"Spiritual Readiness" in the U.S. Military: A Neglected Component of Warrior Readiness.

Recent events have led to concerns about whether U.S. service members are "ready" to engage in combat operations. With most discussions now focused on military readiness, attention paid to warfighter readiness may have fallen behind. Service members typically receive extensive training in the tactical, physical, mental, social, and behavioral aspects of readiness, while the spiritual aspects are often ignored. This review examines (1) recent concerns over warfighter readiness, (2) mental health problems that are common among members of the U.S. military, (3) definitions and determinants of "spiritual readiness" (SR), (4) the impact of SR on human flourishing (HF) and warfighter readiness, (5) research on the effects of religious/spiritual involvement on HF, and (6) those responsible for building and sustaining SR in the military. An extensive body of research over the past 30 years has documented the impact of religious/spiritual (R/S) involvement on many aspects of human flourishing, thereby affecting the warfighter's readiness to perform duties at the highest level. Military chaplains, mental health professionals, and medical providers all play important roles in building and sustaining the spiritual readiness of those in the U.S. military, thereby ensuring that these individuals perform in a way that maximizes their success during combat operations.

Evaluation of Three Field Rewarming Techniques During Cold Weather Military Training.

INTRODUCTION: The purpose of this work was to evaluate the effectiveness of 3 rewarming techniques to determine how warfighters, and perhaps other populations in wilderness environments, should prioritize field rewarming options after a brief accidental immersion in cold water. METHODS: As part of a cold weather military training exercise, 31 military personnel (mean±SD age: 26±5 y, height: 180±10 cm, weight: 83.2±10.9 kg) completed a 10-min immersion in cold (0°C) water and subsequently rewarmed for 60 min using 3 different field rewarming techniques (sleeping bag, sleeping bag + warm fluids, or exercise). Heart rate, core and skin temperatures, thermal and shivering sensations, and manual dexterity (intravenous setup and insertion) were measured during the training exercise. RESULTS: Cold water immersion decreased core temperature (pre: 37.4±0.4; post: 36.4±1.0°C; P<0.001) and mean skin temperature (pre: 27.9±1.3; post: 15.6±1.8°C; P<0.001) and impaired manual dexterity (intravenous insertion time, pre: 71±12, post: 166±48 s; P<0.001). Recovery from mild cold stress was similar among all 3 rewarming techniques for all measurements. CONCLUSIONS: Findings suggesting similar rewarming responses in field settings are beneficial for the warfighter, and perhaps others, in that rewarming options exist and can be implemented with no compromise in recovery from cold stress.

Development of an auditory situation awareness test battery for advanced hearing protectors and TCAPS: detection subtest of DRILCOM (detection-recognition/identification-localization-communication).

OBJECTIVE: To design a test battery and conduct a proof-of-concept experiment of a test method that can be used to measure the detection performance afforded by military advanced hearing protection devices (HPDs) and tactical communication and protective systems (TCAPS). DESIGN: The detection test was conducted with each of the four loudspeakers located at front, right, rear and left of the participant. Participants wore 2 in-ear-type TCAPS, 1 earmuff-type TCAPS, a passive Combat Arms Earplug in its "open" or pass-through setting and an EB-15LE™ electronic earplug. Devices with electronic gain systems were tested under two gain settings: "unity" and "max". Testing without any device (open ear) was conducted as a control. STUDY SAMPLE: Ten participants with audiometric requirements of 25 dBHL or better at 500, 1000, 2000, 4000, 8000 Hz in both ears. RESULTS: Detection task performance varied with different signals and speaker locations. The test identified performance differences among certain TCAPS and protectors, and the open ear. CONCLUSIONS: A computer-controlled detection subtest of the Detection-Recognition/Identification-Localisation-Communication (DRILCOM) test battery was designed and implemented. Tested in a proof-of-concept experiment, it showed statistically-significant sensitivity to device differences in detection effects with the small sample of participants (10). This result has important implications for selection and deployment of TCAPS and HPDs on soldiers and workers in dynamic situations.

Effects of user training with electronically-modulated sound transmission hearing protectors and the open ear on horizontal localization ability.

OBJECTIVE: To determine if training with electronically-modulated hearing protection (EMHP) and the open ear results in auditory learning on a horizontal localization task. DESIGN: Baseline localization testing was conducted in three listening conditions (open-ear, in-the-ear (ITE) EMHP, and over-the-ear (OTE) EMHP). Participants then wore either an ITE or OTE EMHP for 12, almost daily, one-hour training sessions. After training was complete, participants again underwent localization testing in all three listening conditions. A computer with a custom software and hardware interface presented localization sounds and collected participant responses. STUDY SAMPLE: Twelve participants were recruited from the student population at Virginia Tech. Audiometric requirements were 35 dBHL at 500, 1000, and 2000 Hz bilaterally, and 55 dBHL at 4000 Hz in at least one ear. RESULTS: Pre-training localization performance with an ITE or OTE EMHP was worse than open-ear performance. After training with any given listening condition, including open-ear, performance in that listening condition improved, in part from a practice effect. However, post-training localization performance showed near equal performance between the open-ear and training EMHP. Auditory learning occurred for the training EMHP, but not for the non-training EMHP; that is, there was no significant training crossover effect between the ITE and the OTE devices. CONCLUSION: It is evident from this study that auditory learning (improved horizontal localization performance) occurred with the EMHP for which training was performed. However, performance improvements found with the training EMHP were not realized in the non-training EMHP. Furthermore, localization performance in the open-ear condition also benefitted from training on the task.

A mobile app for military operational entomology pesticide applications.

Multiple field studies conducted for the Deployed War-Fighter Protection (DWFP) research program have generated more than 80 specific guidance points for innovative combinations of pesticide application equipment, pesticide formulations, and application techniques for aerosol and residual pesticide treatments in 6 ecological regions against a range of mosquito, sand fly, and filth fly nuisance and disease-vector threats. To synthesize and operationalize these DWFP field and laboratory efficacy data we developed an interactive iOS and Android mobile software application, the Pesticide App, consisting of specific pesticide application guidance organized by environment and target insect vector species.

Dietary Supplementation on Physical Performance and Recovery in Active-Duty Military Personnel: A Systematic Review of Randomized and Quasi-Experimental Controlled Trials.

BACKGROUND: Warfighters, often called tactical athletes, seek dietary supplementation to enhance training and recovery. Roughly 69% of active-duty US military personnel have reported consuming dietary supplements. The objective of this systematic review was to examine the impact of dietary supplements on muscle-related physical performance and recovery in active-duty military personnel. METHODS: Randomized controlled trials and quasi-experimental controlled trials of oral dietary supplementation in active-duty military members were examined. A protocol was registered (PROSPERO CRD42023401472), and a systematic search of MEDLINE and CINAHL was undertaken. Inclusion criteria consisted of studies published between 1990-2023 with outcomes of muscle performance and recovery among active-duty military populations. The risk of bias was assessed with the McMaster University Guidelines and Critical Review Form for Quantitative Studies. RESULTS: Sixteen studies were included. Four were conducted on protein or carbohydrate; four on beta-alanine alone, creatine alone, or in combination; two on mixed nutritional supplements; two on probiotics alone or in combination with beta hydroxy-beta methylbutyrate calcium; and four on phytonutrient extracts including oregano, beetroot juice, quercetin, and resveratrol. Ten examined outcomes related to physical performance, and six on outcomes of injury or recovery. Overall, protein, carbohydrate, beta-alanine, creatine, and beetroot juice modestly improved performance, while quercetin did not. Protein, carbohydrates, beta-alanine, probiotics, and oregano reduced markers of inflammation, while resveratrol did not. CONCLUSIONS: Nutrition supplementation may have small benefits on muscle performance and recovery in warfighters. However, there are significant limitations in interpretation due to the largely inconsistent evidence of ingredients and comparable outcomes. Thus, there is inadequate practical evidence to suggest how dietary supplementation may affect field performance.

Heat stress increases carbohydrate oxidation rates and oxygen uptake during prolonged load carriage exercise.

Military missions are conducted in a multitude of environments including heat and may involve walking under load following severe exertion, the metabolic demands of which may have nutritional implications for fueling and recovery planning. Ten males equipped a military pack loaded to 30% of their body mass and walked in 20°C/40% relative humidity (RH) (TEMP) or 37°C/20% RH (HOT) either continuously (CW) for 90 min at the first ventilatory threshold or mixed walking (MW) with unloaded running intervals above the second ventilatory threshold between min 35 and 55 of the 90 min bout. Pulmonary gas, thermoregulatory, and cardiovascular variables were analyzed following running intervals. Final rectal temperature (MW: p < 0.001, g = 3.81, CW: p < 0.001, g = 4.04), oxygen uptake, cardiovascular strain, and energy expenditure were higher during HOT trials (p ≤ 0.05) regardless of exercise type. Both HOT trials elicited higher final carbohydrate oxidation (CHOox) than TEMP CW at min 90 (HOT MW: p < 0.001, g = 1.45, HOT CW: p = 0.009, g = 0.67) and HOT MW CHOox exceeded TEMP MW at min 80 and 90 (p = 0.049, g = 0.60 and p = 0.024, g = 0.73, respectively). There were no within-environment differences in substrate oxidation indicating that severe exertion work cycles did not produce a carryover effect during subsequent loaded walking. The rate of CHOox during 90 minutes of load carriage in the heat appears to be primarily affected by accumulated thermal load.

Evaluation of the Effectiveness of ROTC Army Cadet Exercise Training for the Army Combat Fitness Test.

The Army Combat Fitness Test (ACFT) is used to evaluate the fitness level of potential Cadets for military readiness. The purpose of this study was to evaluate the effectiveness of the exercise training program implemented by an Army Reserve Officers' Training Corps (ROTC) program to gauge the performance metrics of the ACFT. METHODS: Twenty-six student Cadets of the ROTC at the University of Alabama at Birmingham (UAB) program participated in the study. Over an 8-month period, the ROTC Cadets trained on campus three days per week. Training was performed in a circuit training format and each participant cycled through each of the four training stations (Strength, Conditioning, Core, and Endurance) for 15 minutes each session (for a total training time of 60 minutes). Each Cadet had body mass and body composition assessed as well as each component of the ACFT [maximum dead lift (MDL), standing power throw (SPT), hand release push-up (HRP), sprint-drag-carry (SDC), leg tuck/plank (LTK/PLK), and 2-mile run (2MR)]. Each variable was evaluated at three time points (pre-, mid-, and post-training program). RESULTS: There was a significant difference in the 2MR score between time points [F(2,50) = 4.530, p = .016, η2 = 0.153] with a significant difference between time point at pre- and post-training (p = .02). No other variables displayed a significant change: body mass (p = .741), body fat percentage (p = .238), MDL (p = .061), SPT (p = .308), HRP (p = .126), SDC (p = 0.132), LTK/PLK (p = 0.583). CONCLUSION: The results of this study suggest that the short-term training program used improves 2MR, but not other components of the ACFT over the course of an academic year.

Prevalence of hypothermia and critical hand temperatures during military cold water immersion training.

Cold-weather military operations can quickly undermine warfighter readiness and performance. Specifically, accidental cold-water immersion (CWI) contributes to rapid body heat loss and impaired motor function. This study evaluated the prevalence of hypothermia and critical hand temperatures during CWI. One-hundred seventeen (N = 117) military personnel (mean ± SD age: 27 ± 6 yr, height: 176 ± 8 cm, weight: 81.5 ± 11.6 kg) completed CWI and rewarming during cold-weather training, which included a 10-min outdoor CWI (1.3 ± 1.4°C) combined with cold air (-4.2 ± 8.5°C) exposure. Following CWI, students removed wet clothing, donned dry clothing, and entered sleeping systems. Core (Tc) and hand (Thand) temperatures were recorded continuously during the training exercise. Tc for 96 students (mean ± SD lowest Tc = 35.6 ± 0.9°C) revealed that 24 students (25%) experienced Tc below 35.0°C. All of 110 students (100%) experienced Thand below 15.0°C, with 71 students (65%) experiencing Thand at or below 8.0°C. Loss of hand function and hypothermia should be anticipated in warfighters who experience CWI in field settings. Given the high prevalence of low Thand, focus should be directed on quickly rewarming hands to recover function.

Body composition as a marker of performance and health in military personnel.

Introduction: Body composition standards are set to ensure operational readiness in active-duty military personnel. To meet body composition standards, some individuals, however, may engage in unhealthy weight control behaviors (i.e., weight cycling and disordered eating). The objectives of this review are to: (1) evaluate the evidence regarding body composition and the associations to physical and military specific performance; (2) discuss body composition and potential health consequences; and (3) examine the evidence of weight cycling and disordered eating behaviors in military personnel for weight control. Methods: A systematic search to identify peer-reviewed research articles was conducted in PubMed on 2/20/2023 using Medical Subject Headings (MeSH) including but not limited to "Military Personnel", "Tactical Athlete", "Weight Loss", "Body Composition", and "Weight Cycling". Results: A total of 225 research articles were identified. The list was narrowed down to articles from the last 20 years (2003-2023) in military personnel. Only studies in which percent body fat was directly measured were included resulting in 17 research articles for this review. Discussion: Evidence-based research is limited on the relationship between body composition and operational readiness. Weight cycling and disordered eating behaviors also has been reported for weight control, yet additional research is needed. Specifically, future research should focus on female service members, racial and ethnic differences, age, and postpartum status and include other service branches (i.e., Air Force and Navy). A comprehensive survey on weight cycling, disordered eating, and weight management would be valuable to determine the prevalence and extent of this issue. This information along with performance data would guide policy makers on the relevance and appropriateness of existing body composition standards.

A History of Heat Health Management Policies in the Singapore Military.

Our paper, which is the first historical study about heat injuries in Singapore, seeks to situate the Singapore Armed Forces' (SAF) history of heat stress management policies within the national context. Firstly, we observe that since the late 1970s, a research-driven approach has been adopted by the SAF's military medical leaders to formulate a range of policies to address the Forces' high incidence of heat injuries. This has resulted in the introduction of SAF-wide training measures, and the assembling of local scientific research expertise, which has led to a sharp reduction in heat injury incidence from the 1980s to 2000s. Through this, the SAF sought to demonstrate that its heat stress mitigation measures made the Singapore military 'heat proof'. Secondly, the state shaped a soldier safety agenda in the late 2000s on the back of an increasing emphasis on safety and the transformation of the SAF into a highly-educated and technologically-sophisticated force. This meant a shift towards concern about the welfare of every soldier, particularly through the state's drive to eradicate all training-related deaths. Accordingly, the SAF medical military leaders responded to the state's safety agenda by introducing heat stress management research and policies that were oriented towards the target of eradicating deaths due to heat stress. This policy and research direction, as such, has been strongly guided by the state's safety agenda and utilised to demonstrate to the public that all efforts have been taken to comprehensively mitigate the risks of heat.

The ethics of AI-assisted warfighter enhancement research and experimentation: Historical perspectives and ethical challenges.

The military applications of AI raise myriad ethical challenges. Critical among them is how AI integrates with human decision making to enhance cognitive performance on the battlefield. AI applications range from augmented reality devices to assist learning and improve training to implantable Brain-Computer Interfaces (BCI) to create bionic "super soldiers." As these technologies mature, AI-wired warfighters face potential affronts to cognitive liberty, psychological and physiological health risks and obstacles to integrating into military and civil society during their service and upon discharge. Before coming online and operational, however, AI-assisted technologies and neural interfaces require extensive research and human experimentation. Each endeavor raises additional ethical concerns that have been historically ignored thereby leaving military and medical scientists without a cogent ethics protocol for sustainable research. In this way, this paper is a "prequel" to the current debate over enhancement which largely considers neuro-technologies once they are already out the door and operational. To lay the ethics foundation for AI-assisted warfighter enhancement research, we present an historical overview of its technological development followed by a presentation of salient ethics research issues (ICRC, 2006). We begin with a historical survey of AI neuro-enhancement research highlighting the ethics lacunae of its development. We demonstrate the unique ethical problems posed by the convergence of several technologies in the military research setting. Then we address these deficiencies by emphasizing how AI-assisted warfighter enhancement research must pay particular attention to military necessity, and the medical and military cost-benefit tradeoffs of emerging technologies, all attending to the unique status of warfighters as experimental subjects. Finally, our focus is the enhancement of friendly or compatriot warfighters and not, as others have focused, enhancements intended to pacify enemy warfighters.

Quantifying warfighter performance during a bounding rush (prone-sprinting-prone) maneuver.

A single sacrum mounted inertial measurement unit (IMU) was employed to analyze warfighter performance on a bounding rush (prone-sprinting-prone) task. Thirty-nine participants (23M/16F) performed a bounding rush task consisting of four bounding rush cycles. The sacrum mounted IMU recorded angular velocity and acceleration data were used to provide estimates of sacral velocity and position. Individual rush cycles were parsed into three principal movement phases; namely, the get up, sprint, and get down phases. The timing of each phase was analyzed, averaged for each participant, and compared to the overall rush cycle time using regression analysis. A cluster analysis further reveals differences between high and low performers. Get down time was most predictive of bounding rush performance (R2 = 0.75) followed by get up time (R2 = 0.58) and sprint time (R2 = 0.40). Comparing high and low performers, the get down time exhibited nearly twice the effect on mean rush cycle time compared to get up time (effect size of -2.61 to -1.46, respectively). Overall, this IMU-based method reveals key features of the bounding rush that govern performance. Consequently, this objective method may support future training regimens and performance standards for military recruits, and parallel applications for athletes.

Evaluation of Probiotics for Warfighter Health and Performance.

The probiotic industry continues to grow in both usage and the diversity of products available. Scientific evidence supports clinical use of some probiotic strains for certain gastrointestinal indications. Although much less is known about the impact of probiotics in healthy populations, there is increasing consumer and scientific interest in using probiotics to promote physical and psychological health and performance. Military men and women are a unique healthy population that must maintain physical and psychological health in order to ensure mission success. In this narrative review, we examine the evidence regarding probiotics and candidate probiotics for physical and/or cognitive benefits in healthy adults within the context of potential applications for military personnel. The reviewed evidence suggests potential for certain strains to induce biophysiological changes that may offer physical and/or cognitive health and performance benefits in military populations. However, many knowledge gaps exist, effects on health and performance are generally not widespread among the strains examined, and beneficial findings are generally limited to single studies with small sample sizes. Multiple studies with the same strains and using similar endpoints are needed before definitive recommendations for use can be made. We conclude that, at present, there is not compelling scientific evidence to support the use of any particular probiotic(s) to promote physical or psychological performance in healthy military personnel. However, plausibility for physical and psychological health and performance benefits remains, and additional research is warranted. In particular, research in military cohorts would aid in assessing the value of probiotics for supporting physical and psychological health and performance under the unique demands required of these populations.

Biomimetic Gut Model Systems for Development of Targeted Microbial Solutions for Enhancing Warfighter Health and Performance.

The human gut microbiome plays a vital role in both health and disease states and as a mediator of cognitive and physical performance. Despite major advances in our understanding of the role of gut microbes in host physiology, mechanisms underlying human-microbiome dynamics have yet to be fully elucidated. This knowledge gap represents a major hurdle to the development of targeted gut microbiome solutions influencing human health and performance outcomes. The microbiome as it relates to warfighter health and performance is of interest to the Department of Defense (DoD) with the development of interventions impacting gut microbiome resiliency among its top research priorities. While technological advancements are enabling the development of experimental model systems that facilitate mechanistic insights underpinning human health, disease, and performance, translatability to human outcomes is still questionable. This review discusses some of the drivers influencing the DoD's interest in the warfighter gut microbiome and describes current in vitro gut model systems supporting direct microbial-host interactions.

Physical fitness, hormonal, and immunological responses during prolonged military field training.

Physical fitness is crucial to warfighters' performance in the battlefield. Previous studies have shown negative changes in their hormonal and neuromuscular responses induced by military field training (MFT). The purpose of this study was to investigate the changes in hormonal and immunological values and body composition during a prolonged MFT and to find out how warfighters' physical condition influences these changes. Conscripts (n = 49, age 20 ± 1 years, height 179 ± 9 cm, body mass 73.8 ± 7.8 kg, fat 12.6 ± 3.7% and BMI 23 kg/m²) were measured before, during, after MFT, and after a 4-day recovery period. Serum insulin-like growth factor-1 (IGF-1), tumor necrosis factor alpha (TNF-α), interleukin-6 (IL-6) concentrations, creatine kinase (CK) activity and leptin concentration were analyzed as well as body composition throughout MFT. Neuromuscular performance was assessed via lower and upper body muscle endurance at the beginning of the study. During MFT, there was a significant decrease (P < 0.05) in body mass (2.3%), fat mass (7.7%) and in muscle mass (2.2%), but all of these values recovered to PRE-levels after the recovery period. Serum IGF-1 (22%) and leptin decreased (66%) while CK increased (88%) significantly (P < 0.05) during MFT but recovered at the end of MFT. Upper body dynamic and trunk isometric muscular endurance had a positive correlation (r = 0.37. P < 0.05) with the change in IGF-1 during MFT and a negative correlation with the changes in CK (-0.34, P < 0.05). The results show that there were negative changes in conscript's body composition and hormonal and immunological values during the prolonged MFT. These changes suggest that the physiological stress was high during MFT. High levels of upper body and trunk muscular strength were negatively correlated with warfighters' physiological effects and should therefore be developed prior to actual deployment to reduce the physical decline experienced during prolonged MFTs.

The Current and Future State of Department of Defense (DoD) Microbiome Research: a Summary of the Inaugural DoD Tri-Service Microbiome Consortium Informational Meeting.

The Tri-Service Microbiome Consortium (TSMC) was recently established to enhance collaboration, coordination, and communication of microbiome research among Department of Defense (DoD) organizations. The TSMC aims to serve as a forum for sharing information related to DoD microbiome research, policy, and applications, to monitor global advances relevant to human health and performance, to identify priority objectives, and to facilitate Tri-Service (Army, Navy, and Air Force) collaborative research. The inaugural TSMC workshop held on 10 to 11 May 2017 brought together almost 100 attendees from across the DoD and several key DoD partners. The meeting outcomes informed attendees of the scope of current DoD microbiome research efforts and identified knowledge gaps, collaborative/leveraging opportunities, research barriers/challenges, and future directions. This report details meeting presentations and discussions with special emphasis on Tri-Service labs' current research activities.

Quantifying warfighter performance in a target acquisition and aiming task using wireless inertial sensors.

An array of inertial measurement units (IMUS) was experimentally employed to analyze warfighter performance on a target acquisition task pre/post fatigue. Eleven participants (5M/6F) repeated an exercise circuit carrying 20 kg of equipment until fatigued. IMUs secured to the sacrum, sternum, and a rifle quantified peak angular velocity magnitude (PAVM) and turn time (TT) on a target acquisition task (three aiming events with two 180° turns) within the exercise circuit. Turning performance of two turns was evaluated pre/post fatigue. Turning performance decreased with fatigue. PAVMs decreased during both turns for the sternum (p < 0.001), sacrum (p = 0.007) and rifle (p = 0.002). TT increased for the sternum (p = 0.001), sacrum (p = 0.003), and rifle (p = 0.02) during turn 1, and for the rifle (p = 0.04) during turn 2. IMUs detected and quantified changes in warfighter aiming performance after fatigue. Similar methodologies can be applied to many movement tasks, including quantifying movement performance for load, fatigue, and equipment conditions.

A systematic literature review of the use and effectiveness of the Computer Assisted Rehabilitation Environment for research and rehabilitation as it relates to the wounded warrior.

BACKGROUND: Several U.S. military treatment and research facilities employ a Computer Assisted Rehabilitation Environment (CAREN) [Motek Medical BV, Amsterdam, The Netherlands] for research and rehabilitation of complex injuries exhibited by Wounded Warriors. There has been little scientific evidence of the effectiveness of this type of system for rehabilitation. OBJECTIVE: A systematic review of the literature was completed to determine what type of work has been performed on the CAREN and report findings of clinical significance. METHODS: Specific terms were searched on electronic databases to include journal articles, abstracts, and peer-reviewed conference proceedings related to the CAREN. RESULTS: Twenty-six publications were elicited that met our criteria. These were divided by their primary focus: rehabilitation, clinical research, and technical reports. DISCUSSION: Results from published articles have determined that the system is a capable tool for both assessment and rehabilitation, but little has currently been published, particularly on patient populations. CONCLUSION: More research needs to be performed to evaluate its effectiveness as a rehabilitation tool compared to other rehabilitation methods. It is expected that a system, such as the CAREN, will challenge patients multifactorially (e.g. physically and cognitively) and provide biofeedback while decreasing rehabilitation time and increasing effectiveness of treatment.