Exposome Signatures of Gastrointestinal Disorders Among Active Duty Service Members.

Introduction: We evaluated the risk factors associated with gastrointestinal disorders (GD) among the soldiers of the Army and Marine Aviation community (AMAC) using an exposomic approach. Specifically, we aimed to determine the medical and operational factors associated with reported GD in the Military Health System.

Methods: Longitudinal data were obtained from the Medical Assessment and Readiness System (MARS) housed at Womack Army Medical Center, Fort Liberty, NC, for a retrospective cohort study that included 79,249 active duty United States AMAC active duty service members (ADSMs) from October 2015 to December 2019.

Human epididymis protein 4: Analysis of national health and nutrition examination survey data.

Background: Human epididymis protein 4 (HE4) is a tumor marker overexpressed in ovarian cancer and is commonly utilized to aid with diagnosis of an adnexal mass. HE4 levels vary based on pregnancy, age, menopausal status, and tobacco use.

Objective(s): The objective of this study was to evaluate population-based data to examine factors that affect HE4 among adult women in the United States and stratify levels of HE4 by demographic and gynecologic factors.

Changes in the Seroprevalence of Tick-Borne Rickettsia and Ehrlichia Among Soldiers-Fort Liberty, North Carolina, 1991-2019.

We obtained samples from the Department of Defense Serum Repository from soldiers who were stationed at Fort Liberty, North Carolina, between 1991 and 2019 to assess temporal trends in tick-borne rickettsiosis and ehrlichiosis. Serological evidence of infection was common, with nearly 1 in 5 (18.9%) demonstrating antibodies.

Randomized, controlled clinical trial of acoustic stimulation to reduce postconcussive symptoms.

Objective: Effective interventions are needed to address postconcussive symptoms. We report the results of randomized, sham-controlled trial of Cereset Research™ Standard Operating Procedures (CR-SOP), a noninvasive, closed-loop, allostatic, acoustic stimulation neurotechnology previously shown to improve insomnia.

Methods: Military service members, veterans, or their spouses with persistent symptoms (Neurobehavioral Symptom Inventory [NSI] Score ≥23) after mTBI 3 months to 10 years ago, were randomized to receive 10 sessions of engineered tones linked to brainwaves (LB, intervention), or random engineered tones not linked to brainwaves (NL, sham control).

Exposomic Signatures of Cervical Pain.

Introduction: We evaluated risk factors associated with cervical pain (CP) among officers and enlisted members of the U.S. Army and Marine Aviation community using an exposomic approach.

Exposomic Signatures of Tinnitus and/or Hearing Loss.

Introduction: We evaluated the risk factors associated with tinnitus and/or hearing loss (THL) among active duty (AD) members of the U.S. Army and Marine Aviation Community (AMAC) using an exposomic approach.

Prediction of Metabolic Syndrome in U.S. Adults Using Homeostasis Model Assessment-Insulin Resistance.

The prevalence of obesity among U.S. adults has risen steadily over recent decades.

Streamlining orthopaedic trauma surgical care: do all patients need medical clearance?

Introduction: Preoperative medical optimization is necessary for safe and efficient care of the orthopaedic trauma patient. To improve care quality and value, a preoperative matrix was created to more appropriately utilize subspecialty consultation and avoid unnecessary consults, testing, and operating room delays. Our study compares surgical variables before and after implementation of the matrix to assess its utility.

Financial Impact of Embedded Injury-Prevention Experts in US Army Initial Entry Training.

Context: The US Army embedded injury-prevention experts (IPEs), specifically athletic trainers and strength and conditioning coaches, into initial entry training (IET) to limit musculoskeletal (MSK) conditions and their negative consequences. However, little is known about the financial impact of IPEs.

Objective: To assess whether IPEs were associated with fewer sunk training costs due to MSK-related early discharges from service.

Rates of Lapidus Procedures in the US Military Before and After the Advent of and Advocacy for Tri-Plane Lapidus Corrective Surgery.

Tri-plane corrective Lapidus surgery has been described as advantageous with respect to its anatomic basis and outcomes. Because the procedure has been broadly publicized, changes in overall Lapidus procedure rates due to increased numbers of patients opting for the tri-plane approach could have occurred. Data supporting this possibility appears lacking.

Attention deficit hyperactivity disorder medications and bone mineral density of adults in the United States.

Introduction: Several medications used to treat attention deficit hyperactivity disorder (ADHD) have been associated with diminished bone mineral density (BMD) in children. The objective of this study was to determine if evidence exists for a similar association among adults.

Materials And Methods: A retrospective cross-sectional analysis was conducted using data collected by the National Health Nutrition Examination Survey 2013-2018.

Prevalence of Hepatic Steatosis and Fibrosis in the United States.

Nonalcoholic fatty liver disease (NAFLD) is the most common liver disease in the world. We evaluated vibration-controlled transient elastography (VCTE) data to determine the prevalence of two principle manifestations of NAFLD, hepatic steatosis and hepatic fibrosis. Data were sourced from the 2017 to 2018 National Health and Nutrition Examination Survey, which provides a representative cross-section of the noninstitutionalized U.

Normative formaldehyde-hemoglobin adduct levels among the US Population: Analysis of the 2013-2016 National Health and Nutrition Examination Survey.

Introduction: Formaldehyde (FA) is currently classified as a known carcinogen. In addition to being a ubiquitous compound with many common exogenous exposure sources, it is also part of multiple metabolic pathways and present in every living cell. The objectives of this study were to determine normative levels of FA as measured by FA-Hemoglobin (Hb) adducts in the United States (US) and to determine if FA-Hb levels differ based on a variety of demographic factors.

Feasibility of Mild Traumatic Brain Injury Assessment Based on Cardiovascular Response to Postural Change.

Objective: To determine the feasibility of short-term cardiovascular responses to postural change as a screening tool for mild traumatic brain injury (mTBI), using heart rate metrics that can be measured with a wearable electrocardiogram sensor.

Setting: Military TBI clinic.

Design: Data collected from active-duty service members who had sustained a medically diagnosed mTBI within the prior 72 hours and from age- and sex-matched controls.

Augmented Reality Forward Damage Control Procedures for Nonsurgeons: A Feasibility Demonstration.

Introduction: This article presents an emerging capability to project damage control procedures far forward for situations where evacuation to a formal surgical team is delayed. Specifically, we demonstrate the plausibility of using a wearable augmented reality (AR) telestration device to guide a nonsurgeon through a damage control procedure.

Methods: A stand-alone, low-profile, commercial-off-the-shelf wearable AR display was utilized by a remotely located surgeon to synchronously guide a nonsurgeon through proximal control of the distal external iliac artery on a surgical manikin.

US Army Soldiers With Type 1 Diabetes Mellitus.

US Army soldiers diagnosed with type 1 diabetes were previously considered unfit for duty. For highly motivated soldiers, current advanced technologies allow the possibility of not only retention on active duty, but military deployment. We present our experience at Fort Bragg, North Carolina, taking care of soldiers newly diagnosed with type 1 diabetes mellitus.

Gender differences in the associations of body mass index, physical fitness and tobacco use with lower extremity musculoskeletal injuries among new US Army soldiers.

Background: Musculoskeletal (MSK) injuries are a leading cause of morbidity among US Army soldiers, especially among women and the newly enlisted. While extremes of body mass index (BMI), low physical fitness and tobacco use have been identified as risk factors, no prior studies have determined the combined effects of these risk factors or tested for gender differences in the associations.

Methods: We conducted a retrospective cohort study utilising the Stanford Military Data Repository to study all enlisted soldier accessions to the US Army between January 2011 and January 2014, with follow-up through December 2014 (n=238 772).

Which Matters More? A Retrospective Cohort Study of Headache Characteristics and Diagnosis Type in Soldiers with mTBI/Concussion.

Objective: To describe the diagnostic types and characteristics of headaches in soldiers with mild traumatic brain injury during the wars in Afghanistan and Iraq.

Background: Persistent post-traumatic headache interferes with returns to activity or duty. The most commonly cited headache diagnosis after concussion is migraine.

Metabolites as biomarkers of adverse reactions following vaccination: A pilot study using nuclear magnetic resonance metabolomics.

An Adverse Event Following Immunization (AEFI) is an adverse reaction to a vaccination that goes above and beyond the usual side effects associated with vaccinations. One serious AEFI related to the smallpox vaccine is myopericarditis. Metabolomics involves the study of the low molecular weight metabolite profile of cells, tissues, and biological fluids, and provides a functional readout of the phenotype.

Prevalence of Genital Human Papillomavirus Infection and Human Papillomavirus Vaccination Rates Among US Adult Men: National Health and Nutrition Examination Survey (NHANES) 2013-2014.

Importance: Human papillomavirus (HPV) is a common sexually transmitted infection that is a major cause of noncervical anogenital and oropharyngeal cancers. Prophylactic HPV vaccine is available for primary prevention. However, the population prevalence data for male genital HPV infection is not well known, while the HPV vaccination coverage is low in the United States.

Telemedicine in US Army soldiers with type 1 diabetes.

A retrospective study of a telemedicine clinic for active duty US Army soldiers with type 1 diabetes was conducted. Fifty-one consecutive patients (mean age 33.9 years) were enrolled into the clinic.

Interacting effects of selected trace and toxic metals on thyroid function.

Interacting effects of blood levels of manganese (Mn), selenium, cadmium (Cd), lead (Pb), and mercury, and serum levels of iron (Fe), zinc (Zn), and copper (Cu) on thyroid function in general US population were evaluated. Data from the National Health and Nutrition Examination Survey for 2011-2012 were used for this evaluation. The variables used to evaluate thyroid function were as follows: thyroid-stimulating hormone, free and total triiodothyronine (FT3, TT3), free and total thyroxine (FT4, TT4), and thyroglobulin (Tg).

Normal reference ranges for and variability in the levels of blood manganese and selenium by gender, age, and race/ethnicity for general U.S. population.

Data from National Health and Nutrition Examination Survey for the period 2011-2012 were used to determine normal reference ranges and percentile distributions for manganese (Mn) and selenium (Se) in blood by gender, age, race/ethnicity, socioeconomic status as determined by annual family income, and smoking status. The effect of gender, age, race/ethnicity, family income, and smoking status on the levels of Mn and Se was also determined by fitting regression models. Males had lower adjusted levels of Mn and higher adjusted levels of Se than females.

Novel noninvasive anthropometric measure in preterm and full-term infants: normative values for waist circumference:length ratio at birth.

Background: Waist circumference:length ratio (WLR) and ponderal index (PI) appear to be useful markers of visceral and total adiposity, respectively. However, there are no normative birth data across the full range of gestational ages.

Methods: In this retrospective cohort study of 500 preterm and 1,426 full-term infants, born in 1998 and 2008 at three military hospitals, the percentile growth curves for WLR and PI were calculated.