Development and Validation of the Veteran Military Occupational and Environmental Exposure Assessment Tool.

Introduction: Military exposures may present a cumulative load and increased individual susceptibility to negative health outcomes. Currently, there are no comprehensive and validated environmental exposure assessment tools covering the full spectrum of occupational and environmental exposures for Veterans. The Veterans Affairs (VA) War Related Illness and Injury Study Center in Washington, DC, developed the Veteran Military Occupational and Environmental Exposure Assessment Tool (VMOAT) to establish a structured, comprehensive self-report tool that captures military and non-military occupational and environmental exposures.

Preparedness of Military Public Health for Epidemic and Pandemic Recognition and Response.

Disease epidemics have threatened American military preparedness and operational capabilities since 1775. The ongoing Severe Acute Respiratory Syndrome Coronavirus 2 (COVID-19) pandemic, which began in 2019, again demonstrates the significant potential for infectious diseases to impact military units and threaten military readiness. We reviewed the historical and continuing threats to the U.

Military Epidemics, Then and Now: Smallpox and COVID-19.

We compared the COVID-19 experience in the first year of the current pandemic in the US with the smallpox experience of the 18th century, focusing on the US military but recognizing civilian and military populations are not separate and distinct. Despite the epidemics being separated by 21/2 centuries and with great advancements in technology having occurred over that time, we observed similarities which led us to several conclusions: • Infectious disease outbreaks will continue to occur and novel agents, naturally occurring or manipulated by humans, will threaten military and civilian populations nationally and globally. • Infectious disease outbreaks can affect both military and civilian populations, persist for long periods, and be catastrophic to military peacetime and wartime operations.

The Capability Gap in Occupational Health Information Management.

The lack of an integrated approach to data capture, information management, and analysis limits the contribution of occupational and environmental medicine to protecting 2.3 million uniformed and civilian DoD workers. Despite an abundance of military information systems that include the terms "Safety" and "Occupational Health" in their names, none of these systems provide capabilities needed to aggregate and analyze the results of occupational medicine exams, use medical surveillance to mitigate exposure incidents, provide enterprise-level management of occupational medicine services, or comply with privacy and recordkeeping law and regulation.

Hazardous Non-Combat Exposures in the U.S. Department of Defense.

Hazardous non-combat exposures are inherent to military service and occur in three settings: installation workplaces, installation environments, and deployment environments. Few military clinicians receive training in how to recognize, assess, and manage patients with these exposures, and systems improvements are needed to support clinicians with respect to exposure recognition and management. This commentary highlights key concepts surrounding military non-combat exposures by discussing three case examples of exposures occurring in each of these settings.

The Future of Military Occupational and Environmental Medicine in the Department of Defense.

Objective: Transfer of military medical facilities to the Defense Health Agency is transforming the Military Health System. Our objective is to inform this transformation with respect to optimum application of occupational and environmental medicine (OEM) expertise.

Methods: We defined and analyzed the external influences on military OEM practice using a structured framework to identify key drivers.

Training Occupational and Environmental Medicine (OEM) Residents at the Uniformed Services University.

Objective: To develop an actionable plan to sustain and improve the quality of the Uniformed Services University of the Health Sciences (USU) Occupational and Environmental Medicine (OEM) Residency Program.

Methods: Program metrics were collected and analyzed to assess strengths, weaknesses, opportunities, and threats (SWOT analysis).

Results: Program strengths are stable funding, full-time faculty and large class size.

Uniformed Services University Occupational and Environmental Medicine Residency Program.

In 2019, the Uniformed Services University of the Health Sciences (USU) F. Edward Hébert School of Medicine celebrated the 30th anniversary of its Occupational and Environmental Medicine (OEM) Residency program. This unique program is among the largest preventive medicine residency programs in the United States.

Exposure to Heptachlorodibenzo-p-dioxin (HpCDD) Regulates microRNA Expression in Human Lung Fibroblasts.

Objective: Benzo(ghi)perylene (BghiP) and 1,2,3,4,6,7,8-Heptachlorodibenzo-p-dioxin (HpCDD) were elevated in serum from personnel deployed to sites with open burn pits. Here, we investigated the ability of BghiP and HpCDD to regulate microRNA (miRNA) expression through the aryl hydrocarbon receptor (AHR).

Methods: Human lung fibroblasts (HLFs) were exposed to BghiP and HpCDD.

Benzo[a]pyrene Perturbs Mitochondrial and Amino Acid Metabolism in Lung Epithelial Cells and Has Similar Correlations With Metabolic Changes in Human Serum.

Objective: A study was conducted to identifymetabolic-related effects of benzo[a]pyrene (BaP) on human lung epithelial cells and validate these findings using human sera.

Methods: Human lung epithelial cells were treated with BaP, and extracts were analyzed with a global metabolome-wide association study (MWAS) to test for pathways and metabolites altered relative to vehicle controls.

Results: MWAS results showed that BaP metabolites were among the top metabolites differing between BaP-treated cells and controls.

Integrative Network Analysis Linking Clinical Outcomes With Environmental Exposures and Molecular Variations in Service Personnel Deployed to Balad and Bagram.

Objective: To develop a computational approach to link clinical outcomes with environmental exposures and molecular variations measured in Department of Defense (DOD) serum-repository samples.

Methods: International Classification of Diseases, Ninth Division codes which corresponded to cardiopulmonary symptoms for service personnel were selected to test for associations with deployment-related inhalation hazards and metabolomics, micro-RNA, cytokine, plasma markers, and environmental exposure analyses for corresponding samples. xMWAS and Mummichog were used for integrative network and pathway analysis.

Machine Learning Approach for Predicting Past Environmental Exposures From Molecular Profiling of Post-Exposure Human Serum Samples.

Objective: To develop an approach for a retrospective analysis of post-exposure serum samples using diverse molecular profiles.

Methods: The 236 molecular profiles from 800 de-identified human serum samples from the Department of Defense Serum Repository were classified as smokers or non-smokers based on direct measurement of serum cotinine levels. A machine-learning pipeline was used to classify smokers and non-smokers from their molecular profiles.

Analysis of Postdeployment Serum Samples Identifies Potential Biomarkers of Exposure to Burn Pits and Other Environmental Hazards.

Objective: The potential health risks of deployment to sites with open burn pits remain poorly understood, in part, because personal exposure monitoring was not performed. Here, we investigated whether postdeployment serum samples contain biomarkers associated with exposure to burn pits.

Methods: A total of 237 biomarkers were measured in 800 serum samples from deployed and never-deployed subjects.

Associations of Benzo(ghi)perylene and Heptachlorodibenzo-p-dioxin in Serum of Service Personnel Deployed to Balad, Iraq, and Bagram, Afghanistan Correlates With Perturbed Amino Acid Metabolism in Human Lung Fibroblasts.

Objective: A study was conducted to identify metabolic-related effects of benzo(ghi)perylene (BghiP) and 1,2,3,4,6,7,8-heptachlorodibenzo-p-dioxin (HpCDD), on primary human fibroblasts to verify biological associations previously found in occupational health research.

Methods: Human lung fibroblasts were exposed to BghiP or HpCDD and extracts were analyzed with a metabolome-wide association study to test for pathways and metabolites altered relative to controls. Gene expression was measured by quantitative-real time polymerase chain reaction.

Metabolome-Wide Association Study of Deployment to Balad, Iraq or Bagram, Afghanistan.

Objective: To use high-resolution metabolomics (HRM) to identify metabolic changes in military personnel associated with deployment to Balad, Iraq, or Bagram, Afghanistan.

Methods: Pre- and post-deployment samples were obtained from the Department of Defense Serum Repository (DoDSR). HRM and bioinformatics were used to identify metabolic differences associated with deployment.

Environmental Chemicals Altered in Association With Deployment for High Risk Areas.

Objective: A study was conducted using serum samples and high-resolution metabolomics (HRM) to test for changes in abundance of environmental chemicals in deployment in high-risk areas (Balad, Iraq; Bagram, Afghanistan).

Methods: Pre and Post-deployment serum samples for deployment (cases) and matched controls stationed domestically were analyzed by HRM and bioinformatics for the relative abundance of 271 environmental chemicals.

Results: Of the 271 chemicals, 153 were measurable in at least 80% of the samples in one of the pre- or post-deployment groups.

Advances in Comprehensive Exposure Assessment: Opportunities for the US Military.

Objective: Review advances in exposure assessment offered by the exposome concept and new -omics and sensor technologies.

Methods: Narrative review of advances, including current efforts and potential future applications by the US military.

Results: Exposure assessment methods from both bottom-up and top-down exposomics approaches are advancing at a rapid pace, and the US military is engaged in developing both approaches.

Systematic review of military motor vehicle crash-related injuries.

Context: Motor vehicle crashes account for nearly one third of U.S. military fatalities annually.

Harmful algal bloom-associated marine toxins: a risk assessment framework.

Marine toxins produced by harmful algal blooms (HABs) present a health risk to humans, but the extent of that risk remains unquantified. Increases in bloom frequency and geographic distribution present a potential for increased human exposure to these toxins, raising concerns among HAB researchers regarding an emerging public health problem. A risk assessment framework is presented with 2 objectives: (1) to provide a road map for integration and coordination of health-related research efforts and (2) to provide an overview of this complex problem to possible collaborators.

Mental health disorders in a cohort of U.S. Navy and Marine Corps personnel receiving waivers of medical accession standards.

To assess risk of disability discharge in U.S. Navy and Marine Corps personnel receiving waivers of medical accession standards for mental health, we retrospectively identified a cohort of 22,960 waiver recipients from February 2001 to November 2005.

Public health potential of a disability tracking system: analysis of U.S. Navy and Marine Corps physical evaluation boards 2005-2006.

Clinical and demographic data in administrative disability tracking systems have the potential to support disability reduction programs. We analyzed recent Navy Physical Evaluation Board data, compared our findings with previous studies, and evaluated the quality of the case-tracking database as a public health information system. The overall rate of cases was 50% higher than in 2000 and 40% higher than the rate of new long-term group disability insurance claims.