic analysis indicated that both horizontal and vertical gene transmission mechanisms are likely to be involved in phage-plasmid propagation. Finally, phage-plasmids were present in isolates that were resistant and non-resistant to antimicrobials. In addition to providing a first comprehensive view of the presence of phage-plasmids in Salmonella, our work highlights the need for a better surveillance and understanding of phage-plasmids as AMR carriers, especially through their characterization with long-read sequencing.

Water beetles (Coleoptera) associated with Afrotemperate Forest patches in the Garden Route National Park, South Africa.

Southern Afrotemperate Forest is concentrated in the southern Cape region of South Africa and whilst it is relatively well known botanically, the fauna, specifically the aquatic invertebrate fauna, is poorly documented. The majority of remaining intact forest habitat is contained within the Garden Route National Park (GRNP), which straddles the provincial boundary between the Western and Eastern Cape. This study undertakes a survey of the water beetle fauna inhabiting the GRNP. The aquatic ecosystems within temperate forests of the region are poorly researched from an ecological and biodiversity perspective, despite being known to harbour endemic invertebrate elements. We collected water beetles and in situ physico-chemical data from a total of 31 waterbodies across the park over two seasons (summer and late winter) in 2017. The waterbodies sampled were mostly small freshwater perennial streams and isolated forest ponds. A total of 61 beetle taxa was recorded (29 Adephaga, 32 Polyphaga) from these waterbodies. The water beetle fauna of these forests appears to be diverse and contains many species endemic to the fynbos-dominated Cape Floristic Region, but very few of the species appear to be forest specialists. This is in contrast to the fynbos heathland habitat of the region, which harbours a high number of water beetle species endemic to this habitat, often with Gondwanan affinity. Our study is the first to document the water beetles of Afrotemperate Forests in the southern Cape region and provides an important baseline for future work on such habitats in the region and in other parts of southern Africa.

Association of clinically-measured and dynamic ankle dorsiflexion assessed by markerless motion capture during the drop-jump task on landing biomechanics and risk of ankle injury in military personnel undergoing 10 weeks of physical training.

OBJECTIVES: Determine the influence of clinically-measured maximum dorsiflexion, dynamic peak dorsiflexion and percent of clinically-measured maximum dorsiflexion used during a drop-jump task on landing biomechanics and risk of ankle injury in military personnel. DESIGN: Prospective cohort study. METHODS: 672 participants (122 women) enrolled. The weightbearing lunge test assessed clinically-measured maximum dorsiflexion averaged across limbs (degrees). Markerless motion capture and force plates collected lower extremity kinematic and kinetic data during a drop-jump task. Percent of clinically-measured maximum dorsiflexion used during landing was calculated as dynamic peak dorsiflexion divided by clinically-measured value, multiplied by 100 (%). De-identified injury data was derived from military physical therapists. Simple linear regression analysis determined the association between dorsiflexion measures and landing biomechanics. Simple binary logistic regression analyses identified predictors of ankle injuries. Statistical significance was set at α = 0.05. RESULTS: Eighteen participants sustained a traumatic ankle injury from a landing. All measures of dorsiflexion were associated with movement patterns that countered the stiff-legged landing strategy with dynamic measures showing a higher predictive value. Protective factors against ankle injury included height (odds ratio: 0.818, p = 0.006) and weight (odds ratio: 0.824, p = 0.023) for women. Relative braking impulse was a risk factor for men (odds ratio: 1.890, p = 0.001). CONCLUSIONS: Greater clinically-measured and dynamic measures of dorsiflexion were associated with movement patterns that countered the stiff-legged landing strategy but neither measure of dorsiflexion predicted ankle injury risk. Resultant biomechanics and anthropometrics influenced ankle injury risk to warrant recognition for injury prevention initiatives.

Musculoskeletal Injury Risk Stratification: A Traffic Light System for Military Service Members.

Risk factor identification is a critical first step in informing musculoskeletal injury (MSKI) risk mitigation strategies. This investigation aimed to determine if a self-reported MSKI risk assessment can accurately identify military service members at greater MSKI risk and determine whether a traffic light model can differentiate service members' MSKI risks. A retrospective cohort study was conducted using existing self-reported MSKI risk assessment data and MSKI data from the Military Health System. A total of 2520 military service members (2219 males: age 23.49 ± 5.17 y, BMI 25.11 ± 2.94 kg/m2; and 301 females: age 24.23 ± 5.85 y, BMI 25.59 ± 3.20 kg/m2, respectively) completed the MSKI risk assessment during in-processing. The risk assessment consisted of 16 self-report items regarding demographics, general health, physical fitness, and pain experienced during movement screens. These 16 data points were converted to 11 variables of interest. For each variable, service members were dichotomized as at risk or not at risk. Nine of the 11 variables were associated with a greater MSKI risk and were thus considered as risk factors for the traffic light model. Each traffic light model included three color codes (i.e., green, amber, and red) to designate risk (i.e., low, moderate, and high). Four traffic light models were generated to examine the risk and overall precision of different cut-off values for the amber and red categories. In all four models, service members categorized as amber [hazard ratio (HR) = 1.38-1.70] or red (HR = 2.67-5.82) were at a greater MSKI risk. The traffic light model may help prioritize service members who require individualized orthopedic care and MSKI risk mitigation plans.

Foodborne Outbreak of Extended Spectrum Beta-lactamase Producing Shigella sonnei Associated with Contaminated Spring Onions in the United Kingdom.

Globalization of the food supply chain has created conditions favorable for emergence and spread of multidrug-resistant (MDR) foodborne pathogens. In November 2021, the UK Health Security Agency detected an outbreak of 17 cases infected with the same strain of MDR extended spectrum beta-lactamase (ESBL)-producing Shigella sonnei. Phylogenetic analysis of whole-genome sequencing data revealed the outbreak was closely related to strains of S. sonnei isolated from travelers returning to the UK from Egypt. None of the outbreak cases reported travel and all 17 cases reported eating food from a restaurant/food outlet in the week prior to symptom onset, of which 11/17 (64.7%) ate at branches of the same national restaurant franchise. All 17 cases were adults and 14/17 (82.4%) were female. Ingredient-level analyses of the meals consumed by the cases identified spring onions as the common ingredient. Food chain investigations revealed that the spring onions served at the implicated restaurants could be traced back to a single Egyptian producer. The foodborne transmission of ESBL-producing bacteria is an emerging global health concern, and concerted action from all stakeholders is required to ensure an effective response to mitigate the risks to public health.

Kinetics and Energetics of Electron Transfer to Dimer Radical Cations.

Spectra of the dimer cations naphthalene (Nap2•+) and ethene (Ethene2•+) were measured in liquid dichloromethane (DCM). The spectra peak at very different energies, 1.2 and 3.3 eV. In DCM dimerization stabilizes Nap2•+ by ΔGd°(Nap2•+) = -218 meV relative to the monomer Nap•+ as determined from the dimerization equilibrium constant. Both dimers can transfer a positive charge to hole acceptor molecules, but for both the rate constants rise more gradually with reaction energetics than do many charge transfer reactions previously studied. A striking observation finds that the rate constant for hole transfer from the Nap2•+ dimer to phenanthrene is smaller by two decades than that from biphenyl•+ monomer to Nap, although both reactions have the same -ΔG° = 0.05 eV. A plausible interpretation for these observations is the presence of an energy of reorganization, λ(M2), for the dimer that involves movement apart of the two partners in the dimer. While the dimerization equilibrium cannot be measured for Ethene2•+, the charge transfer data imply that both ΔGd°(Ethene2•+) and λ(Ethene2•+) are considerably larger, perhaps by factors of 2-4 than for Nap2•+.

Epidemiology of Musculoskeletal Injuries Among Naval Special Warfare Personnel.

BACKGROUND: Musculoskeletal injuries (MSIs) are an important cause of morbidity in the military, especially among Special Forces. The aim of this analysis was to describe MSIs among two groups of Naval Special Warfare (NSW) personnel-Special Warfare Combatant-Craft Crewman (SWCC) Operators and Crewman Qualification Training (CQT) students. METHODS: In this cross-sectional study, we describe self-reported MSIs that occurred during a one-year period and the calculated financial costs of MSIs. Group comparisons were conducted using Fisher's exact tests and independent samples t tests. RESULTS: Data were available for 142 SWCC Operators (26.9 ± 5.9 years, 1.8 ± 0.1 meters, 85.4 ± 10.4 kilograms) and 187 CQT students (22.8 ± 3.2 years, 1.8 ± 0.2 meters, 81.4 ± 8.9 kilograms). The one-year cumulative MSI incidence was significantly lower among SWCC Operators (21.1%) compared to CQT students (37.4%, p = 0.002). The most common anatomic location for MSIs was the lower extremity (SWCC: 50.0% of MSIs, CQT: 66.3%). Physical training was the predominant activity when MSIs occurred (SWCC: 31.6%, CQT: 77.6%). The lifetime cost of all the MSIs included in the analysis was approximately $580,000 among 142 SWCC Operators and $1.2 million among 187 CQT students. CONCLUSION: MSIs, especially those affecting the lower extremity and occurring during physical training, cause considerable morbidity and financial burden among NSW personnel. Many of the musculoskeletal injuries are to musculotendinous tissue, which typically results from tissue overload or inadequate recovery. Further investigation of the preventable causes of these MSIs and development of a customized, evidence-based MSI prevention program is required to reduce the burden of these MSIs.

Predictive utility of commercial grade technologies for assessing musculoskeletal injury risk in US Marine Corps Officer candidates.

Recently, commercial grade technologies have provided black box algorithms potentially relating to musculoskeletal injury (MSKI) risk and functional movement deficits, in which may add value to a high-performance model. Thus, the purpose of this manuscript was to evaluate composite and component scores from commercial grade technologies associations to MSKI risk in Marine Officer Candidates. 689 candidates (Male candidates = 566, Female candidates = 123) performed counter movement jumps on SPARTA™ force plates and functional movements (squats, jumps, lunges) in DARI™ markerless motion capture at the start of Officer Candidates School (OCS). De-identified MSKI data was acquired from internal OCS reports for those who presented to the Physical Therapy department for MSKI treatment during the 10 weeks of training. Logistic regression analyses were conducted to validate the utility of the composite scores and supervised machine learning algorithms were deployed to create a population specific model on the normalized component variables in SPARTA™ and DARI™. Common MSKI risk factors (cMSKI) such as older age, slower run times, and females were associated with greater MSKI risk. Composite scores were significantly associated with MSKI, although the area under the curve (AUC) demonstrated poor discrimination (AUC = .55-.57). When supervised machine learning algorithms were trained on the normalized component variables and cMSKI variables, the overall training models performed well, but when the training models were tested on the testing data the models classified MSKI "by chance" (testing AUC avg = .55-.57) across all models. Composite scores and component population specific models were poor predictors of MSKI in candidates. While cMSKI, SPARTA™, and DARI™ models performed similarly, this study does not dismiss the use of commercial technologies but questions the utility of a singular screening task to predict MSKI over 10 weeks. Further investigations should evaluate occupation specific screening, serial measurements, and/or load exposure for creating MSKI risk models.

A Minimal Sensor Inertial Measurement Unit System Is Replicable and Capable of Estimating Bilateral Lower-Limb Kinematics in a Stationary Bodyweight Squat and a Countermovement Jump.

This study aimed to validate a 7-sensor inertial measurement unit system against optical motion capture to estimate bilateral lower-limb kinematics. Hip, knee, and ankle sagittal plane peak angles and range of motion (ROM) were compared during bodyweight squats and countermovement jumps in 18 participants. In the bodyweight squats, left peak hip flexion (intraclass correlation coefficient [ICC] = .51), knee extension (ICC = .68) and ankle plantar flexion (ICC = .55), and hip (ICC = .63) and knee (ICC = .52) ROM had moderate agreement, and right knee ROM had good agreement (ICC = .77). Relatively higher agreement was observed in the countermovement jumps compared to the bodyweight squats, moderate to good agreement in right peak knee flexion (ICC = .73), and right (ICC = .75) and left (ICC = .83) knee ROM. Moderate agreement was observed for right ankle plantar flexion (ICC = .63) and ROM (ICC = .51). Moderate agreement (ICC > .50) was observed in all variables in the left limb except hip extension, knee flexion, and dorsiflexion. In general, there was poor agreement for peak flexion angles, and at least moderate agreement for joint ROM. Future work will aim to optimize methodologies to increase usability and confidence in data interpretation by minimizing variance in system-based differences and may also benefit from expanding planes of movement.

Mitochondria metabolism sets the species-specific tempo of neuronal development.

Neuronal development in the human cerebral cortex is considerably prolonged compared with that of other mammals. We explored whether mitochondria influence the species-specific timing of cortical neuron maturation. By comparing human and mouse cortical neuronal maturation at high temporal and cell resolution, we found a slower mitochondria development in human cortical neurons compared with that in the mouse, together with lower mitochondria metabolic activity, particularly that of oxidative phosphorylation. Stimulation of mitochondria metabolism in human neurons resulted in accelerated development in vitro and in vivo, leading to maturation of cells weeks ahead of time, whereas its inhibition in mouse neurons led to decreased rates of maturation. Mitochondria are thus important regulators of the pace of neuronal development underlying human-specific brain neoteny.

Physiological biomarker monitoring during arduous military training: Maintaining readiness and performance.

OBJECTIVES: Physiological and psychological stressors can degrade soldiers' readiness and performance during military training and operational environments. Integrative and holistic assessments of biomarkers across diverse human performance optimization domains during multistressor training can be leveraged to provide actionable insight to military leadership regarding service member health and readiness. DESIGN/METHOD: A broad categorization of biomarkers, to include biochemical measures, bone and body composition, psychometric assessments, movement screening, and physiological load can be incorporated into robust analytical pipelines for understanding the complex factors that impact military human performance. RESULTS: In this perspective commentary we overview the rationale, selection, and methodologies for monitoring biomarker domains that are relevant to military research and specifically highlight methods that have been incorporated in a research program funded by the Office of Naval Research, Code 34 Biological and Physiological Monitoring and Modeling of Warfighter Performance. CONCLUSIONS: The integration of screening and continuous monitoring methodologies via robust analytical approaches will provide novel insight for military leaders regarding health, performance, and readiness outcomes during multistressor military training.

Trust, social protection, and compliance: Moral hazard in Latin America during the COVID-19 pandemic.

Political trust is an important predictor of compliance with government policies, especially in the face of natural disasters or public health emergencies. During the COVID-19 pandemic, for example, multiple studies related political trust to increased compliance with mobility restrictions. Yet these findings come mostly from high-income countries where political trust and wealth correlate positively. In Latin America, both variables correlate negatively, allowing for better testing of competing explanations. Using a difference-in-differences design, we find that in Latin America wealth and, counterintuitively, low political trust predict increased compliance. To understand mechanisms, we decompose political trust and wealth into underlying predictors (social protection, corruption, and education) and reinsert them into the model. While education, as a wealth proxy, predicts decreased mobility across all periods, social protection, which was the strongest predictor of political trust, relates significantly to increased mobility, but only at the beginning of the lockdown prior to distribution of emergency support. This suggests the existence of a public health moral hazard early in the pandemic, whereby citizens who benefited previously from government benefits may have been more risk tolerant in the face of the COVID-19 threat. We interpret these findings within the context of the region's recent "inclusionary turn." Future studies should explore the distinct relationships between political trust, risk perception, and compliance, especially in low- and middle-income countries, and their implications for policy responses to national emergencies.

Changes in eating pathology symptoms during initial military training in men and women and associations with BMI and injury risk.

Nutritional fitness, which comprises food choices, meal timing, and dietary intake behaviors, is an important component of military service member health and performance that has garnered recent attention. This study utilized generalized linear mixed effects modeling (GLMM) to investigate changes in eating pathology symptoms in men and women during initial military training (Marine Corps Officer Candidates School (OCS)). Associations among eating pathology, musculoskeletal injury risk and BMI were also assessed. This investigation includes data from the Eating Pathology Symptoms Inventory (EPSI) and BMI at the start of OCS (n = 598: Male n = 469, Female n = 129) and end of the 10-week program (n = 413: Male n = 329, Female n = 84), and injury surveillance throughout. At baseline, female candidates presented with greater body dissatisfaction, binge eating, purging, and restricting, but lower negative attitudes toward obesity compared to male candidates (p < 0.001). Eating symptoms changed during military training indicated by decreased body dissatisfaction in women (p = 0.003), decreased excessive exercise and negative attitudes toward obesity in men (p < 0.001), decreased cognitive restraint (p < 0.001), restricting (p < 0.001), purging (p = 0.013), and muscle building (p < 0.001) and increased binge eating (p < 0.001) in both sexes. Changes in restricting were significantly related to changes in BMI during training (p < 0.05). The likelihood of future injury was 108 % higher in female candidates than males and decreased by 5 % for each unit increase in excessive exercise. Eating attitudes and behaviors change during military training environments and are associated with military health and readiness outcomes including BMI and injury risk.