Sex differences in mood, hormone and immune response to combatives training in West Point Cadets.

Hand-to-hand combat training, known as combatives, instructs Soldiers in close-quarters combat techniques and how to cope with stress, understand controlled physical aggression, and develop self-confidence when engaged in such activities. Limited research in combat sports suggests men and women may respond to combatives stress differently. Given the increasing integration of women into close combat roles in the military, investigation of sex differences in the physiological and psychological response to combatives among military-trained personnel is warranted. PURPOSE: This study was designed to identify sex differences in stress and gonadal hormones, mucosal immunity, and mood states in a military combatives training course. METHODS: U.S. Military Academy Cadets (men = 144, women = 37) enrolled in a 2-month Combat Applications Course at West Point completed the Profile of Mood States and Competitive State Anxiety Inventory-2 and provided salivary samples at baseline prior to the course, and immediately prior to their midterm and final combat matches. Combat matches were gender- and weight-matched. Additional salivary samples were collected immediately following the first midterm and final matches. Salivary cortisol, testosterone, secretory immunoglobulin A (SIgA) and estradiol (women only) were measured via immunoassay. Men and women were compared over time with linear mixed effects models. RESULTS: In both men and women, confusion, tension, anger, cognitive anxiety, somatic anxiety, and self-confidence increased throughout the course whereas friendliness and SIgA secretion rate decreased (all p < 0.05). Compared to women, men had a greater acute increase in cortisol from pre- to post-match (p = 0.043). Prior to the final match, women displayed higher ratings of tension (20.5 ± 9.3 vs. 16.0 ± 8.6) and cortisol (0.6 ± 0.3 vs. 0.4 ± 0.3 µg/dL) than men (all p < 0.05). After controlling for previous combative experience, ratings of tension did not differ by sex but remained elevated prior to midterm and final compared to baseline. CONCLUSION: Combatives training elicited significant psychological and physiological stress and decreased mucosal immunity in both men and women. Women exhibited higher tension at the final match, likely due to lack of previous combative experience. Self-confidence increased from baseline suggesting that the skills learned may help Cadets prepare for combatives and other activities that require controlled aggression.

Barriers to Academic Surgery in the US Armed Forces: A Study of the AAS Military Committee.

INTRODUCTION: The purpose of this study is to explore current perceptions within the military surgery community to stratify key obstacles to pursuing a career in academic surgery and identify opportunities for mitigation. METHODS: After receiving institutional review board approval, an anonymous electronic survey was distributed to military surgeons across all branches. Survey response data were collected and analyzed using chi-square test. RESULTS: The response rate was approximately 22%. Of those who responded to the survey, most are interested in an academic career (61.5%); however, 64% believe this to be much more difficult as a military surgeon than as a civilian surgeon. The top three perceived obstacles include administrative obstacles (76.4%), operational commitments (65.8%), and lack of funding for academic pursuits (62.7%). Most respondents indicated that they have never received formal education regarding how to apply for research funding (84.5%) and most do not have a research mentor (60.9%). Additionally, 42.9% state that obstacles to an academic career in surgery impact their decision to leave the military. Younger surgeons were more likely to leave the military upon completion of their service commitment (67.9% versus 46.4% aged 20-39 y, P = 0.02). CONCLUSIONS: We characterized the perceived challenges to academic surgery within the military. These barriers between academic surgery and military service risk medical force attrition, particularly in future generations of surgeons. Dedicated faculty billets (positions) with limited operational demands as well as associated mentorship and research funding may enhance the retention and productivity of military surgeons.

Exploring formation mechanism and source attribution of ozone during the 2019 Wuhan Military World Games: Implications for ozone control strategies.

A series of emission reduction measures were conducted in Wuhan, Central China, to ensure good air quality during the 7th Military World Games (MWG) in October 2019. To better understand the implications for ozone (O3) pollution control strategies, we applied integrated analysis approaches based on the de-weathered statistical model, parameterization methods, chemical box model, and positive matrix factorization model. During the MWG, concentrations of O3, NOx, and volatile organic compound (VOCs), OFP (O3 formation potential), LOH (OH radical loss rate) were 83 µg/m3, 43 µg/m3, 26 ppbv, 188 µg/m3, and 3.9 s-1, respectively, which were 26%, 18%, 3%, 15%, and 13% lower than pre-MWG values and 6%, 39%, 30%, 33%, and 50% lower than post-MWG values, respectively. After removing meteorological influence, O3 and its precursors during the MWG decreased largely compared with post-MWG values, and only O3, NO2, and oxygenated VOCs (OVOCs) declined compared with pre-MWG values, which revealed the emission reduction measures during the MWG played an important role for O3 decline. For six VOCs sources, the mass contributions of biomass burning and solvents usage during the MWG decreased largely compared with pre-MWG values. O3 production was sensitive to VOCs and the key species were aromatics, OVOCs, and alkenes, which originated mainly from solvents usage, biomass burning, industrial-related combustion, and vehicle exhaust. Decreasing O3 concentration during the strict control was mainly caused by OVOCs reduction due to biomass burning control. Generally, the O3 abatement strategies of Wuhan should be focused on the mitigation of high-reactivity VOCs.

A comparison of Expert and Novice marksmanship performance and postural mechanics using inertial measurement units (IMUs) during dynamic live-fire shooting.

Marksmanship is a foundational Soldier skill required for all active-duty military personnel regardless of duty position. This research compared shooting performance and underlying postural mechanics of Expert and Novice marksmen during a dynamic, live-fire shooting task. Eighteen military personnel volunteered to participate in this study (n = 9 Experts and n = 9 Novices). All participants completed the dynamic marksmanship task with an M4 carbine under each of two equipment conditions: (I) a No Load Condition (6 kg) and (II) a Loaded Condition (31 kg) using standard-issue military equipment. Marksmanship performance was assessed using lethality measures including total hits and course efficiency. Postural mechanics were collected via body- and weapon-mounted inertial measurement units (IMUs). Significant differences (p < 0.05) in shooting performance and course efficiency were found between Expert and Novice marksmen for both load conditions. Significant differences were also found in postural movement patterns between Expert and Novice marksmen utilizing IMU-derived performance measures, especially when transitioning between targets, though these findings were not always consistent across load conditions. Based on these results, training interventions that focus on target acquisition, increasing torso stability, and maximizing the linkage between the torso and weapon could be recommended to improve performance in Novice marksmen.

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.

Plantar Pressure Characteristics and Prevention of Painful Accessory Navicular in Military Recruits.

OBJECTIVE: The objective of this study was to provide practical guidance for the prevention of painful accessory navicular among recruits by comparing and analyzing the plantar pressure parameters of individuals with normal foot, flat foot, and accessory navicular. METHODS: After training, a total of 90 military recruits were included in this study, comprising 30 with normal foot, 30 with flat foot, and 30 with painful accessory navicular. The plantar pressure distribution was measured for all participants. RESULTS: In individuals with flat feet, there was an increase in plantar pressure on the medial side of the forefoot, as well as a significant increase in pressure on the medial side of the heel and arch (P<0.05). Conversely, there was a significant decrease in pressure on the lateral side of the heel and arch (P<0.05). In patients with painful accessory navicular, the medial pressure on the foot arch showed a further increase (P<0.001), while the lateral pressure on the foot arch exhibited a further decrease (P<0.001), indicating highly significant differences. CONCLUSION: Compared to participants with flat feet, participants with accessory navicular demonstrated faster and more impulsive impact on the ground within the same stress area, resulting in more noticeable pain caused by the injury to the accessory navicular.

Relationship of indicators of ability and experience of military sports skydiving with the psychological state and performance in competition of elite jumpers / Relación de indicadores de habilidad y experiencia del paracaidismo deportivo militar con el estado psicológico y rendimiento en competición de saltadores de élite / Relação dos indicadores de habilidade e experiência do paraquedismo esportivo militar com o estado psicológico e desempenho em competição de saltadores de elite

Se deben considerar múltiples variables cuando se habla de rendimiento deportivo. Entre ellas, la literatura establece la importancia de la psicología y las técnicas indicadoras de la experiencia adquirida en la disciplina. Este estudio pretende establecer la relación entre determinados constructos que definen el perfil psicológico del deportista con indicadores de habilidad en paracaidismo militar. Para ello, se encuestó a 42 saltadores de 40,86 años (±7,35) pertenecientes al ejército español y a la guardia civil durante la celebración del Campeonato Nacional Militar de paracaidismo que se celebra anualmente, para conocer su nivel de optimismo, resiliencia, bienestar psicológico y burnout. Se concluye que los años de experiencia en paracaidismo y el número de saltos, como indicadores de habilidad, deben ser tomados en cuenta con un mayor nivel de concreción y especificidad, ya que ciertas variables psicológicas pueden aumentar o disminuir dependiendo de ellas. Conviene estudiar cada caso en particular para comprender qué puede ocurrir en el estado del paracaidista y desarrollar estrategias para optimizar el rendimiento deportivo. (AU)

Multiple variables must be considered when talking about sports performance. Among them, the literature establishes the importance of psychology and indicator techniques of experience acquired in the discipline. This study aims to establish the relationship between certain constructs that define the psychological profile of the athlete with skill indicators in military parachuting. For this, 42 jumpers aged 40.86 years old (±7.35) belonging to the Spanish army and the civil guard during the celebration of the National Military Championship of Skydiving which is held annually surveyed to know their level of optimism, resilience, psychological well-being, and burnout. It is concluded that the years of skydiving experience and the number of jumps, as indicators of skill, must be taken into account with a higher level of concreteness and specificity since certain psychological variables can increase or decrease depending on them. It is convenient to study each case, in particular, to understand what can happen in the state of the parachutist and develop strategies for optimizing sports performance. (AU)

Múltiplas variáveis devemser consideradas quando se fala em desempenho desportivo. Eentre eles, a literatura estabelece a importância da psicologia e das técnicas indicadoras daexperiência adquirida na disciplina. Este estudo visa estabelecer a relaçãoentre determinados constructos que definem o perfil psicológico do atleta com indicadores de habilidade no paraquedismo militar. Para tal, foram inquiridos 42 saltadores com 40,86anos (±7,35) pertencentes ao exército espanhol e à guarda civil durante a celebração do Campeonato Nacional Militar de paraquedismo que se realiza anualmente para conhecer o seu nível de optimismo, resiliência, bem-estar psicológicoe esgotamento. Conclui-se que os anos de experiência em paraquedismo e o número de saltos, como indicadores de habilidade, devem ser levados em consideração com maior grau deespecificidade, pois certas variáveis psicológicas podem aumentar ou diminuir. É conveniente estudar cada caso em particular para entender o que pode acontecer no estado do paraquedista e desenvolver estratégias para otimizar o desempenho esportivo. (AU)

The Association Between Glasgow Coma Scale Scores and PTSD in Military Trauma Casualties: Does Mental Status Following Injury Play a Role in PTSD Development?

BACKGROUND: Posttraumatic stress disorder (PTSD) is prevalent among military personnel and may arise following a wide range of traumatic exposures. Consciousness level following traumatic injury may play a role in the development of PTSD, but its effects have been primarily investigated in the context of traumatic brain injury. METHODS: Registry-based study surveying three databases documenting care from point of injury to long-term rehabilitation of traumatic injuries among military personnel. The study population was divided according to Glasgow Coma Scale (GCS) scores upon emergency department admission (GCS scores 15, 13 and 14, 9-12, and 3-8), with PTSD diagnoses being determined according to disability claim records. Multivariable logistic regression was utilized to determine the association between GCS score at admission and PTSD. RESULTS: Overall, 3,376 military personnel hospitalized following traumatic injuries between 1997 and 2020 were included. The majority were male (92.3%), with a median age of 20 (interquartile range 19-22) at the injury time. Of these, 569 (16.9%) were diagnosed with PTSD according to disability claims, with a median follow-up time of 10.9 years. PTSD diagnosis was most prevalent (30.3% of patients), with a GCS score of 13 and 14. In the adjusted multivariable model, a GCS score of 13 and 14 was associated with significantly higher odds of PTSD diagnosis when compared to a GCS score of 15 (odds ratio 2.19, 95% CI, 1.21-3.88). The associations of other GCS groupings with PTSD diagnosis were nonsignificant. CONCLUSIONS: Minimally impaired consciousness following traumatic injuries is associated with increased odds of PTSD. The role of patient awareness, analgesia, and sedation following an injury in developing PTSD warrants further investigation and could guide early diagnosis and preventive interventions.

Behavioral Health-related Reasons for Permanent Duty Limitation Profiles in the U.S. Army: Population-Based Data from 2017 to 2019.

INTRODUCTION: When warfighters are unable to fight, they are formally removed from battle through temporary or permanent duty limitation profiles. This study uses a population-based data repository to characterize permanent behavioral health (BH)-related profiles across the army for an identified 2-year period. The absolute risk of a permanent duty limitation for specific BH categories was also examined. MATERIALS AND METHODS: This study utilized a retrospective population-based design to identify all new BH diagnoses across the U.S. Army. Service members identified as having a new BH diagnosis were tracked for 12 months following the diagnosis to determine the recommendation of a permanent duty limitation profile. RESULTS: From 2017 to 2018, 16% (n = 102,440) of service members received a "new" BH diagnosis. Less than 10% (9.5%; n = 9,752) of soldiers diagnosed with a BH disorder were issued a permanent BH-related duty profile within 12 months of the initial diagnosis. The absolute risk of a permanent profile was highest for soldiers diagnosed with a psychotic or delusional disorder (42%; n = 324) followed by dissociative or somatoform disorders (26%; n = 178) and eating disorders (23%; n = 108). CONCLUSIONS: Military regulations dictating medical readiness and retention standards reflect both the standards required for mission readiness and a layer of medical protection for the service member. This study provides important information on the relationship between a new BH diagnosis and the likelihood that a service member will be referred for a retirement evaluation.

Prevalence and Risk Factors of Self-reported Dizziness in Post-9/11 Service Members and Veterans.

INTRODUCTION: Dizziness is prevalent in the general population, but little is known about its prevalence in the U.S. military population. Dizziness is commonly associated with blast exposure and traumatic brain injury (TBI), but the potential independent contributions of blast and TBI have yet to be evaluated. This study's goal was to estimate the prevalence of dizziness among post-9/11 service members and Veterans and to examine independent and joint associations between military TBI history, blast exposure, and self-reported dizziness. MATERIALS AND METHODS: The study sample consisted of service members (n = 424) and recently separated (< ∼2.5 years) Veterans (n = 492) enrolled in the Noise Outcomes in Service members Epidemiology (NOISE) Study. We examined associations between self-reported history of probable TBI and blast exposure and recent dizziness using logistic regression. Models were stratified by service member versus Veteran status and adjusted to account for potentially confounding demographic and military characteristics. RESULTS: Overall, 22% of service members and 31% of Veterans self-reported dizziness. Compared to those with neither TBI nor blast exposure history, both service members and Veterans with TBI (with or without blast) were three to four times more likely to self-report dizziness. Those with blast exposure but no TBI history were not more likely to self-report dizziness. There was no evidence of an interaction effect between blast exposure and a history of TBI on the occurrence of dizziness. CONCLUSION: Self-reported dizziness was prevalent in this sample of service members and Veterans. Probable TBI history, with or without blast exposure, was associated with dizziness, but blast exposure without TBI history was not. This suggests that treatment guidelines for TBI-related dizziness may not need to be tailored to the injury mechanism. However, future efforts should be directed toward the understanding of the pathophysiology of TBI on self-reported dizziness, which is fundamental to the design of treatment strategies.

Increasing Hearing Readiness Using Boothless Audiometry.

INTRODUCTION: U.S. Army regulations require all soldiers to undergo annual audiometric testing to maintain hearing readiness. The standard method of monitoring hearing in the DoD is via multi-person testing in sound-treated booths using the Defense Occupational and Environmental Health Readiness System-Hearing Conservation. COVID-19 significantly hindered the standard method, resulting in alarming declines in hearing readiness. In response, the Army Hearing Program initiated a pilot program to use boothless audiometers to supplement standard methods to increase hearing readiness. MATERIALS AND METHODS: Funding from the Coronavirus Aid, Relief, and Economic Security Act was used to purchase 169 boothless audiometers and increase staffing at dozens of Army Hearing Program clinics. Standard operating procedures were established for audiometric testing outside the booth using a process matching standard test parameters (i.e., test frequencies, tone characteristics, and interstimulus intervals). Additional capabilities developed to leverage this new technology during the annual hearing exam include the administration of automated contralateral masking, enhanced tinnitus screening, and hearing health education and training. RESULTS: Monitoring audiometry using boothless audiometers has been conducted for nearly 12,000 service members worldwide. Thresholds obtained via boothless audiometers are comparable to follow-up thresholds obtained from the standard test methods in the booth (mean difference 95% CI, -1.2, 0.9), and hearing readiness has returned to pre-pandemic levels at installations where this novel technology is being used regularly. CONCLUSIONS: Significant reductions in patient encounters as a direct result of the COVID-19 pandemic have led to innovative solutions leveraging boothless audiometers. While this has aided the primary mission to maintain a medically ready force, innovations from this endeavor highlight several additional improvements relative to current standards of care that should be considered for permanent inclusion in DoD Hearing Conservation Programs.

Association of Chronic Pain With Alcohol Consumption and Tobacco Use in Active Duty Soldiers.

INTRODUCTION: Chronic pain and lifestyle habits, namely alcohol consumption and tobacco use, impact soldier readiness. This study examines the relationship between chronic pain and these lifestyle habits in soldiers seen at the Interdisciplinary Pain Management Center (IPMC). MATERIALS AND METHODS: This cross-sectional retrospective review utilized data from active duty soldiers receiving treatment at the IPMC. Soldiers (N = 203, 85% men) treated at the IPMC completed an intake questionnaire that included the Defense and Veterans Pain Rating Scale, the Alcohol Use Disorders Identification Test-Concise, and inquiries about tobacco use. Tobacco use was quantified as the amount and frequency of cigarettes smoked. Other tobacco products were converted to an equivalent number of cigarettes. Data were analyzed using descriptive statistics, Pearson's correlation, and independent samples t-test analyses. RESULTS: The mean duration of pain reported was 34.73 ± 38.66 months (median = 24.00). Soldiers engaging in hazardous drinking reported significantly higher interference with sleep (mean = 6.53 versus 5.40, P = .03) and greater negative effect on mood (mean = 6.33 versus 5.30, P = .04) compared to the no hazardous drinking group. Nonsignificant differences were found between tobacco users and non-tobacco users regarding pain intensity and pain effect on activity, sleep, mood, and stress (all P > .05). Among tobacco users, a significant negative correlation was found between a daily number of cigarettes used and sleep interference (r = -0.29, P = .024) as well as effect on mood (r = -0.33, P = .010). Years of tobacco use showed a significant negative correlation with the average pain intensity (r = -0.32, P = .025). CONCLUSIONS: The results suggest that addressing alcohol consumption is an essential part of chronic pain treatment. The finding of a negative association between years of nicotine use and pain intensity suggests that nicotine use may have served as a coping mechanism. Further research is needed.

Completeness and Timeliness of Reporting Notifiable Medical Events, U.S. Military Active Component and Other DOD Beneficiaries, 2018-2022.

Complete and timely reporting of notifiable medical conditions among the Department of Defense (DOD) beneficiary population is important for the control of communicable and preventable diseases and injuries. The Defense Medical Surveillance System was used to identify all hospital and ambulatory care encounters during 2018-2022 for which a notifiable medical condition was indicated among active component service members as well as all other DOD beneficiaries. Inci-dent cases with diagnoses of DOD-notifiable medical conditions were matched with reportable medical events entered through the Disease Reporting System internet (DRSi). During the study period, 61.2% of notifiable hospitalized cases and 65.5% of notifiable ambulatory care cases at a military hospital or clinic among active component service members were reported. Among other beneficiaries treated at a military hospital or clinic, only 15.2% of notifiable hospitalized cases and 22.1% of notifiable ambulatory care cases were reported to DRSi. Reporting percentages were much lower for care at outsourced facilities, regardless of the population. The timeliness of reporting for active component service members fluctuated annually, but in both 2018 and 2022, 64.2% of notifiable cases at a military hospital were reported within 1 week. For ambulatory care cases, timeliness of reporting decreased over time, with 50.1% reported within 1 week in 2018 and 43.3% in 2022. A total of 1,306 hospitalized and 100,163 ambulatory incident cases for notifiable medical conditions among active component service members occurred from January 2018 to December 2022. Reporting of these events though the DRSi (Disease Reporting System Internet) increased since the last report in 2015, but timeliness decreased. Data on other beneficiaries and outsourced care facilities were added to the analysis for this report. Improvements to reporting and timeliness of active component service member notifiable medical conditions is needed to effectively track and mitigate communicable diseases and preventable injuries. Although reporting currently is not required for all non-service member beneficiaries, they present another source of communicable diseases that could affect disease among service members, making them a potential population for report consideration.

Force Protection Risks in AFRICOM, INDOPACOM and SOUTHCOM Due to Rapid Diagnostic Test Failures for Falciparum Malaria, 2016-2022.

Malaria, caused by various species of the Plasmodium parasite, remains a significant health threat in most U.S. military regions-AFRICOM, CENT-COM, INDOPACOM, and SOUTHCOM-and although less prevalent, also poses periodic risks to military personnel in NORTHCOM through imported cases. Early diagnosis is crucial for effective malaria chemotherapy, and rapid diagnostic tests (RDTs) have proven valuable in resource-poor settings and operational environments. The BinaxNow Malaria RDT is currently the sole U.S. Food and Drug Administration (FDA)-approved test for use on U.S. military personnel. This simple RDT targets Plasmodium falciparum, the deadliest malaria species, by detecting the histidine-rich protein 2 (HRP2), as well as pan-Plasmodium species by detecting aldolase. The emergence of mutant P. falciparum parasites lacking pfhrp2/pfhrp3 genes and thus not expressing HRP2/HRP3 proteins poses a significant challenge in many malaria-endemic areas. This genetic variation has led to false-negative results in all HRP2-detecting RDTs including BinaxNow, undermining its utility. Current U.S. military force health protection (FHP) measures for preventing malaria, including chemoprophylaxis, permethrin-treated uniforms, and DEET application to exposed skin, are effective, but breakthrough infections still occur. The use of portable and user-friendly malaria diagnostics is necessary in remote locations that lack microscopy or nucleic acid-based diagnostic capabilities. The alarmingly high prevalence of mutant pfhrp2/3-deleted parasites poses a threat to malaria diagnosis in all Combatant Commands where point-of-care testing is vital. This review emphasizes the importance of ongoing monitoring to determine the frequency and distribution of mutant parasites. Urgent attention is needed to develop alternative RDTs that can effectively detect malaria infections caused by these mutant strains. These findings confirm that mutant pfhrp2/3-deleted parasites are highly prevalent in SOUTHCOM and parts of AFRICOM, rendering HRP2-based RDTs such as BinaxNow an unsuitable diagnostic tool for malaria in many of the SOUTHCOM and AFRICOM countries surveyed: Peru (14.3-62% between 2011-2018), Eritrea (62% in 2016 and 9.4% in 2020), Nigeria (13.3%), Sudan (11.2%), South Sudan (17.7%), and Uganda (3.3%). In INDOPACOM countries surveyed, no prevalence greater than 5% pfhrp2 deletions were observed. It is critical to continue surveillance on the frequency and distribution of these mutant parasites and develop alternative RDTs. WHO recommends that countries switch to non-HRP2-based RDTs when prevalence of pfhrp2/3 deletions that cause false-negative RDT results exceed 5%. Current prevalence of mutant pfhrp2/3-deleted parasites causing false-negative RDT results has exceeded this threshold in most parts of SOUTHCOM and several areas of AFRICOM. If alternative diagnostic tests are not utilized in areas affected, life-saving malaria treatment for U.S. military personnel could be delayed. Continuous mapping of the frequency and distribution of mutant parasites directly informs FHP protection policy decisions for alternative diagnostic tool utilization.

[Stress fractures in the military context]. / Stressfrakturen im militärischen Kontext.

BACKGROUND: Soldiers, especially as recruits, are exposed to significantly elevated stress patterns of the foot due to occupation-related marching and excessive running. This can lead to military-specific stress fractures of the metatarsals, i.e., marching fractures. The treatment and prevention of stress fractures are of particular importance in the military context due to the impact on operational capability and treatment costs. A uniform classification of these fractures does not yet exist. OBJECTIVE: Review of stress fractures in the military setting with presentation of the incidence, risk factors, classification, treatment and prevention possibilities. MATERIAL AND METHODS: A PubMed®-based review of the current literature on stress fractures in the military context was conducted and the results were discussed with a focus on specific military medical treatment options. RESULTS: There are several possibilities to classify stress fractures, the most well-known being a 4-level magnetic resonance imaging (MRI)-based classification. Prevention and treatment possibilities are multifaceted but so far insufficiently validated. CONCLUSION: Military-specific stress fractures should be grouped according to a 4-level and MRI-based classification. The treatment options include both conservative and surgical measures and should be implemented taking the patient's individual requirements into account. Preventive measures play a key role in the military context. They include the adaptation of screening tools, training and equipment and require continuous evaluation and development.

[War wounds and ballistics]. / Plaies de guerre et balistique.

Ballistic wounds, which historically concerned military populations, now also affect civilian practice. Terrorist attacks, urban violence and certain accidents have brought them into the daily routine of some French hospitals. Their frequency fully justifies the need for every health-care professional to be aware of the major issues involved in their management. In this section, we will describe the various penetrating ballistic wounds and their specific features. We will also rectify certain preconceived ideas that should not be peddled by healthcare professionals, in order to maintain a high standard of care.

Clinical Inquiry in Nursing Readiness Fellowship: Increasing Air Force Nurse Corps Evidence-Based Practice Leadership Infrastructure.

BACKGROUND: Increasing demands to generate, translate, and implement evidence into practice in manpower and budget-constrained environments triggered innovative support for the nursing scientific community. The Clinical Inquiry in Nursing Readiness (CINR) fellowship is a solution to integrate readiness into clinical inquiry priorities and develop future experts in the field. METHODS: This article describes the fellowship program structure, implementation, and contributions to nursing science, readiness, and professional development. We share specific recommendations based on our experiences to enhance and sustain this valuable fellowship program. RESULTS: Six fellows have completed the CINR fellowship since its launch in July 2019. Fellows garnered $40,000 in grant funds for five evidence-based practices, two research studies, and six clinical inquiry initiatives. So far, the fellows have produced 20 knowledge products: Three published manuscripts, three evidence-based resource toolkits, nine professional conference presentations (one international), five professional certifications, a variety of organization-wide leadership briefings, and two military decorations specific to the pandemic response. CONCLUSIONS: Establishing a fellowship program to develop a pipeline of readiness-focused nurse scientists and evidence-based practice experts builds future capacity for the enterprise while professionally developing individual nurses for advanced degrees and clinical inquiry leadership roles. Individuals and organizations aspiring to promote a culture of nursing inquiry may benefit from fellowships such as the CINR program.

Incidence of Colorectal Cancer Among Active Component Service Members, 2010-2022.

Colorectal cancer, which is more predominant among men than women, has been shown to be associated with environmental and occupational risk factors experienced by military members. The Defense Medical Surveillance System (DMSS) was used to determine the crude and age-adjusted incidence rates of colorectal cancer among active component service members from all military services from January 1, 2010 to December 31, 2022. Results from this analysis show higher crude incidence rates of colorectal cancer among those who are older and male. The overall age-adjusted incidence rate throughout the surveillance period ranged from 3.56 (95% CI: 2.54-4.58) to 7.92 (95% CI: 5.98-9.86) cases per 100,000 person-years. Age-adjusted colorectal cancer rates were similar for males and females (4.46 and 4.33 cases per 100,000 person-years, respectively) and rates were relatively similar by service as well as race and ethnicity. This finding could be attributed to the small number of cases in this study due to better screening practices in the Military Health System (MHS). Although non-Hispanic Black service members have historically had the highest incidence of colorectal cancer within the U.S. military, this study observed similar rates of colorectal cancer for all races and ethnicities after adjusting for age. Incident rates of colorectal cancer within the U.S. military increase monotonically with age, with service members over the age of 45 with the highest incidence, re-enforcing the need to promote wellness screening among military populations. The importance of the DHA guideline changes that decreased colorectal screenings to age 45 years is significant.

Protocol for the Implementation of Psychologically Informed Physical Therapy to Prevent Chronification in Service Members With Musculoskeletal Disorders.

INTRODUCTION: Musculoskeletal disorders (MSDs) are a primary cause of separation and long-term disability in active duty service members (ADSMs). Psychologically informed physical therapy (PiPT) is designed to identify and address modifiable psychological risk factors early in an MSD episode and has been proven effective in preventing chronicity in civilian populations. We developed a course to train military physical therapy (PT) personnel in PiPT for treating ADSM with MSD. This study tests the feasibility and effectiveness of our training. OBJECTIVE: Establish the feasibility of implementing PiPT and its effectiveness in the U.S. military. MATERIALS AND METHODS: An observational, prospective, comparative cohort study will test implementation and effectiveness. First, we will observe clinical outcomes in a cohort of ADSM with MSD receiving usual PT care at a military outpatient PT clinic. Next, we will train all PT staff in PiPT. Finally, PiPT will be implemented in a second cohort of ADSM. Data will be collected from each cohort at pre-treatment, fourth PT visit, 6 months post enrollment, and 12 months post enrollment. The primary outcomes are pain interference and psychological risk for chronicity. RESULTS AND CONCLUSIONS: Data collection is ongoing. Findings will identify the factors associated with PiPT outcomes in ADSM, inform the implementation of PiPT across health care settings, and allow us to document the prevalence of risk factors for chronicity in ADSM. Findings can help to prevent chronification from MSD, thereby reducing lost man-hours and enhancing military readiness, contribute to the development of a highly skilled workforce for the provision of health services to ADSM, and enhance the efficiency of health care delivery through optimal allocation of PT resources, resulting in significant cost savings for the military.