Military Occupational Specialty Research Articles

CORR Insights®: Is Self-reported Return to Duty an Adequate Indicator of Return to Sport and/or Return to Function in Military Patients?

CORR Insights®: Is Self-reported Return to Duty an Adequate Indicator of Return to Sport and/or Return to Function in Military Patients?

Cohort profile: a migratory cohort study of US Marines who train in Australia

PurposeIn 2012, US Marines and Sailors began annual deployments to Australia to participate in joint training exercises with the Australian Defence Force and other partners in the region. During their...

Traumatic Brain Injury and Subsequent Musculoskeletal Injury Risk by Body Region

BACKGROUND AND AIM: Traumatic brain injuries (TBI) have been associated with increased risk of musculoskeletal (MSK) injuries, particularly lower extremity injuries as TBIs may influence gait and postural stability. This study evaluated the association across multiple body regions. METHODS: Incident TBI and MSK injuries were identified from accessible electronic medical records among active-duty U.S. Army Soldiers in 2016 through 2019. TBI was defined using International Classification of Diseases (ICD)-9 and -10 and Department of Defense codes. MSK injuries were grouped into body regions based on ICD-10 codes. Each Soldier with TBI (n=21,625) was matched with replacement to five Soldiers without TBI (n=108,125) on age, sex, and calendar month. Hazard ratios (HR) and 95% confidence intervals (CI) were calculated from Cox proportional hazards regression models stratified by matching factors and adjusted for race, education, rank, years of service, military occupational specialty, and history of deployment to combat countries. RESULTS:Soldiers were 30.3 (9.1) years old at the start of follow-up and predominantly male (87.3%) and White (69.8%). By the end of follow-up, there were 15,335 any MSK injuries in 10,965 person-years among Soldiers with TBI and 55,860 any MSK injuries in 104,396 person-years among Soldiers without TBI. Soldiers with TBI had significantly elevated rates of injury for any MSK [HR (95% CI): 2.33 (2.29, 2.37)], lower extremity [1.43 (1.39, 1.46)], upper extremity [2.00 (1.95, 2.06)], head/neck/cervical [4.16 (4.02, 4.30)], torso [3.44 (3.31, 3.59)], low back/pelvis [2.03 (1.98, 2.09)], spine [2.98 (2.83, 3.15)], and other [3.61 (3.43, 3.81)]. CONCLUSIONS:In addition to lower extremity injuries, TBI may increase MSK injuries risk in multiple other body regions. The mechanisms underlying how TBI could affect MSK injuries across the body should be evaluated. The views expressed are those of the authors and do not reflect the official policy of the Department of Army, Department of Defense, or the U.S. Government. KEYWORDS: Occupational epidemiology, occupational exposures, exposures

Is Self-reported Return to Duty an Adequate Indicator of Return to Sport and/or Return to Function in Military Patients?

In the military, return-to-duty status has commonly been used as a functional outcome measure after orthopaedic surgery. This is sometimes regarded similarly to return to sports or as an indicator of return to full function. However, there is variability in how return-to-duty data are reported in clinical research studies, and it is unclear whether return-to-duty status alone can be used as a surrogate for return to sport or whether it is a useful marker for return to full function. (1) What proportion of military patients who reported return to duty also returned to athletic participation as defined by self-reported level of physical activity? (2) What proportion of military patients who reported return to duty reported other indicators of decreased function (such as nondeployability, change in work type or level, or medical evaluation board)? Preoperative and postoperative self-reported physical profile status (mandated physical limitation), physical activity status, work status, deployment status, military occupation specialty changes, and medical evaluation board status were retrospectively reviewed for all active-duty soldiers who underwent orthopaedic surgery at Madigan Army Medical Center, Joint Base Lewis-McChord from February 2017 to October 2018. Survey data were collected on patients preoperatively and 6, 12, and 24 months postoperatively in all subspecialty and general orthopaedic clinics. Patients were considered potentially eligible if they were on active-duty status at the time of their surgery and consented to the survey (1319 patients). A total of 89% (1175) were excluded since they did not have survey data at the 1 year mark. Of the remaining 144 patients, 9% (13) were excluded due to the same patient having undergone multiple procedures, and 2% (3) were excluded for incomplete data. This left 10% (128) of the original group available for analysis. Ninety-eight patients reported not having a physical profile at their latest postoperative visit; however, 14 of these patients also stated they were retired from the military, leaving 84 patients in the return-to-duty group. Self-reported "full-time duty with no restrictions" was originally used as the indicator for return to duty; however, the authors felt this to be too vague and instead used soldiers' self-reported profile status as a more specific indicator of return to duty. Mean length of follow-up was 13 ± 3 months. Eighty-three percent (70 of 84) of patients were men. Mean age at the preoperative visit was 35 ± 8 years. The most common surgery types were sports shoulder (n = 22) and sports knee (n = 14). The subgroups were too small to analyze by orthopaedic procedure. Based on active-duty status and requirements of the military profession, all patients were considered physically active before their injury or surgery. Return to sport was determined by asking patients how their level of physical activity compared with their level before their injury (higher, same, or lower). We identified the number of other indicators that may suggest decreased function by investigating change in work type/level, self-reported nondeployability, or medical evaluation board. This was performed with a simple survey. Of the 84 patients reporting return to duty at the final follow-up, 67% (56) reported an overall lower level of physical activity. Twenty-seven percent (23) reported not returning to the same work level, 32% (27) reported being nondeployable, 23% (19) reported undergoing a medical evaluation board (evaluation for medical separation from the military), and 11% (9) reported a change in military occupation specialty (change of job description). Return to duty is commonly reported in military orthopaedics to describe postoperative functional outcome. Although self-reported return to duty may have value for military study populations, based on the findings of this investigation, surgeons should not consider return to duty a marker of return to sport or return to full function. However, further investigation is required to see to what degree this general conclusion applies to the various orthopaedic subspecialties and to ascertain how self-reported return to duty compares with specific outcome measures used for particular procedures and subspecialties. Level IV, therapeutic study.

Training Strategies Maintain Performance Characteristics in Marines Selected for Marine Forces Special Operations Individualized Training Course.

Marines must complete an intensive Assessment and Selection (A&S) course before becoming a U.S. Marine Forces Special Operations Command (MARSOC) Raider. Following selection, marines are given training recommendations designed to maintain performance characteristics deemed relevant to successfully complete a rigorous 9-month Individualized Training Course (ITC). However, training strategies are individually implemented by the marine, and the time between the two courses is highly irregular, ranging between 2months and 24 months based on operational factors related to military occupational specialty (MOS). The purpose of this study was to evaluate changes in performance between the completion of A&S and the start of ITC and to examine if the duration between courses and previous MOS influenced changes in performance. Body fat percentage (BF%), anaerobic power (AP), anaerobic capacity (AC), aerobic capacity (VO2max), knee flexion (KF), knee extension (KE), trunk extension (TE), and trunk flexion (TF) isokinetic strength were collected on 38 marines (age: 25.1 ± 2.7 years, height: 1.77 ± 0.05 m, mass: 83.2 ± 7.7 kg, Post-A&S to ITC start: 204.1 ± 68.4 days) following A&S and directly before ITC. Pre-ITC students had significantly greater mass (P = .002), BF% (P = .000), and AP (P = .039). There were no significant changes in AC (P = .170), VO2max (P = .259), KF (P = .400), KE (P = .320), TE (P = .178), and TF (P = .643). There was no significant relationship between performance outcomes and time between courses and previous MOS. Current training strategies appear effective at addressing performance deficits that occur as a result of A&S, while maintaining high levels of KF, KE, TE, TF, AC, and VO2max. However, pre-ITC students still exhibited AP deficits compared to active marine raiders, so forthcoming programming may benefit from an increased emphasis on AP. Assessment of additional selectees at these timepoints, as well as students before A&S may provide valuable information to MARSOC human performance specialists to develop programing, ultimately leading to a higher ITC graduation rate, increased force readiness, and decreased financial burden forcewide.

Foreword by Guest Editor LTC James H. Schreiner, PhD, PMP, CPEM

FOREWORD
 This special issue of the Industrial and Systems Engineering Review highlights top papers from the 2020 annual General Donald R. Keith memorial capstone conference held at the United States Military Academy in West Point, NY. The conference was certainly a first of its kind virtual conference including asynchronous delivery of paper presentations followed by synchronous question and answer sessions with evaluation panels. Following a careful review of 63 total submissions, eleven were selected for publication in this journal. Unique to this year’s special edition is the mixed selection of seven project team capstone papers, and four honors research papers. Each paper incorporated features of systems or industrial engineering and presented detailed and reflective analysis on the topic. Although there are many elements which cut across the works, three general bodies of knowledge emerged in the papers including: systems engineering and decision analysis, systems design, modeling and simulation, and system dynamics.
 Systems Engineering and Decision Analysis topics included three unique contributions. Recognized as ‘best paper’ at the 2020 virtual conference, the work of Robinson et al. designed a multi-year predictive cost engineering model enabled through an MS O365 Power BI decision support interface to support U.S. Army Corps of Engineer (USACE) inland waterway national investment strategies. Schloo and Mittal’s work presents research in testing and evaluation of the Engagement Skills Trainer (EST) 2000 towards improving real-world soldier performance. Gerlica et al. employs a robust and scalable K-means clustering methodology to improve decision making in defensive shift schemes for Air Force Baseball outfield personnel.
 Systems Design works included three unique contributions. Binney et al. worked to design evaluation criteria for military occupational specialties associated with open-source intelligence (OSINT) analysts for the Army’s OSINT Office. Hales et al. interdisciplinary work aided in the design of search and identification systems to be incorporated on autonomous robotics to enable survivability improvements for the Army’s chemical, biological, radiological, nuclear, and explosives (CBRNE) units. Burke and Connell evaluated and designed a performance measurement-based assessment methodology for U.S. Pacific Command’s Key Leader Engagement process.
 System modeling and simulation included three unique contributions: Arderi et al. simulated and assessed how the Hyper-Enabled Operator (HEO) project improves situational awareness for U.S. Special Forces using the Infantry Warrior Simulation (IWARS). Blanks et al. employed a VBA module and Xpress software for a scheduling optimization model for enhancement of final exam scheduling at the U.S. Air Force Academy. Kelley and Mittal utilized a Batch Run Analysis and Simulation Studio (BRASS) program to batch multiple iterations of IWARS scenarios to study the integration of autonomous systems alongside military units.
 Finally, two unique contributions utilizing system dynamics (SD) modeling is presented: Dixon and Krueger developed a Vensim SD model to examine how policy recommendations across Central America could restrict gang activities while positively promoting women’s involvement in society. Cromer et al. utilized systems design approaches and a K-means clustering machine learning techniques to develop SD models in support of the U.S. Africa Command and Defense Threat Reduction Agency to examine the interdependence of threats across the Horn of Africa.
 Thank you and congratulations to the 2020 undergraduate scholars and all authors who provided meaningful contributions through steadfast intellectual efforts in their fields of study! Well done!
 
 LTC James H. Schreiner, PhD, PMP, CPEM
 Program Director, Systems and Decision Sciences (SDS)
 Department of Systems Engineering
 United States Military Academy
 Mahan Hall, Bldg 752, Room 423
 West Point, NY 10996, USA
 james.schreiner@westpoint.edu

Comparison of Different Variants of the U.S. Army Occupational Physical Assessment Test

The U.S. Army Occupational Physical Assessment Test (OPAT) is a pre-enlistment physical employment screening assessment developed to place recruits and soldiers into Military Occupational Specialties (MOSs) based on their physical capabilities in order to optimize performance and limit injury. The OPAT consists of the seated power throw (SPT), strength deadlift (SDL), standing long jump, and interval aerobic run. During the scientific validation of the OPAT, two variants of the SPT and two variants of the SDL were used. Although the OPAT was validated using both variants for each test, U.S. Army scientists and policymakers have received queries regarding how these variants compare to each other. Therefore, the purpose of this study was to compare different variants of the SPT and SDL. Thirty-two participants (14 male and 18 female) between the ages of 18 and 42 years visited the laboratory on one occasion and performed two variants of the SPT (seated on the ground [the current OPAT standard] versus seated in a chair with a 35 cm seat height) and two variants of the SDL (using a hex-bar [the current OPAT standard] versus using paired dumbbells). Testing order for the different variants was randomized. The protocol was approved by the U.S. Army Medical Research and Development Command Institutional Review Board. Performing the SPT from a chair significantly (P < .05) increased performance when compared to performing the SPT from the ground (5.4 ± 1.3 m versus 5.0 ± 1.4 m, respectively). Values for the two SPT variants were correlated (tau = 0.90). Performing the SDL using the hex-bar significantly increased the maximal weight lifted when compared to performing the SDL using paired dumbbells (86.9 ± 18.4 kg versus 83.1 ± 18.0 kg, respectively). Values for the two SDL variants were correlated (tau = 0.83). Performing different variants of the SPT and SDL influenced the resulting score. Although these findings do not alter the administration or scoring of the OPAT, they do provide a valuable reference in the event of future inquiries regarding the development of the OPAT.

1180. Seroincidence and Risk of Coccidioidomycosis Infection Among Active Duty Personnel Stationed at Naval Air Station Lemoore in the San Joaquin Valley of California

BackgroundCoccidioidomycosis ranges clinically from a self-limited respiratory illness to multi-organ dissemination. Based largely on skin testing from the 1940s, 60% of infections are thought to be asymptomatic. Limited Coccidioides seroincidence data support our understanding of the epidemiology and pathogenicity of this disease.MethodsThis retrospective cohort study tested 2000 U.S. military personnel for Coccidioides exposure after transfer to an endemic region of California between 2011 and 2017. The presence of IgG and IgM anti-Coccidioides antibodies were tested on pre- and post-transfer serum samples from the DoD Serum Repository to establish rates of seroconversion. Medical histories and participant demographics including race/ethnicity and military occupational specialty codes were collected from the electronic medical record and participants were stratified by a history of Coccidioides-specific or general respiratory illness based on ICD9/ICD10 coding.ResultsThirty of 2000 participants tested newly positive for anti-Coccidioides antibodies after 12 months on station. Seroconversion incidence varied from 0.0-1.32 annually and overall 0.5 per 100 person years. Seroconverters were more frequently diagnosed with coccidioidomycosis or pneumonia than non-converters (p=0.027). No statistically significant association between demographic characteristics and seroconversion or disease was observed. Clinical disease was detected in only three seroconverters (10%).Incidence Rate of Coccidioidomycosis Infection among Active Duty Stationed at NAS Lemoore, 2011-2017 Seroconversion Status by Cocci/Pneumonia Diagnosis Status ConclusionIn this study Coccidioides seroincidence was similar to that observed by others, adding longitudinal evidence to epidemiologic assumptions about coccidioidomycosis. A trend toward increasing incidence over the course of the study is consistent with the classification of coccidioidomycosis as an emerging infectious disease. While transmission is typically related to exposure, we did not detect a difference based on military occupational specialty codes. Overall, rates of diagnosed disease in our cohort were lower than the historically-assumed 40% symptomatic rate, although this conclusion is limited by the retrospective nature of the study. Further clinical and epidemiologic coccidioidomycosis research, particularly in broader endemic regions, is warranted.Disclosures All Authors: No reported disclosures

Analysis of the impact of military organization's safety culture on safety behavior

The purpose of this study is to analyze the effect of safety culture in the military organization on safety behavior and to verify the mediating effect of safety leadership in this process. The research subjects collected data by classifying the military class and the military class, and the analysis resulted by applying the cross-over analysis model. As a measuring tool, a safety climate scale was used to measure safety culture, and a scale divided into safety knowledge and safety communication was used to measure safety leadership. As a result of analysis, there was no difference in the safety culture due to the difference between the military rank and military occupational specialty in the military organization. In terms of military rank, most of the commanders showed higher level of safety leadership than soldiers, and there was no difference on safety culture. However, the military occupational specialty was functioning as a variable to control the influence of the military rank on safety climate and safety communication. As a result, the influence of safety culture on safety behavior was significant, and it was verified that safety knowledge and safety communication function as mediaters, and the dual perfect mediation model was verified. Based on these results, a strategic education program or content development point suitable for redinforcing the safety culture of military organizations was presented.

Association of MOS-Based Blast Exposure With Medical Outcomes.

The study of effects associated with human exposure to repeated low-level blast during training or operations of select military occupational specialties (MOS) challenges medical science because acute negative effects that might follow such exposures cannot be expected to be clear or prevalent. Any gross effects from such occupational blast exposure on health or performance should be expected to have been already identified and addressed by affected military units through changes to their standard training protocols. Instead, effects, if any, should be expected to be incremental in nature and to vary among individuals of different susceptibilities and exposure histories. Despite the challenge, occupational blast-associated effects in humans are emerging in ongoing research. The purpose of the present study was to examine medical records for evidence of blast-associated effects that may have clinical significance in current standard of care. We hypothesized that populations exposed to blast by virtue of their military occupation would have poorer global medical outcomes than cohorts less likely to have been occupationally exposed. Records from a population of 50,254 service members in MOSs with a high likelihood of occupational blast exposure were compared to records from a matched cohort of 50,254 service members in MOSs with a lower likelihood of occupational blast exposure. These two groups were compared in hospitalizations, outpatient visits, pharmacy, and disability ratings. The clearest finding was higher risk among blast-exposed MOSs for ambulatory encounters for tinnitus, with adjusted risk ratios of 1.19 (CI 1.03–1.37), 1.21 (CI 1.16–1.26), and 1.31 (CI 1.18–1.45) across career time points. Other hypothesized effects (i.e., neurological outcomes) were smaller and were associated with acute exposure. This study documents that service members in occupations that likely include repeated exposure to blast are at some increased risk for neurosensory conditions that present in medical evaluations. Other hypothesized risks from occupational exposure may manifest as symptomology not visible in the medical system or current standard of care. Separate studies, observational and epidemiological, are underway to evaluate further the potential for occupational risk, but the evidence presented here may indicate near-term opportunities to guide efforts to reduce neurosensory risk among exposed service members.

Urology Individual Critical Task List: Creation and Validation of a Simulation Curriculum.

Individual critical task lists (ICTLs) are skills identified by the U.S. Army for the maintenance of combat readiness in each military occupational specialty, including physicians. These lists vary by medical and surgical specialties and are being utilized by leaders to determine individual deployment capability. The lists for urologists include broader tasks that are not routinely performed in a urology practice. Our goal was to create a simulation curriculum to train urologists and to perform validation testing. Urology staff and residents at a single military treatment facility underwent a simulation event of urology ICTLs: chest tube, needle decompression, intubation, cricothyroidotomy, and extended focused assessment with sonography for trauma. The simulation was broken down into a pretest, cognitive acquisition, in-person training with subject matter experts for skills acquisition, and a posttest. Content validity questionnaires were administered to participants after the training session. Cognitive acquisition consisted of a series of videos demonstrating task execution and in-person demonstration of tasks and clinical scenarios of when they would be needed. In-person simulation was performed on training mannequins and a sonography simulation trainer. There were a total of nine participants: three residents and six staff urologists, ranging from postgraduate year 2 to more than 10years out of residency. The total simulation time was 120min, including 30min for pretest and viewing of videos. Knowledge-based questions improved from pretest to posttest significantly (mean of 1.2 to 0.1, P<.001). Confidence performing tasks improved significantly on all tasks (P≤.01). All participants felt the simulation to be beneficial and had more comfort with the tasks. The novel urology ICTL curriculum using simulation is a feasible and well-received way to keep competency on these tasks and maintain readiness. Face and content validity was established for the urology ICTL simulation curriculum, and the curriculum is exportable to equip urologists at other facilities for the urology ICTLs and for deployments, where life-saving interventions may be necessary from urologists that may be outside their ordinary scope of practice.

Foot Acceleration Attenuation Reduces During Military Load Carriage

Military personnel are at risk of stress fracture injuries, especially those in load carriage-based military occupational specialty, such as infantry. Recently, wearable inertial measurement unit (IMU)-based accelerometry has become a useful tool for identifying markers of lower extremity musculoskeletal injury risk in soldiers in field settings. PURPOSE: To compare differences in accelerometry between non-dominant and dominant foot using foot-worn IMU sensors during a 2km best effort run with heavy (20kg) load carriage. METHODS: Acceleration data from six healthy participants (3 male: 30.33±6.7 y, 1.82±0.01 m, 77.80±11.0 kg and 3 female: 21.0±2.6 y, 1.66±0.1 m, 64.62±13.5 kg) were recorded using tri-axial IMU affixed to the dorsum of each foot. Participant performed a 2km best effort march (run and walk) across grass carrying 20 kg on their back. Data were divided into 200m +/- blocks from the beginning, middle and end of the exercise for analysis. The acceleration amplitudes from each trial were expressed as the root mean square (GRMS), calculated as the average of the square of the acceleration over time, and were used to quantify the accelerations attenuation. The magnitude of the resultant acceleration signal Accr, referred to as the “composite acceleration signal”, was computed as: sqrt ( accx+accy+accz), where accx, accy and accz are obtained from each individual axis of the tri-axial accelerometer. RESULTS: The mean GRMS values at the three phases obtained for the dominant and non-dominant feet of the men were 4.72, 5.15, and 5.23, and 4.93, 4.75, and 4.41 m/s2, respectively whereas those obtained for the dominant and non-dominant feet of the women were 3.91, 4.32, and 4.78, and 3.87, 4.42, and 4.71 m/s2, respectively. These findings revealed that the GRMS values of the feet obtained for both sexes gradually increased during the load carriage task, except for the non-dominant foot of the men, which decreased. CONCLUSION: Increases in GRMS during loaded marching suggest non-linear increases in culminative mechanical stress exposure as distance increases. Foot worn IMU-based measurement systems may provide means to accurately assess injury risk in real time. Supported by UK Ministry of Defence (WGCC 5.5.6-Task 0107) and US Dept. of Defense (W81XWH-17-2-0070).

Retrospective Cohort Analysis of the Army Physical Fitness Test and the Occupational Physical Assessment Test in Reserve Officer Training Corps Cadets: A Brief Report.

Because of the physical fitness requirements of Military Occupational Specialties (MOSs) within the US Army, fitness testing batteries have been developed. The Occupational Physical Assessment Test (OPAT) has been used for determining occupation assignment and is meant to assess upper and lower body muscular power, muscular strength, and aerobic capacity. The Army Physical Fitness Test (APFT) is a general fitness assessment meant to test upper and lower body muscular endurance and aerobic capacity. Comparisons of the two testing batteries as well as evaluation of potential sex differences are missing from current literature. Therefore, the purpose of this study was to investigate the sex differences in APFT and OPAT performances, as well as the relationship between the APFT and OPAT individual test events. A retrospective analysis, approved by the university's institutional review board, was conducted on a sample of 90 Reserve Officer Training Corps (ROTC) cadets (men, n=72, age=19.7±2.2years, height=1.79±0.21m, mass=75.18±12.38kg; women, n=18, age=19.8±2.2years, height=1.63±0.09m, mass=65.56±9.03kg) from the Fall 2018 semester. The cadets completed the APFT (maximal push-ups, maximal sit-ups, 2-mile run) and OPAT (standing long jump, seated power throw, a deadlift test, and interval aerobic run) protocols per army standards. Analysis of variance assessed sex differences and correlation coefficients were computed to examine the strength of relationships between individual test events (p<0.05). All APFT and OPAT event performances were lower in women compared to men (p<0.05), except the sit-up test (p=0.382). Seated power throw (Z=2.285; p=0.011), 2-mile run (Z=1.97; p=0.024), and strength deadlift (Z=1.783; p=0.037) were more highly correlated to push-up than aerobic interval run. The standing long jump (Z=1.741; p=0.041), power throw (Z=3.168; p=0.001), strength deadlift (Z=2.989; p=0.001), and shuttle run (Z=2.933 p=0.002) were less correlated with the sit-up than 2-mile run. The interval aerobic run was more related to the 2-mile run than the power throw (Z=1.809, p=0.035). Compared to the aerobic interval run, the standing long jump (Z=2.969, p=0.001) and strength deadlift (Z=4.237, p<0.001) were more related to the seated power throw. Sex differences and varied relationships among individual events on two common military fitness test batteries were observed. Lower performances on APFT and OPAT by women may suggest the need to evaluate potential training methods to assist women in reaching their desired MOS. Further, individual OPAT events displayed weaker relationships compared with the relationships among individual APFT event, suggesting a greater degree of redundancy among the events on the APFT. Therefore, the combination of APFT and OPAT may offer a greater opportunity to measure physical fitness capabilities as related to various military job performance tasks.

Incidence and pattern of musculoskeletal injuries among women and men during Marine Corps training in sex-integrated units

ObjectivesThe purpose of this analysis was to describe and compare the incidence and pattern of musculoskeletal injuries in women and men during the United States Marine Corps Ground Combat Element Integrated Task Force work-up and assessment phases in sex-integrated units. DesignDescriptive cross-sectional study. MethodsCertified athletic trainers and Navy corpsmen reported injury data for 302 Marines (women: 27.8%, men: 72.2%). Injury frequency, location, cause, type, and activity during injury were described. Fisher’s exact tests were used to compare proportions of injured women and men. The cost of injuries was calculated using the Web-based Injury Statistics Query and Reporting System. ResultsA greater proportion of women (40.5%) sustained an injury compared with men (18.8%, p < 0.001). The lower extremity was the most frequent location for injury (women: 68% of injuries, men: 60%). The most frequent sub-location was the hip (24%) in women and foot/toes (26%) in men. Marching under load was the most common cause (women: 64%, men: 48%). Most injuries occurred during physical training (women: 78%, men: 66%), and were classified as pain/spasm/ache (women: 56%, men: 36%). The total lifetime cost of these injuries that occurred among 302 Marines was approximately $1.4 million U.S. dollars. ConclusionsThe high risk of lower extremity injuries that occurred while marching under load during physical training, and the greater risk of injuries among women compared to men, indicates the need for further research to identify the components of combat Military Occupational Specialty specific training that could be modified to mitigate injuries.

Examining personality for the selection and classification of soldiers: Validity and differential validity across jobs

ABSTRACTA number of past studies have demonstrated that personality traits are modest predictors of workplace attitudes and behaviors and can provide incremental validity over cognitive ability. However, less is known about the utility of personality for job classification. In addition, concerns about the effects of faking on personality measures still remain. In this study, we examined the validity of a forced choice personality measure administered under operational conditions to explore the use of personality traits in high-stakes settings. In addition, we also examined the potential use of personality for classification into military occupational specialties (MOS). We explored these issues in a large sample of Soldiers from five different MOS to examine the prediction of performance during initial military training (IMT). Results indicated that composites of personality traits were valid predictors of performance and attrition and that these composites may be useful for classifying individuals into different military occupations. The implications of these results for Soldier selection and classification are discussed.

Adaptive vocational interest diagnostic: Informing and improving the job assignment process

ABSTRACTThe history of vocational interests shows that these measures have great promise for use in job assignment, suggesting that individuals will be more satisfied and successful in their job when they are doing work that interests them. Recent research has provided empirical support for these predictions and demonstrated that the match between an individual’s interests and his or her work activities is positively related to job performance and negatively related to attrition. Building on these positive empirical findings, the U.S. Army Research Institute is investigating vocational interest measures for personnel job assignment. Person-job fit is very important in a context such as the U.S. Army, where applicants have over 140 military occupational specialties from which to choose. This paper begins by reviewing evidence for the validity of interests and discussing how vocational interest measures may be used for assigning Soldiers in a military context followed by our recent research to develop a new measure of vocational interests to improve the process of matching Soldiers to military occupational specialties. We will conclude with the next steps for this research and potential paths of implementation.

Military Occupational Specialty Codes: Utility in Predicting Inhalation Exposures in Post-9/11 Deployers.

The aim of this study was to examine military occupational specialty (MOS) codes to identify those at risk from inhalation exposures during Southwest Asia deployment. Exposure intensity to diesel exhaust, sandstorms, burn pit smoke, combat dust, and occupational vapors/dusts/gases/fumes (VDGF) were scored for all Army/Marine MOS codes by an expert panel. Based on MOS code, panel-rated exposure scores were compared with questionnaire data from military personnel with postdeployment respiratory illnesses. All exposures except VDGF were rated higher (range P < 0.0001 to P = 0.003) for combat versus noncombat MOS codes. Deployers with respiratory illnesses reported more intense exposure to diesel exhaust (P < 0.0001), burn pit smoke (P < 0.0001), and sandstorms (P = 0.005) compared with panel raters. These deployers clustered in MOS codes rated highest for inhalation hazard exposure intensity. MOS codes are useful in identifying high-risk military occupations where medical surveillance and exposure control should be focused.

Blast Exposure and Risk of Recurrent Occupational Overpressure Exposure Predict Deployment TBIs.

Traumatic brain injury (TBI) has been the leading cause of morbidity and mortality in recent military conflicts and deployment-related TBIs are most commonly caused by blast. However, knowledge of risk factors that increase susceptibility to TBI following an acute, high-level blast is limited. We hypothesized that recurrent occupational overpressure exposure (ROPE) may be one factor that increases susceptibility to mild TBI (mTBI) following blast. Using military occupational specialty as a proxy, we examined the effects of high versus low ROPE on mTBI following blast exposure. Initial analyses included 111,641 active-duty-enlisted U.S. Marines who completed the 2003 or 2008 version of the Post-Deployment Health Assessment. Final analyses examined probable mTBI screens among Marines with at least one qualifying exposure as a function of whether the exposure was a blast and level of ROPE (N=12,929). This study was approved by the Institutional Review Board at the Naval Health Research Center. Blast and ROPE were both independently and jointly associated with a probable mTBI. Marines who experienced a blast (vs other qualifying exposure) and those in high (vs low) risk occupations were 1.07 and 1.23 times more likely to sustain a probable mTBI, respectively. Furthermore, among those who experienced a blast during deployment, those in high-risk occupations were 1.45 times more likely than those in low-risk occupations to sustain a probable mTBI. Blast exposure and ROPE were independently associated with mTBIs, and Marines with both blast exposure during deployment and ROPE were especially likely to sustain an mTBI. This suggests that ROPE heightens the risk of mTBI following blast. Ongoing research is examining the severity, symptomology, and sequelae of TBIs as a function of ROPE.

Cohesion and Performance in Military Occupation Specialty Training.

Cohesion within military teams is not only vital to their performance but also modulates the adverse impact of work stressors on mental health, including depression, distress, and morale. This study stems from previous findings concerning cohesion during recruit training in the Australian Army. In that study, ratings of cohesion clustered on three dimensions, namely horizontal bonding among team members, vertical bonding with leaders, and organizational bonding with the wider army. Ratings on all three dimensions increased during recruit training, similar to what has been during U.S. Army basic training. The present study takes the next step, which is to determine the relationship between team cohesion and external measures of group performance during training in three types of military occupational specialty, specifically, infantry, quartermaster, and administrative clerk. The final sample of respondents consisted of 261 infantry trainees, 22 quartermaster trainees, and 39 administrative clerk trainees. These sample sizes, their gender distribution (9% female), and age distribution are proportional to their representation in the Australian Army. The questionnaires given to trainees and their instructors were adapted from Siebold and Kelly's Platoon Cohesion Index used for measuring the types of bonding within a team. The questionnaire for trainees was administered three times during their respective courses. The cohesion questionnaire for instructors was administered at the completion of training. This study was conducted under defence ethics approval DPR-LREP 069-15. The trainees' ratings of horizontal, vertical, and organizational bonding generally started at a high value and further increased throughout each of the three courses. Vertical bonding tended to be higher than the horizontal bonding, which in turn was consistently higher than organizational bonding. At the end of each course, the trainees' ratings of horizontal bonding had a large significant correlation with their instructors' ratings of the trainees' horizontal bonding (r=0.70), while the ratings of vertical bonding by the trainees versus their instructors had a smaller correlation (r=0.21). In relation to the trainees' individual grades on their course, the trainees' grades were not significantly correlated with their section's horizontal bonding (r=0.29), while their section's mean grade was correlated with their instructors' ratings of horizontal bonding (r=0.44). The present results during military occupational specialty training paralleled previous findings that Australian Army recruits quickly developed solid team cohesion early in their training, which generally continued to rise in all three courses. Furthermore, as seen previously with recruits, vertical bonding between section members in all three courses and their instructor leaders tended to be higher than horizontal bonding among team members, which in turn was higher than vertical bonding of the trainees with the wider Army. These findings have useful implications for health professionals. When discussing feelings of depression, distress, and low morale, health professionals might explore a military member's sense of bonding with their team members, their leaders, and their wider organization as possible contributors to their concerns. By the same token, advice aimed at promoting cohesion may help evoke their protective effects.

Prevalence of Lyme Disease Attributable to Military Service at the USMA, West Point NY: FY2016-2018.

Lyme disease incidence rates have steadily increased since its official recognition in 1975. Since exposure to Lyme is associated with activities conducted in and around tick-habitats including tall grass, shrubs, deciduous forest, and leaf litter, it has been suggested that service members, who are thought to spend higher amounts of time in these habitats due to training requirements, may have higher risk for exposure. Specifically, this study looks at service member and family member exposure to Ixodes scapularis, the vector for Lyme in the Northeastern and Midwestern United States. While literature pertaining to occupational and military specific exposures to Lyme vectors have attempted to quantify the possible elevated risk of Lyme disease for service members, thus far, studies have not consistently confirmed that service members are at a greater risk than family members. This cross-sectional study looks at cases of Lyme disease at Keller Army Community Hospital (KACH) on the West Point Military Reservation in New York during Fiscal Year (FY) 2016 through FY2018. Lyme cases were pulled from Military Health System Mart using current ICD-10-CM codes for Lyme related conditions (A69.20 and A69.29). In total, 144 cases were considered for the analysis. Totaling all service members and family members enrolled at KACH over the three-year period account for 35,526 person-years. Period prevalence, attributable risk percentage, population attributable risk percentage, and corresponding 95% confidence intervals were calculated for service members and family member categories. This study was conducted on human subject research according to 32CFR219 and meets the requirements of exempt status under 32CFR219.101(b)(4) because it is a cross-sectional study on existing de-identified patient data. During FY2016-2018, service members accounted for 63 cases of Lyme totaling 21,595 person-years with a period prevalence of 292 cases per 100,000 (219.8, 363.7). Family members accounted for 81 cases with a total of 13,931 person-years with a period prevalence of 581 cases per 100,000 (455.2, 707.7). The percentage of attributable risk during the three-year period credited to military status is -99.30% (-145.69%, -52.91%). The population attributable risk percentage is -43.4%. While this study was unable to capture the military specific occupational exposure to I. scapularis, it does show a difference in period prevalence between service members and family members with the family members being at higher risk to contract Lyme instead of service members as is commonly suggested in the literature. Additional studies may be conducted to see if this holds true across service member Military Occupational Specialties as a proxy for occupational exposure. Similar studies should be conducted at military installations situated in Lyme endemic areas to determine if these results are comparable across the military or specific to West Point. Future research should attempt to identify all the service member protective factors against Lyme with attribution to permethrin-treated uniforms and other military interventions designed to defend soldiers against vector-borne diseases.