Civilian Data Research Articles

Analysis of emergency resuscitative thoracotomy in the combat setting

IntroductionEmergency resuscitative thoracotomy (ERT) is a resource-intensive procedure that can deplete a combat surgical team’s supply and divert attention from casualties with more survivable injuries. An understanding of survival after...

Molecular and physiological changes in the SpaceX Inspiration4 civilian crew

Human spaceflight has historically been managed by government agencies, such as in the NASA Twins Study1, but new commercial spaceflight opportunities have opened spaceflight to a broader population. In 2021, the SpaceX Inspiration4 mission launched the first all-civilian crew to low Earth orbit, which included the youngest American astronaut (aged 29), new in-flight experimental technologies (handheld ultrasound imaging, smartwatch wearables and immune profiling), ocular alignment measurements and new protocols for in-depth, multi-omic molecular and cellular profiling. Here we report the primary findings from the 3-day spaceflight mission, which induced a broad range of physiological and stress responses, neurovestibular changes indexed by ocular misalignment, and altered neurocognitive functioning, some of which match those of long-term spaceflight2, but almost all of which did not differ from baseline (pre-flight) after return to Earth. Overall, these preliminary civilian spaceflight data suggest that short-duration missions do not pose a significant health risk, and moreover present a rich opportunity to measure the earliest phases of adaptation to spaceflight in the human body at anatomical, cellular, physiological and cognitive levels. Finally, these methods and results lay the foundation for an open, rapidly expanding biomedical database for astronauts3, which can inform countermeasure development for both private and government-sponsored space missions.

Mechanism matters: Differential benefits of cold-stored whole blood for trauma resuscitation from a prospective multicenter study.

Resuscitation with cold-stored low-titre whole blood (LTOWB) has increased despite the paucity of robust civilian data. Most studies are in predominately blunt trauma and lack analysis of specific subgroups or mechanism of injury. We sought to compare outcomes between patients receiving LTOWB versus balanced component therapy (BCT) after blunt (BL) and penetrating (PN) trauma. Secondary analysis of a prospective multicenter study of patients receiving either LTWOB-containing or BCT resuscitation was performed. Patients were grouped by mechanism of injury (BL vs. PN). A generalized estimated equations model using inverse probability of treatment weighting was employed. Primary outcome was mortality and secondary outcomes were acute kidney injury, venous thromboembolism, pulmonary complications, and bleeding complications. Additional analyses were performed on no-traumatic brain injury (TBI), severe torso injury, and LTOWB-only resuscitation patients. There were 1,617 patients (BL 47% vs PN 54%) identified; 1,175 (73%) of which received LTOWB. PN trauma patients receiving LTOWB demonstrated improved survival compared to BCT (77% vs. 56%; p < 0.01). Interval survival was higher at 6 hours (95% vs. 88%), 12 hours (93% vs. 80%), and 24 hours (88% vs. 57%) (all p < 0.05). The survival benefit following LTOWB was also seen across PN non-TBI (83% vs. 52%), and severe torso injuries (75% vs. 43%) (all p < 0.05). After controlling for age, sex, injury severity, and trauma center, LTWOB was associated with decreased odds of death (odds ratio, 0.31, p < 0.05) in PN trauma. However, no difference in overall mortality was seen across the BL groups. Both PN and BL patients receiving LTOWB had more frequent acute kidney injury compared to BCT (19% vs. 7% and 12% vs 6%, respectively; p < 0.05). Low-titre whole blood resuscitation was independently associated with decreased mortality following PN trauma, but not BL trauma. Further analysis in BL trauma is required to identify subgroups that may demonstrate survival benefit. Therapeutic/Care Management; Level III.

The U.S. Workforce From 1960 to 2020: A RIASEC View

This paper analyzes civilian occupations and employment data collected by the U.S. Census Bureau over seven decades (1960–2020) with respect to six kinds of work (Holland’s RIASEC classification). The focus is on (a) occupational titles used, (b) civilian employment, and (c) income. This study is a continuation and extension of eight articles published earlier by 11 different scholars, and it represents a 10th contribution to career development and vocational psychology literature with respect to the environmental aspects of Holland’s theory. In each census period, the Artistic area was the smallest area of employment at 1% or 2%. At the other extreme, the Realistic area was a large area of employment, ranging from 55% in 1960 to 26% in 2020. The principal findings of the current study are examined in terms of three research questions followed by a discussion of the implications for career counseling practice.

Short-term effect of a carbon fiber custom dynamic orthosis and integrated rehabilitation on self-reported physical function, pain, speed, and agility in civilians.

Ankle-foot orthoses (AFOs) are widely used to restore mobility and reduce pain in individuals with lower extremity pain and disability. The use of a carbon fiber custom dynamic orthosis (CDO) with integrated physical training and psychosocial intervention has been shown to improve outcomes in a military setting, but civilian data are limited. To use existing clinical data to evaluate the initial effectiveness of an integrated CDO and rehabilitative program and identify baseline characteristics that impact patient response to the intervention. Retrospective cohort. Records of 131 adult patients who received a CDO and device specific training were reviewed. Patient-reported measures of pain and lower extremity function and physical measurements of walking and agility were extracted at baseline and on training completion. A majority of patients reported improved or greatly improved physical function (92%), maximum pain (69%), and typical pain (55%) and experienced improved or greatly improved walking speed (92%) and agility (52%) irrespective of age and sex. Regression models for examining short-term improvement in pain and physical function accounted for 52% (p < 0.001) and 26% (p < 0.001) of the outcome variance, respectively. Improvement in typical pain was influenced by baseline typical and maximum pain, and functional improvement was influenced by sex and baseline physical function. Most patients (92.4%) reported a positive initial outcome after intervention as measured using patient-reported and objective measures.

Relationship Between Gender and Academic and Military Achievement Among USU Medical School Graduates

ABSTRACT Introduction Despite increases in the number of female matriculants in medical school, civilian data demonstrate that women still struggle to reach parity in attainment of leadership positions. In military medicine, we have seen a major increase in the number of women graduating from the USU. Yet, we still know little about the representation of female military physicians in leadership positions. The aim of this study is to examine the relationship between gender and academic and military achievement among USU School of Medicine graduates. Methods Utilizing the USU alumni survey sent to graduates from the classes of 1980 to 2017, items of interest, such as highest military rank, leadership positions held, academic rank, and time in service, were used to evaluate the relationship between gender and academic and military achievement. Contingency table statistical analysis was conducted to compare the gender distribution on the survey items of interest. Results Pairwise comparison demonstrated significant differences between gender in the O-4 (P = .003) and O-6 (P = .0002) groups, with females having a higher-than-expected number of O-4 officers and males having a higher-than-expected number of O-6 officers. These differences persisted in a subsample analysis that excluded those who separated from active duty prior to 20 years of service. There was a significant association between gender and holding the position of commanding officer (χ2(1) = 6.61, P &amp;lt; .05) with fewer females than expected. In addition, there was a significant association between gender and the highest academic rank achieved (χ2(3) = 9.48, P &amp;lt; 0.05) with lower-than-expected number of females reaching the level of full professor, in contrast to males who exceed the expected number. Conclusions This study suggests that female graduates of USU School of Medicine have not achieved promotion to the highest levels of rank, military, or academic leadership at the projected rate. Efforts to explore what barriers may impact military medicine’s desire to have more equal representation of women in higher ranks and positions should be undertaken with specific attention to what drives retention versus separation of medical officers and if systematic changes are needed to help promote equity for women in military medicine.

Prehospital tourniquet use in civilian extremity trauma: an Australian observational study.

Prehospital tourniquets (PHTQ) for trauma have been shown to be safe and effective in the military environment and in some civilian settings. However, the supporting civilian data are mostly from North America with a differing case mix and trauma system and may not be applicable to the Australian environment. The aim of this study is to describe our initial experience with PHTQ from safety and efficacy viewpoints. Retrospective review of all patients with PHTQ from 1 August 2016 to 31 December 2019 was conducted. Data were matched from the RMH Trauma Registry and Ambulance Victoria Registry. Clinical presentation including prehospital observations, PHTQ times, limb outcomes and complications are described. Thirty-one cases met inclusion criteria, for whom median age was 37 (IQR: 23.9-66.3), median ISS 17 (13-34) and 80.6% were male. The majority (n = 19, 61.3%) were as a result of road traffic crash, and six (19.4%) from penetrating mechanisms, usually glass. Over a quarter (29.0%) suffered a traumatic amputation. The median prehospital SBP was 100 (IQR: 80-110), the median prehospital HR was 101 (IQR: 77.0-122.3) and was the median PHTQ time was 124 min (IQR: 47-243). Complications attributable to the tourniquet were seen in 4/30 cases (13.3%). This Australian series differs from North American civilian PHTQ series with a lower penetrating trauma rate and longer PHTQ times. Despite this, complication rates are within the published literature's range. Concerns regarding limited transferability of overseas studies to the Australian context suggests that ongoing audit is required.

Prolonged casualty care: Extrapolating civilian data to the military context.

Civilian and military populations alike are increasingly faced with undesirable situations in which prehospital and definitive care times will be delayed. The Western Cape of South Africa has some similarities in capabilities, injury profiles, resource limitations, and system configuration to US military prolonged casualty care (PCC) settings. This study provides an initial description of civilians in the Western Cape who experience PCC and compares the PCC and non-PCC populations. We conducted a 6-month analysis of an ongoing, prospective, large-scale epidemiologic study of prolonged trauma care in the Western Cape (Epidemiology and Outcomes of Prolonged Trauma Care [EpiC]). We define PCC as ≥10 hours from injury to arrival at definitive care. We describe patient characteristics, critical interventions, key times, and outcomes as they may relate to military PCC and compare these using χ 2 and Wilcoxon tests. We estimated the associations between PCC status and the primary and secondary outcomes using logistic regression models. Of 995 patients, 146 experienced PCC. The PCC group, compared with non-PCC, were more critically injured (66% vs. 51%), received more critical interventions (36% vs. 29%), and had a greater proportionate mortality (5% vs. 3%), longer hospital stays (3 vs. 1 day), and higher Sequential Organ Failure Assessment scores (5 vs. 3). The odds of 7-day mortality and a Sequential Organ Failure Assessment score of ≥5 were 1.6 (odds ratio, 1.59; 95% confidence interval, 0.68-3.74) and 3.6 (odds ratio, 3.69; 95% confidence interval, 2.11-6.42) times higher, respectively, in PCC versus non-PCC patients. The EpiC study enrolled critically injured patients with PCC who received resuscitative interventions. Prolonged casualty care patients had worse outcomes than non-PCC. The EpiC study will be a useful platform to provide ongoing data for PCC relevant analyses, for future PCC-focused interventional studies, and to develop PCC protocols and algorithms. Findings will be relevant to the Western Cape, South Africa, other LMICs, and military populations experiencing prolonged care. Therapeutic/care management; Level IV.

Recognizing Gender Parity in Military Medicine: An Analysis of Plenary Speakers and Award Recipients at Military American College of Physicians Chapter Meetings.

Despite the advances toward gender parity in medicine, a gap exists in the recognition of women physicians at academic and subspecialty medical conferences as plenary speakers and award winners. Conferences are cornerstones in the practice of medicine because they serve as platforms to showcase physicians' successes and disseminate work. The selection of who is honored at such events can impact an individual's career by creating networks that may lead to future opportunities. Additionally, the trend of who is honored may create expectations in the minds of trainees and early career physicians about what qualities help an individual achieve success. Our group sought to determine whether there was a gender gap in award recognition and speakership opportunities at the American College of Physicians (ACP) annual military chapter meetings. This was a cross-sectional study with data extracted from publicly available conference programs for the Army-Air Force annual ACP meetings and the Navy annual ACP meetings. Five years of data erewere reviewed for invited plenary speakers. Ten years of data were reviewed for award recipients. For an award to be included, it had to have a preset description and criteria for recipient selection. Awards not given annually or awards given for less than 3 years were excluded. Individuals' gender was determined based on the first name and confirmed through internet searches of pronoun descriptors from professional websites. Comparisons were done using Fisher's exact test and chi-square tests when appropriate, with statistical significance set at a two-tailed P-value of <.05. Women comprised 26-30% of the chapter membership and there was no significant difference in gender distribution between the chapters. Fourteen of the 69 plenary speakers were women (20%), with significantly fewer women presenters in the Navy as compared to men. Thirty-six of the 134 award winners were women (27%), which was not significantly different from the overall chapter gender distributions. While women recipients of lifetime, teaching, research, and medical student awards were not significantly different from chapter gender distribution, women faculty were significantly more likely to receive an award for teaching than for research, with women receiving 13 of the 28 teaching awards (41%), and none of the 10 faculty research awards. The military chapter ACP meetings reviewed mirrored civilian data in many ways, although military plenary speaker and award recipient distributions were more representative of the gender distribution of the branches. Review of the nomination process, planning committee selection, and opportunities for diversity training could be optimized to ensure that future conferences have a gender-balanced representation of individuals being honored. Improving upon current practices is important for the growth and retention of women military physicians.

Optimal Target Classification Using Frequency-Based Radar Waveform Design

In this article, we introduce a frequency-based waveform design to maximize binary target classification. The optimization problems can be solved via optimal solvers available in the literature. The presented formulation is applicable to the classification scenarios where the extended target frequency responses (TFRs) are complex, random, and normally distributed with unequal mean vectors. However, their covariance matrices are either identical or different. For the former, i.e., identical covariance matrices, the optimization problem consists of a cost function that has been obtained by deriving a closed-form expression of the probability of misclassification. For the latter, i.e., different covariance matrices, we present an optimization problem where the cost function has been obtained via the Fisher separation function. For this, we also present a closed-form expression for an approximate solution to the optimization problem. We show that the proposed solution achieves performance levels comparable to the exact solution of the optimization problem obtained via state-of-the-art optimization solvers while incurring low computational complexity. We expand on the two main scenarios by introducing clutter (i.e., signal-dependent interference) in the signal model and studying possible closed-form designs in extreme waveform energy levels. Simulations are conducted using synthetically generated data in addition to the civilian vehicle data from the Moving and Stationary Target Acquisition and Recognition (MSTAR) dataset, in order to validate the proposed method.

Cyber Operations against Civilian Data

Abstract Cyber operations are becoming an increasing part of armed conflict. This article assesses whether cyber operations against data during an armed conflict could amount to a war crime in the Statute of the International Criminal Court. It unpacks the plausibility of computer data being included in the categories of ‘object’ and ‘property’ in the Statute, showing there is no doctrinal and jurisprudential unanimity in either case. However, the Court can and should take a wide view of when tangible objects are affected in a legally relevant way by attacks on or through data. Considering this question forces us to reflect about the proper interpretation of the Statute in light of the principle of legality, and about whether and how the Statute will be able to ‘keep up’ with new forms of warfare.

Gynecologic Surgery and Obstetrics Leadership Roles in Academic Military Treatment Facilities by Subspecialty and Gender.

Gender distribution in academic ob-gyn leadership positions has previously been examined in the civilian sector, but not in military medicine. To characterize the distribution of department-level leadership positions by gender and subspecialty in academic military facilities in comparison to those reported in the civilian sector. This is an observational cross-sectional study. We queried military obstetrics and gynecology (ob-gyn) specialty consultants, for title and gender of personnel assigned to academic military treatment facilities. Roles were characterized by gender and subspecialty, and the proportion of female leaders was compared to published civilian leadership data. Women comprised 25% of Department Chairs, 45% of Assistant Chairs, and 42% of Division Directors. In educational leadership roles, women comprised 25% of Residency Program Directors, 0% of Fellowship Directors, and 62% of medical Student Clerkship Directors. Female department chairs were most often uro-gynecologists (44%) followed by specialists in ob-gyn (37%). Most female residency program directors were specialists in general obstetrics and gynecology. The proportion of women in leadership roles in military departments was not different than in the civilian sector. In contrast to civilian academic leadership positions, Department Chairs were most likely to be uro-gynecologists. Similar to civilian programs, women remain underrepresented as chairs, Assistant Chairs, Fellowship Directors, and Division Directors and similarly represented as Residency Program Directors. Despite a smaller pool of women available to fill academic leadership positions in military ob-gyn departments, the proportion of women in leadership roles reaches parity with the civilian sector. This suggests that a greater proportion of women rise to leadership positions in military academic ob-gyn departments than in the civilian sector.

Prevalence of and Factors Associated with Dietary Supplement Use in a Stratified, Random Sample of US Military Personnel: The US Military Dietary Supplement Use Study

BackgroundAbout 50% of Americans and 70% of US military service members use dietary supplements (DSs). ObjectivesThis cross-sectional survey examined current prevalence of and factors associated with DS use in service members. MethodsA stratified random sample of 200,000 service members from the Air Force, Army, Marine Corps, and Navy was obtained from military manpower records, and these service members were asked to complete a questionnaire on their DS use and personal characteristics. Chi-square statistics and multivariable logistic regression examined differences across various strata of demographic, lifestyle, and military characteristics. ResultsAbout 18% of successfully contacted service members (n = 26,681) completed the questionnaire between December 2018 and August 2019 (mean ± SD age: 33 ± 8 y, 86% male). Overall, 74% reported using ≥1 DS/wk. Multivitamins/multiminerals were the most commonly used DSs (45%), followed by combination products (44%), proteins/amino acids (42%), individual vitamins/minerals (31%), herbals (20%), joint health products (9%), and purported prohormones (5%). In multivariable analysis, factors independently associated with DS use included female gender [OR (female/male): 1.91; 95% CI: 1.73, 2.11], older age [OR (≥40/18–24 y): 1.25; 95% CI: 1.08, 1.44], higher education level [OR (college degree/high school or less): 1.35; 95% CI: 1.19, 1.53], higher BMI [OR (≥30/<25 kg/m2): 1.37; 95% CI: 1.25, 1.52], more weekly resistance training [OR (>300/≤45 min/wk): 5.05; 95% CI: 4.55, 5.61], smokeless tobacco use [OR (user/nonuser): 1.30; 95% CI: 1.17, 1.44], higher alcohol intake [OR (≥72/0 mL/wk): 1.41; 95% CI: 1.29, 1.54], and higher military rank [OR (senior officer/junior enlisted): 1.26; 95% CI: 1.06, 1.51]. ConclusionsCompared with civilian data from the NHANES, service members were much more likely to use DSs and used different types of DSs, especially combination products and proteins/amino acids often used to purportedly enhance physical performance. Comparisons with previous military data suggest DS use has increased over time.

Systematic review of temporary intravascular shunt use in military and civilian extremity trauma.

The use of temporary intravascular shunts (TIVS) in the setting of military and civilian trauma has grown in recent years, predominantly because of the mounting evidence of improved limb outcomes. We sought to characterize the use and outcomes of TIVS in trauma through a systematic review of military and civilian literature. The MEDLINE, EBSCO, EMBASE, and Cochrane databases were searched for studies on TIVS use in military and civilian trauma settings published between January 2000 and March 2021. Reports lacking systematic data collection along with those with insufficient TIVS descriptive and outcome data were excluded. Data regarding the characteristics and outcomes of TIVS were assessed and collective syntheses of military and civilian data performed. Twenty-one reports were included, 14 from civilian trauma centers or databases and 7 from military field data or databases (total of 1,380 shunts in 1,280 patients). Sixteen were retrospective cohort studies, and four were prospective. Five studies had an unshunted comparison group. Shunts were predominantly used in the lower extremity and most commonly for damage control indications. Dwell times were infrequently reported and were not consistently linked to shunt thrombosis or other complications. Anticoagulation during shunting was sparsely reported and inconsistently applied. Shunted limbs had higher injury severity than unshunted limbs but similar salvage rates. Temporary intravascular shunts are effective for expeditious restoration of perfusion in severely injured limbs and likely contribute to limb salvage. There is a paucity of comparative TIVS data in the literature and no consistently applied reporting standards, so controversies regarding TIVS use remain. Systematic Review, level IV.

P–720 Prevalence of Female Infertility in the UK Armed Forces

Abstract Study question What is the prevalence of female infertility among UK military personnel and does it differ from the Metropolitan Police Service (MPS) and civilian populations? Summary answer Prevalence of self-reported infertility was higher in servicewomen (31.7%) and female MPS officers (36.3%) than in civilian women (24.4%). What is known already Arduous employment is associated with numerous potential occupational hazards and behaviours that may be relevant to fertility. These include physical and psychological stress, smoking, alcohol drinking and other lifestyle factors. A preliminarily report in 2016 indicated that UK servicewomen over 30 years of age were more likely to present with fertility problems compared with reported civilian infertility data for age-matched women. Few previous studies have compared infertility prevalence of servicewomen with civilians, and none have compared infertility prevalence with other occupations. Study design, size, duration A cross-sectional study was undertaken in 2019 to determine prevalence of infertility. All eligible UK servicewomen (14,650) and MPS officers (8,262) aged 18–60 years were invited to participate with sisters of participants recruited as controls using a snowball technique. Data including pregnancy history, time to each pregnancy and self-reported infertility risk-factors were collected using an online questionnaire. We estimated a sample of 4898 servicewomen would give a precision of 1% around infertility prevalence estimates. Participants/materials, setting, methods The questionnaire was developed, piloted and adapted for electronic distribution. The occupational groups were invited by email to complete the questionnaire on three occasions. Prevalence of infertility was defined as the proportion of women at risk of pregnancy who had not become pregnant within 12 months. Only women with pregnancy outcomes, or fully tested for fertility (12 months or more of exposure), were included in the denominator. Main results and the role of chance Participants included 4806 (33%) women serving in the UK Armed Forces, 1237 (15%) female MPS officers and 435 (estimated 8%) non-military, non-MPS sisters (biological, half, step or adopted) of both groups. 98.4% of responses were complete. Prevalence of self-reported 12-month infertility was 31.7% (95% CI 29.9–33.5) in servicewomen, 36.3% (95% CI 33.1–39.7) in MPS officers and 24.4% (95% CI 19.6–29.8) in civilian women. Age, history of polycystic ovary syndrome, endometriosis, fibroids, tubal and pelvic surgery, hysterectomy and a short General Health Questionnaire (GHQ 12) score of &amp;gt; 4 (suggesting a minor psychiatric disorder) were associated with infertility and adjusted for in logistic regression models to estimate odds ratios. The adjusted odds ratio (aOR) of infertility in servicewomen was 1.0 (95% CI 0.8–1.2) compared with MPS officers and 1.5 (95% CI 1.1–2.0) in both servicewomen and MPS officers compared with sisters. Limitations, reasons for caution The major limitation is the low response rate, particularly in the two control groups, potentially resulting in response bias. Prevalence of infertility could have been further over-estimated if fertile women are more likely to have left the military or MPS. There is scope for residual confounding. Wider implications of the findings: Further analyses will explore the key risk factors to identify what aspects of these occupations contribute to infertility and which may be modifiable. Future cohort studies would be helpful to extend the understanding of the influence of occupation on infertility. Trial registration number Not applicable

Hypocalcemia in Military Casualties From Point of Injury to Surgical Teams in Afghanistan.

Hypocalcemia is a known sequela of citrated blood product transfusion. Civilian data suggest hypocalcemia on hospital admission is associated with worse outcomes. Initial calcium levels in military casualties have not previously been analyzed. The objective of this retrospective review aimed to assess the initial calcium levels in military trauma casualties at different Forward Surgical Teams (FST) locations in Afghanistan and describe the effects of prehospital blood product administration on arrival calcium levels. This is a retrospective cohort analysis of military casualties arriving from point of injury to one of two FSTs in Afghanistan from August 2018 to February 2019 split into four locations. The primary outcome was incidence of hypocalcemia (ionized calcium < 1.20 mmol/L). There were 101 patients included; 55 (54.5%) experienced hypocalcemia on arrival to the FST with a mean calcium of 1.16 mmol/L (95% confidence interval [CI], 1.14 to 1.18). The predominant mechanism of injury consisted of blast patterns, 46 (45.5%), which conferred an increased risk of hypocalcemia compared to all other patterns of injury (odds ratio = 2.42, P = .042). Thirty-eight (37.6%) patients required blood product transfusion. Thirty-three (86.8%) of the patients requiring blood product transfusion were hypocalcemic on arrival. Mean initial calcium of patients receiving blood product was 1.13 mmol/L (95% CI, 1.08 to 1.18), which was significantly lower than those who did not require transfusion (P = .01). Eight (7.9%) of the patients received blood products before arrival, with 6/8 (75%) presenting with hypocalcemia. Hypocalcemia develops rapidly in military casualties and is prevalent on admission even before transfusion of citrated blood products. Blast injuries may confer an increased risk of developing hypocalcemia. This data support earlier use of calcium supplementation during resuscitation.

Normative values for the Sensory Organization Test in an active duty military cohort

BackgroundComputerized dynamic posturography is commonly used to assess balance in service members, but normative values for the military population have not been established. Research questionWhat are the normative values for the Motor Control Test (MCT), Sensory Organization Test (SOT) and the enhanced SOT (eSOT) within the military population and at which point do they differ? MethodsCross-sectional study. 237 active duty service members (78 % male) completed the MCT, SOT and the eSOT with the sway manipulated at a gain of 1.2, 1.4, 1.6, 1.8, or 2.0. A Mann-Whitney U test was used to compare the means of men and women for the SOT and MCT composite scores. A Kruskal-Wallis H test was used to compare the means of age groups for the SOT composite score. An independent t-test was used to compare the SOT composite scores from our military population to the manufacturer’s normative (civilian) data. The means and standard deviations for the eSOT scores were reported for each gain. Paired-samples t-tests were performed to compare the SOT composite score with the eSOT composite score for each level of gain. ResultsThere was no difference between SOT composite scores for men and women (Mann-Whitney U = 4363.50, p = 0.19) or among age groups (Kruskal-Wallis = 2.77, p = 0.25). The mean SOT composite scores were not different from the manufacturer’s normative values (p = 0.155). SOT composite scores were significantly higher than eSOT composite scores for gains of 1.4 (t = 3.16, p = 0.003), 1.6 (t = 5.73, p < 0.001), 1.8 (t = 5.26, p < 0.001) and 2.0 (t = 5.89, p < 0.001). MCT composite scores were lower in the 18−26 year old than the 36−45 year old age group (p = 0.013). SignificanceThis study establishes normative values for the MCT, SOT and eSOT in active duty military service members. The results suggest that the manufacturer’s normal values are appropriate for making judgments about the postural stability of service members.

Comparison of Enhanced Noise Model Performance Based on Analysis of Civilian GPS Data.

We recorded the time series of location data from stationary, single-frequency (L1) GPS positioning systems at a variety of geographic locations. The empirical autocorrelation function of these data shows significant temporal correlations. The Gaussian white noise model, widely used in sensor-fusion algorithms, does not account for the observed autocorrelations and has an artificially large variance. Noise-model analysis—using Akaike’s Information Criterion—favours alternative models, such as an Ornstein–Uhlenbeck or an autoregressive process. We suggest that incorporating a suitable enhanced noise model into applications (e.g., Kalman Filters) that rely on GPS position estimates will improve performance. This provides an alternative to explicitly modelling possible sources of correlation (e.g., multipath, shadowing, or other second-order physical phenomena).Dataset License: BY-NC-ND

Twenty years on: International humanitarian law and the protection of civilians against the effects of cyber operations during armed conflicts

AbstractThe use of cyber operations during armed conflicts and the question of how international humanitarian law (IHL) applies to such operations have developed significantly over the past two decades. In their different roles in the Legal Division of the International Committee of the Red Cross (ICRC), the authors of this article have followed these developments closely and have engaged in governmental and non-governmental expert discussions on the subject. In this article, we analyze pertinent humanitarian, legal and policy questions. We first show that the use of cyber operations during armed conflict has become a reality of armed conflicts and is likely to be more prominent in the future. This development raises a number of concerns in today's increasingly cyber-reliant societies, in which malicious cyber operations risk causing significant disruption and harm to humans. Secondly, we present a brief overview of multilateral discussions on the legal and normative framework regulating cyber operations during armed conflicts, looking in particular at various arguments around the applicability of IHL to cyber operations during armed conflict and the relationship between IHL and the UN Charter. We emphasize that in our view, there is no question that cyber operations during armed conflicts, or cyber warfare, are regulated by IHL – just as is any weapon, means or methods of warfare used by a belligerent in a conflict, whether new or old. Thirdly, we focus the main part of this article on how IHL applies to cyber operations. Analyzing the most recent legal positions of States and experts, we revisit some of the most salient debates of the past decade, such as which cyber operations amount to an “attack” as defined in IHL and whether civilian data enjoys similar protection to “civilian objects”. We also explore the IHL rules applicable to cyber operations other than attacks and the special protection regimes for certain actors and infrastructure, such as medical facilities and humanitarian organizations.

International humanitarian law and cyber operations during armed conflicts

Executive summary•Cyber operations have become a reality in contemporary armed conflict. The International Committee of the Red Cross (ICRC) is concerned by the potential human cost arising from the increasing use of cyber operations during armed conflicts.•In the ICRC's view, international humanitarian law (IHL) limits cyber operations during armed conflicts just as it limits the use of any other weapon, means or method of warfare in an armed conflict, whether new or old.•Affirming the applicability of IHL does not legitimize cyber warfare, just as it does not legitimize any other form of warfare. Any use of force by States – cyber or kinetic – remains governed by the Charter of the United Nations and the relevant rules of customary international law, in particular the prohibition against the use of force. International disputes must be settled by peaceful means, in cyberspace as in all other domains.•It is now critical for the international community to affirm the applicability of international humanitarian law to the use of cyber operations during armed conflicts. The ICRC also calls for discussions among governmental and other experts on how existing IHL rules apply and whether the existing law is adequate and sufficient. In this respect, the ICRC welcomes the intergovernmental discussions currently taking place in the framework of two United Nations General Assembly mandated processes.•Events of recent years have shown that cyber operations, whether during or outside armed conflict, can disrupt the operation of critical civilian infrastructure and hamper the delivery of essential services to the population. In the context of armed conflicts, civilian infrastructure is protected against cyber attacks by existing IHL principles and rules, in particular the principles of distinction, proportionality and precautions in attack. IHL also affords special protection to hospitals and objects indispensable to the survival of the civilian population, among others.•During armed conflicts, the employment of cyber tools that spread and cause damage indiscriminately is prohibited. From a technological perspective, some cyber tools can be designed and used to target and harm only specific objects and to not spread or cause harm indiscriminately. However, the interconnectivity that characterizes cyberspace means that whatever has an interface with the Internet can be targeted from anywhere in the world and that a cyber attack on a specific system may have repercussions on various other systems. As a result, there is a real risk that cyber tools are not designed or used – either deliberately or by mistake – in compliance with IHL.•States’ interpretation of existing IHL rules will determine the extent to which IHL protects against the effects of cyber operations. In particular, States should take clear positions about their commitment to interpret IHL so as to preserve civilian infrastructure from significant disruption and to protect civilian data. The availability of such positions will also influence the assessment of whether the existing rules are adequate or whether new rules may be needed. If States see a need to develop new rules, they should build on and strengthen the existing legal framework – including IHL.