Military Service Members Research Articles

Minimally Invasive Distal Biceps Tendon Reconstruction With Semitendinosus Allograft and Dual Unicortical Button Fixation

Complete rupture of the distal biceps tendon is routinely treated with direct repair; however, chronic, mid-substance, or musculotendinous tears are challenging clinical scenarios for surgeons. Although attempts at direct repair should be considered, in cases of severe retraction or tendon deficiency, a reconstruction may be warranted. Herein the authors describe a technique for distal biceps reconstruction using allograft with a Pulvertaft weave via a standard anterior incision, similar to primary repair, with a small catchment incision more proximally for tendon retrieval. Use of this technique with dual unicortical buttons allows for early range of motion, restoration of the distal footprint, and improved biomechanical construct strength, which has proven invaluable in a population of elite and highly active military servicemembers.

The association between kinesiophobia and functional limitations in service members with knee pain

BackgroundKnee diagnoses account for more than 50% of lower extremity musculoskeletal conditions in non-deployed US Service members. However, there is limited information regarding kinesiophobia in Service members with non-operative knee diagnoses. HypothesesThe objectives of this study were to determine the prevalence of high levels of kinesiophobia in US military Service members with knee pain across different knee diagnoses, and to determine the relationships between kinesiophobia and lower extremity function and/or specific functional limitations in Service members with knee pain. It was hypothesized Service members with knee pain would exhibit high levels of kinesiophobia across all knee diagnoses examined, and higher levels of both kinesiophobia and pain would be associated with worse self-reported function in this population. It was also hypothesized higher levels of kinesiophobia would be associated with functional activities with high knee loading. DesignRetrospective cohort study. Level of evidenceIV. MethodsSixty-five US Service members presenting to an outpatient physical therapy clinic were included in this study (20 females; age = 30.8 ± 7.7 years; height = 1.74 ± 0.9 m; mass = 80.7 ± 16.2 kg). Inclusion criterion was the presence of knee pain (duration = 50 ± 59 months); exclusion criterion was knee pain as a sequela of knee surgery. Data regarding demographic, pain chronicity, pain by Numeric Rating Scale (NRS), Tampa Scale of Kinesiophobia (TSK), and Lower Extremity Functional Scale (LEFS) were retrospectively obtained from patients’ medical records. A high level of kinesiophobia was defined as a TSK score of greater than 37 points. Patient diagnoses included: osteoarthritis (n = 16); patellofemoral pain syndrome (n = 23); and other non-operative knee diagnoses (n = 26). Commonality analysis was utilized to determine the effects of age, height, mass, NRS, and TSK on LEFS score. Predictor values were interpreted as <1% = negligible, >1% = small; >9% = moderate, >25% = large. Additionally, exploratory item-specific analyses examined the strength of the relationships between kinesiophobia and LEFS item responses. Binary logistic regression determined if difficulty with an individual LEFS item could be predicted from either NRS or TSK score. Statistical significance was set at P < 0.05. ResultsHigh levels of kinesiophobia were identified in 43 individuals (66%). NRS and TSK explained 19.4% and 8.6% of the unique variance in LEFS, and 38.5% and 20.5% of total variance, respectively. Age, height, and mass explained negligible to small proportions of the unique variance in LEFS. TSK and NRS were independent predictors for 13/20 individual LEFS items, with odds ratios ranging from 1.12 to 3.05 (P < 0.05). ConclusionThe majority of US Service members in this study exhibited high levels of kinesiophobia. Kinesiophobia was significantly related to self-reported functional scores and performance on individual functional tasks in Service members with knee pain. Clinical relevanceTreatment strategies addressing both fear of movement and pain reduction in patients with knee pain may help optimize functional outcomes.

The post-traumatic growth approach to psychological trauma.

The post-traumatic growth approach to psychological trauma.

Immunopathogenesis of Campylobacter jejuniinfection in a small animal model

Abstract We set out to develop and characterize a small animal model of Campylobacter jejuni(CJ) infection that recapitulates human campylobacteriosis. Adult C57BL/6J mice are rendered susceptible to colonization and disease by pre-treatment with a zinc deficient diet and a broad-spectrum antibiotic cocktail. We have established this model with four strains with diverse capsular serotypes and flagellar groups, two key virulence factors for CJ pathogenesis. We measured colonization, weight loss, diarrhea, fecal inflammatory markers, and cytokine production by mesenteric lymphocytes and splenocytes. Diarrhea containing visible mucous and/or blood and degree of weight loss vary in severity depending on the strain and dose. Interestingly, we identified an inverse relationship between inoculum dose and levels of fecal inflammatory markers, with lower inoculum doses inducing significantly higher inflammation. We also observed production of IFNγ and IL-17 at day 9 post infection and despite no decrease in CJ colonization, IFNγ and IL-17 levels decreased by day 21 with a subsequent increase in IL-10 production. We also observed higher levels of IFNγ and IL-17 in mice challenged with strain CG8486 relative to those challenged with strain 81–176 pointing to potential strain differences. These differences observed were more striking in mesenteric lymphocytes versus splenocytes, indicating that local cellular responses differed from systemic responses. We have developed a model of inflammatory diarrhea in adult mice that exhibits hallmarks of CJ infection and further identified significant shifts in cytokine expression associated with the duration of infection, bacterial strain utilized, and therapeutic treatment. Research reported in this presentation is supported by Navy work unit number: 6000.RAD1.DA3.A0308 and CARB-X. CARB-X’s funding for this project is sponsored by the Cooperative Agreement Number IDSEP160030 from ASPR/BARDA and by awards from Wellcome Trust, the UK Global Antimicrobial Resistance Innovation Fund (GAMRIF) funded by the UK Government Department of Health and Social Care (DHSC) and the Bill &amp; Melinda Gates Foundation. The content is solely the responsibility of the authors and does not necessarily represent the official views of CARB-X or any of its funders. Disclaimers: The views expressed in this work are those of the authors and do not necessarily reflect the official policy or position of the Department of the Navy, Department of Defense, nor the U.S. Government. F. Poly is an employee of the U.S. Government. This work was prepared as part of official duties. Title 17 U.S.C. §105 provides that ‘Copyright protection under this title is not available for any work of the United States Government.’ Title 17 U.S.C. §101 defines a U.S. Government work as a work prepared by a military service member or employee of the U.S. Government as part of that person’s official duties.The animal study protocol was reviewed and approved by the Naval Medical Research Center IACUC in compliance with all applicable Federal regulations governing the protection of animals in research.

Advanced Cervical Neoplasia Rates in Young Service Members: Implications of Primary HPV Screening for Military Readiness [ID: 1380248

INTRODUCTION: The new American Cancer Society (ACS) cervical cancer screening guidelines dissuade cervical cancer screening in women younger than 25, and may become universal national screening guidelines. We queried the incidence of advanced cervical dysplasia and carcinoma in military service members to determine the readiness implications of these recommendations. METHODS: A retrospective cohort study using the Military Health System (MHS) Data Repository and Management Analysis and Reporting Tool (MDR/M2) was performed to identify active-duty patients aged 21–25 diagnosed with cervical dysplasia and cancer across all military treatment facilities (MTFs) from January 1, 2017 to December 31, 2021. Additionally, patient age, human papillomavirus (HPV) infection status, and treatment type were collected. RESULTS: Only active-duty patients treated in a MTF fulfilling the above criteria were captured. In the 5 years of data collection, there were 955 active-duty women who met the inclusion criteria. Moderate to severe cervical dysplasia accounted for 62.3%, while carcinoma in situ and cervical cancer accounted for 35.6%, and 2.1%, respectively. The majority of patients did not have HPV testing or vaccination status encoded; therefore, this endpoint was eliminated from analysis. CONCLUSION: There are a militarily significant number of cases of advanced cervical lesions among young service members. If the new ACS guidelines are adopted, service members with treatable precancerous conditions will evade or delay detection, resulting in cancers that compromise readiness, increase cost, and compromise the health of military women. Mandatory HPV vaccination should be considered if ACS guidelines are adopted.

TLR4-A Pertinent Player in Radiation-Induced Heart Disease?

The heart is one of the organs that is sensitive to developing delayed adverse effects of ionizing radiation (IR) exposure. Radiation-induced heart disease (RIHD) occurs in cancer patients and cancer survivors, as a side effect of radiation therapy of the chest, with manifestation several years post-radiotherapy. Moreover, the continued threat of nuclear bombs or terrorist attacks puts deployed military service members at risk of exposure to total or partial body irradiation. Individuals who survive acute injury from IR will experience delayed adverse effects that include fibrosis and chronic dysfunction of organ systems such as the heart within months to years after radiation exposure. Toll-like receptor 4 (TLR4) is an innate immune receptor that is implicated in several cardiovascular diseases. Studies in preclinical models have established the role of TLR4 as a driver of inflammation and associated cardiac fibrosis and dysfunction using transgenic models. This review explores the relevance of the TLR4 signaling pathway in radiation-induced inflammation and oxidative stress in acute as well as late effects on the heart tissue and the potential for the development of TLR4 inhibitors as a therapeutic target to treat or alleviate RIHD.

TV News and the Military: Exploring Media Frames of an American Institution

This exploratory study analyzes television news transcripts ( N = 300) to examine how broadcast news networks (ABC, CBS, and NBC) and cable news networks (CNN, Fox, and MSNBC) cover military veterans and service members in news programming. Findings show that the stories and sources of broadcast news networks focused on veterans and service members or their families, while cable news networks relied on legislative issues, politicians and other elite sources. Other findings and recommendations are discussed.

Where do colleges advertise? Demographic targeting by U.S. colleges

In this paper, we assess the correlation between advertising spending by U.S. higher education institutions and metropolitan area demographics. We explore whether demographic targeting by colleges differs by sector (for-profit, not-for-profit, and public colleges), as well as for predominantly online institutions and multi-campus chains. Our data include spending on television, radio, Internet, print, and outdoor advertising by degree-granting institutions in the United States. We find that advertising spending is positively correlated with the share of Black residents in a local area for all types of institutions. For-profit institutions advertise in communities with larger shares of military service members and Hispanic residents, relative to their public and private not-for-profit counterparts. Campus location plays an important mediating role in college advertising, but cannot fully account for the patterns we observe. More research is needed to understand the welfare implications of our findings, but they raise concerns in light of research showing relatively poor outcomes for students in for-profit institutions.

Moral Coping or Simply Uncomplicated Soldiering? How Soldiers Avoid Moral Injury Through Simplification, Justification, Rationalization, and Compartmentalization

A substantial number of soldiers develop moral injuries, yet just as many do not. Therefore, it is important to explore the question: How do military service members generally interpret and cope with moral challenges related to their profession? This article analyzes the accounts of 80 (former) soldiers, examining how they perceived their profession and the coping strategies they tend to use in the face of moral challenges. The findings show that they generally did not experience as much moral tension as one might expect. Yet, when they did, they used coping strategies of simplification, justification, and rationalization, including doing good, rules and instructions, reciprocity, numbing, and compartmentalization. This leads to a middle position between the view that military personnel never experience moral challenges and the position that they find violence actually highly problematic, with important implications for research on moral injury, trauma, and soldiers’ experience.

3D Finite Element Model of Human Ear with 3-Chamber Spiral Cochlea for Blast Wave Transmission from the Ear Canal to Cochlea

Blast-induced auditory trauma is a common injury in military service members and veterans that leads to hearing loss. While the inner ear response to blast exposure is difficult to characterize experimentally, computational models have advanced to predict blast wave transmission from the ear canal to the cochlea; however, published models have either straight or spiral cochlea with fluid-filled two chambers. In this paper, we report the recently developed 3D finite element (FE) model of the human ear mimicking the anatomical structure of the 3-chambered cochlea. The model consists of the ear canal, middle ear, and two and a half turns of the cochlea with three chambers separated by the Reissner's membrane (RM) and the basilar membrane (BM). The blast overpressure measured from human temporal bone experiments was applied at the ear canal entrance and the Fluent/Mechanical coupled fluid-structure interaction analysis was conducted in ANSYS software. The FE model-derived results include the pressure in the canal near the tympanic membrane (TM) and the intracochlear pressure at scala vestibuli, the TM displacement, and the stapes footplate (SFP) displacement, which were compared with experimentally measured data in human temporal bones. The validated model was used to predict the biomechanical response of the ear to blast overpressure: distributions of the maximum strain and stress within the TM, the BM displacement variation from the base to apex, and the energy flux or total energy entering the cochlea. The comparison of intracochlear pressure and BM displacement with those from the FE model of 2-chambered cochlea indicated that the 3-chamber cochlea model with the RM and scala media chamber improved our understanding of cochlea mechanics. This most comprehensive FE model of the human ear has shown its capability to predict the middle ear and cochlea responses to blast overpressure which will advance our understanding of auditory blast injury.

Effects of foot intensive rehabilitation (FIRE) on clinical outcomes for patients with chronic ankle instability: a randomized controlled trial protocol

BackgroundLateral ankle sprains account for a large proportion of musculoskeletal injuries among civilians and military service members, with up to 40% of patients developing chronic ankle instability (CAI). Although foot function is compromised in patients with CAI, these impairments are not routinely addressed by current standard of care (SOC) rehabilitation protocols, potentially limiting their effectiveness. The purpose of this randomized controlled trial is to determine if a Foot Intensive REhabilitation (FIRE) protocol is more effective compared to SOC rehabilitation for patients with CAI.MethodsThis study will use a three-site, single-blind, randomized controlled trial design with data collected over four data collection points (baseline and post-intervention with 6-, 12-, and 24-month follow-ups) to assess variables related to recurrent injury, sensorimotor function, and self-reported function. A total of 150 CAI patients (50 per site) will be randomly assigned to one of two rehabilitation groups (FIRE or SOC). Rehabilitation will consist of a 6-week intervention composed of supervised and home exercises. Patients assigned to SOC will complete exercises focused on ankle strengthening, balance training, and range of motion, while patients assigned to FIRE will complete a modified SOC program along with additional exercises focused on intrinsic foot muscle activation, dynamic foot stability, and plantar cutaneous stimulation.DiscussionThe overall goal of this trial is to compare the effectiveness of a FIRE program versus a SOC program on near- and long-term functional outcomes in patients with CAI. We hypothesize the FIRE program will reduce the occurrence of future ankle sprains and ankle giving way episodes while creating clinically relevant improvements in sensorimotor function and self-reported disability beyond the SOC program alone. This study will also provide longitudinal outcome findings for both FIRE and SOC for up to two years. Enhancing the current SOC for CAI will improve the ability of rehabilitation to reduce subsequent ankle injuries, diminish CAI-related impairments, and improve patient-oriented measures of health, which are critical for the immediate and long-term health of civilians and service members with this condition.Trial Registration Clinicaltrials.gov Registry: NCT #NCT04493645 (7/29/20).

Lethal means safety counseling among firearm-owning U.S. National Guard personnel: Hyperarousal symptoms as a moderator of treatment outcomes.

The U.S. Department of Defense and other stakeholders recommend lethal means safety counseling (LMSC) to reduce suicide risk among military service members. Despite the promise of LMSC, few studies have examined moderators of LMSC treatment outcomes, such as posttraumatic stress disorder (PTSD) symptoms. Individuals with elevated PTSD symptoms are characteristically hypervigilant to threat and are more likely to store their firearms unsafely, which might impact their treatment response to LMSC. In this secondary analysis of the Project Safe Guard LMSC intervention, 209 firearm-owning members of the Mississippi National Guard completed self-report surveys (M [SD] age = 35.2 [10.1] years; 86.6% male, 79.4% White). We used logistic regression to examine the moderating effect of PTSD symptoms (PTSD Checklist for DSM-5; e.g., hyperarousal symptoms) on the association between treatment groups (LMSC vs. control; cable lock provision vs. no cable lock provision) and the use of new locking devices at 6-month follow-up. At 6-month follow-up, 24.9% (n = 52) of participants reported new firearm locking device use. The interaction between hyperarousal symptoms and LMSC (vs. control) was significant. Specifically, LMSC increased the use of new firearm locking devices relative to control at 6-month follow-up for individuals with low/medium, but not high, levels of baseline hyperarousal symptoms. Hyperarousal symptoms did not moderate the association between cable lock provision (vs. no cable lock provision) and use of new locking devices. Findings suggest that existing LMSC interventions need to be adapted for use with service members with elevated hyperarousal symptoms. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Opioid use disorder in the active service: Implications for intervention.

Military service members experience occupational-specific injuries that may result in chronic pain and comorbid behavioral health concerns. Data from the Defense Medical Epidemiology Database was used to examine opioid use disorder (OUD) diagnoses between 2016 and 2021. Statistical analysis calculated incidence rates and diagnostic variability by demographic density. The average incidence rate of OUD was 6.1 (per 10,000) and declined by 34% between 2016 and 2021. Diagnoses were most frequently made in service members classified as male, married, white, aged 30-39, junior enlisted, and serving in the Army. To our knowledge, this is the first study to examine the incidence rates of OUD among active duty personnel.

GABAA receptor subunit modulation reversed electrophysiological network alterations after blast exposure in rat organotypic hippocampal slice cultures

Throughout training and deployment, some military service members are frequently exposed to shock waves due to blasts, and some complain of myriad neurological symptoms. In rat organotypic hippocampal slice cultures (OHSCs), blast-induced traumatic brain injury (bTBI) causes deficits in some electrophysiological measures, like long term potentiation, a neuronal correlate for learning and memory. In this study, we further characterized the alterations in the hippocampal network of OHSCs following a single moderate blast exposure. Connectivity and clustering coefficients were reduced across the hippocampal network following bTBI, despite the lack of changes in the firing rate, spike amplitude, spike duration, or inter-spike interval. However, interrogation with the GABAA receptor antagonist, bicuculline, revealed additional significant differences between injured and control slices in measures of spike amplitude, spike duration, connectivity, and clustering. bTBI also significantly reduced expression of the α1 and α5 GABAA receptor subunits. Treatment with the FDA-approved histone deacetylase inhibitor suberanilohydroxamic acid (SAHA) restored the α1 subunit and attenuated deficits in network measures, like connectivity and clustering coefficients. These findings suggest that GABAA receptors may be implicated in neuronal network changes in OHSCs following bTBI, and their recovery may be a viable therapeutic intervention to mitigate injury-induced neurological symptoms.

Perceptions of Espoused Versus Enacted Culture Around Sexual Misconduct and Other Offenses Among U.S. Military Service Members

Interviews and focus groups with active-duty U.S. military service members and students at military service academies investigated relationships between espoused and enacted culture in perceptions of sexual assault and harassment versus other types of offenses. Results show that participants widely understood and accepted an espoused culture that is intolerant of sexual misconduct. The enacted culture included tolerance of some forms of sexual misconduct, differences in conduct in private versus public settings, and widespread resentment of frequent trainings. Results also showed cynicism about service treatments for all types of offenses, but especially for sexual misconduct. Of note is that participants tended to perceive inconsistencies in consequences for sexual misconduct in terms of who faced punishment, whereas for other offenses, they tended to see inconsistencies in what types of consequences were administered. Results demonstrate the value of efforts to align trainings with cultures that consistently discourage behaviors trainings are designed to eliminate.

Deployment-related concussion and long-term health-relatedquality of life among US military personnel.

To examine the relationship between deployment-related concussion and long-term health-related quality of life (HRQoL) among injured US military personnel. The study sample included 810 service members with deployment-related injuries between 2008 and 2012 who responded to a web-based longitudinal health survey. Participants were categorized into three injury groups: concussion with loss of consciousness (LOC; n = 247), concussion without LOC (n = 317), or no concussion (n = 246). HRQoL was measured using the 36-Item Short Form Health Survey physical and mental component summary (PCS and MCS) scores. Current post-traumatic stress disorder (PTSD) and depression symptoms were examined. Multivariable linear regression models assessed the effects of concussion on PCS and MCS scores, while controlling for covariates. A lower PCS score was observed in participants with concussion with LOC (B = - 2.65, p = 0.003) compared with those with no history of concussion. Symptoms of PTSD (PCS: B = - 4.84, p < 0.001; MCS: B = - 10.53, p < 0.001) and depression (PCS: B = - 2.85, p < 0.001; MCS: B = - 10.24, p < 0.001) were the strongest statistically significant predictors of lower HRQoL. Concussion with LOC was significantly associated with lower HRQoL in the physical domain. These findings affirm that concussion management should integrate physical and psychological care to improve long-term HRQoL and warrant a more detailed examination of causal and mediating mechanisms. Future research should continue to incorporate patient-reported outcomes and long-term follow-up of military service members to further define the lifelong impact of deployment-related concussion.

Associations of mTBI and post-traumatic stress to amygdala structure and functional connectivity in military Service Members.

Traumatic brain injury (TBI) is one of the highest public health priorities, especially among military personnel where comorbidity with post-traumatic stress symptoms and resulting consequences is high. Brain injury and post-traumatic stress symptoms are both characterized by dysfunctional brain networks, with the amygdala specifically implicated as a region with both structural and functional abnormalities. This study examined the structural volumetrics and resting state functional connectivity of 68 Active Duty Service Members with or without chronic mild TBI (mTBI) and comorbid symptoms of Post-Traumatic Stress (PTS). Structural analysis of the amygdala revealed no significant differences in volume between mTBI and healthy comparison participants with and without post-traumatic stress symptoms. Resting state functional connectivity with bilateral amygdala revealed decreased anterior network connectivity and increased posterior network connectivity in the mTBI group compared to the healthy comparison group. Within the mTBI group, there were significant regions of correlation with amygdala that were modulated by PTS severity, including networks implicated in emotional processing and executive functioning. An examination of a priori regions of amygdala connectivity in the default mode network, task positive network, and subcortical structures showed interacting influences of TBI and PTS, only between right amygdala and right putamen. These results suggest that mTBI and PTS are associated with hypo-frontal and hyper-posterior amygdala connectivity. Additionally, comorbidity of these conditions appears to compound these neural activity patterns. PTS in mTBI may change neural resource recruitment for information processing between the amygdala and other brain regions and networks, not only during emotional processing, but also at rest.

Strongyloides stercoralis in the US Military Health System.

Strongyloides stercoralis is an intestinal nematode most commonly found in subtropical and tropical locations. Military service members are believed to be at increased risk of exposure due to their unique occupational exposures in endemic regions. Burden, clinical course, and risk factors associated with all Strongyloides infections within the US Military Health System from fiscal years 2012 to 2019 were assessed by manual chart review of records with International Classification of Diseases, Ninth Revision/Tenth Revision codes for Strongyloides infection. Infection risk in demographic subgroups based on region of birth, military occupation, and age was quantified with univariate analysis and multivariate logistic regression. We reviewed 243 charts based on diagnosis coding, yielding 210 confirmed diagnoses (86.4%). Immigrant patients born in Latin America/Caribbean, sub-Saharan Africa, and East Asia/Pacific regions had statistically significant increased risk ratios of infection at 34.4, 32.0, and 22.4, respectively, when compared to patients born in Europe and North America. In univariate analysis, active duty members in the healthcare occupational category had a statistically significant increased risk ratio of infection at 2.31 compared to those outside this occupation. Multivariate logistic regression analysis demonstrated that occupational categories of healthcare, admininstrative/support, warfighter/combat specialist, and engineering/repair/maintenance occupations, being an immigrant patient, and age ≥65 were all associated with statistically significant increased odds ratios for infection. In the Military Health System, occupational exposures, region of birth, and age serve as risk factors for Strongyloides infection. Because infections may be chronic, the impact of targeted screening programs to complement routine medical care should be considered.

Racial and Ethnic Differences in Deaths by Suicide, Drug Overdose, and Opioid-Related Overdose in a National Sample of Military Members With Mild Traumatic Brain Injury, 1999-2019.

To examine racial and ethnic differences in suicide and drug and opioid-related overdose deaths among a population-based cohort of military service members who were diagnosed with a mild traumatic brain injury (mTBI) during military service. Retrospective cohort. Military personnel receiving care within the Military Health System between 1999 and 2019. In total, 356 514 military members aged 18 to 64 years, who received an mTBI diagnosis as their index TBI between 1999 and 2019, while on active duty or activated. Death by suicide, death by drug overdose, and death by opioid overdose were identified using International Classification of Diseases, Tenth Revision (ICD-10) codes within the National Death Index. Race and ethnicity were captured from the Military Health System Data Repository. Overall crude rates were 38.67 per 100 000 person-years for suicide; 31.01 per 100 000 person-years for drug overdose death; and 20.82 per 100 000 person-years for opioid overdose death. Crude and age-specific rates for military members who self-identified as Other were higher than all other racial/ethnic groups for all 3 mortality outcomes. Adjusting for age, suicide rates for those classified as Other were up to 5 times that of other racial/ethnic groups for suicide, and up to 11 and 3.5 times that of other race/ethnicity groups for drug and opioid overdose death, respectively. Findings extend previous knowledge regarding risk for suicide and deaths by drug overdose among those with mTBI and highlight new important areas for understanding the impact of race and ethnicity on mortality. Methodological limitations regarding classification of race and ethnicity must be addressed to ensure that future research provides a better understanding of racial and ethnic disparities in suicide and drug overdose mortality among military members with TBI.

Investigating post-mild traumatic brain injury neuromuscular function and musculoskeletal injury risk: A protocol for a prospective, observational, case–controlled study in service members and active individuals

IntroductionMusculoskeletal injury (MSKI) risk is increased following mild traumatic brain injury (mTBI). Increased MSKI risk is present up to 2 years following post-mTBI return-to-duty/activity relative to both non-mTBI peers and...