Force Readiness Research Articles

International experience in governing the main issues of enlistment in the military during mobilization as a basis for improving the relevant provisions of Ukrainian legislation

The author emphasizes that the key to the proper level of defense capability of the state in the conditions of prolonged confrontation during the repulsion and deterrence of armed aggression against Ukraine is a high degree of readiness of the state management system, defense forces, national economy, infrastructure and society for the defense of the state. Achieving these prerequisites for the combat readiness of the state defense forces, especially in conditions of imbalance of military potentials, requires continuous improvement of mobilization training and mobilization systems, which includes, mainly, legislative regulation of these processes in compliance with the quality standards of administrative and legal regulation, which will enable the full and timely implementation of mobilization tasks and ensuring a sufficient level of protection of subjects who have rights, obligations and responsibilities in accordance with regulatory legal acts on mobilization training and mobilization. The article outlines international experience in governing key issues of conscription for military service, which can serve as a basis for improving the relevant provisions of the legislation of Ukraine. Relying on the outcomes of the research, the author puts forward a proposition: (1) to recognize a document on the call-up to the defense forces recruitment body as brought to the attention of its addressee if it was sent by registered letter with a description of the attachment and a notification of delivery to official address of residence of the addressee according to his or her registration data; (2) to send mobilization documents via information and communication networks (via an electronic account or e-mail) only as an additional method of notification that does not give rise to obligations on the part of the addressees of these documents, with the gradual making such documents binding in cases where a conscript or reservist has consented to receiving mobilization documents via electronic means of communication or when the law imposes on him or her the obligation to have an official e-mail address (electronic account) for interaction with state agencies within the framework of any public relations; (3) ensure the highest possible level of detail in rules and regulations regarding issues of granting conscripts a deferment from military service during mobilization (including by establishing objective and understandable criteria for the presence of circumstances that are grounds for a deferment, while simultaneously preventing abuses; by providing for the obligation of conscripts to report that the circumstances under which they were granted the right to a deferment have ceased to exist; and by allowing the authorized authorities to independently lift the decision to grant a deferment in such cases, etc.).

Analysis of Dermatovenerological Pathology Among Military Personnel During Outpatient Clinic Admission in Ukraine

Amidst the rising number of COVID-19 cases, particularly due to the emergence of a new Omicron variant known as “FLIRT,” Ukraine is also experiencing the prolongation of martial law and ongoing mobilization of military personnel. These concurrent events have led to a significant increase in the number of soldiers presenting with various skin lesions at military hospitals. The heightened stress, close living quarters, and potential neglect of personal hygiene during mobilization may contribute to the exacerbation and spread of dermatological and venereal diseases among troops. This surge in dermatovenerological conditions has resulted in a substantial backlog of patients awaiting outpatient consultations. The situation underscores an urgent need to analyze the structure and prevalence of skin pathologies among military personnel, categorized by nosological entities. By conducting a thorough analysis, healthcare providers can identify common conditions, recognize patterns of disease transmission, and understand the underlying factors contributing to this increase. Such insights are crucial for improving and optimizing the provision of specialized medical care at different levels within the military healthcare system. Enhanced understanding will facilitate the development of targeted prevention strategies, efficient resource allocation, and tailored treatment protocols. This will not only alleviate the current strain on medical facilities but also improve overall health outcomes for soldiers during this critical period. Addressing these challenges is essential for maintaining the operational readiness of the military forces and ensuring the well-being of those serving during the mobilization in Ukraine.

Application of Pan-Viral Metagenomic Sequencing on United States Air Force Academy Wastewater to Uncover Potential Causes of Acute Gastroenteritis.

Wastewater surveillance is an important technique to monitor public health and is being studied extensively for pandemic prevention, force health protection and readiness, and as a potential early warning system for chem-bio defense. Wastewater surveillance has traditionally relied on techniques such as quantitative PCR or targeted sequencing, both of which are microbe- or disease-specific tools. Newer pan-viral metagenomics strategies may provide higher specificity for pathogens of interest, resulting in a lower false negative rate and reduced sequencing of undesired background nucleic acids. One such system, VirCapSeq-VERT, has been developed to targetall vertebrate virus pathogens; until recently, its application has been limited to clinical samples. The objective of this study was to use VirCapSeq-VERT to interrogate wastewater samples from the U.S. Air Force Academy (USAFA), Colorado Springs, Colorado, to determine its utility in assessing complex samples and its potential application in public health surveillance. Biweekly samples were analyzed from February 2022 through May 2023. Samples were collected from the wastewater treatment facility at USAFA before treatment and stored at -20 °C until total nucleic acid (tNA: DNA and RNA) extraction. tNA was then subject to the probe-based capture system, VirCapSeq, and run through a collection of public bioinformatics pipelines to identify captured viral pathogens and perform phylogenetic analysis. It was determined by the USAFA IRB that the study was non-human subject research and was deemed exempt. In total, 68 families of viruses were identified, comprising thousands of individual strains. This study focused on viruses responsible for gastrointestinal dysfunction as a test of the use of the VirCapSeq-VERT to identify human pathogenic viruses within a complex and highly enriched biological sample. Four enteric viruses dominated the wastewater samples, with Adenoviridae most prevalent before the cadet winter recess (December 17, 2022-January 4, 2023) and Astroviridae most abundant thereafter. Although gastroenteritis outbreaks at USAFA are commonly attributed to norovirus because of clinical presentation and the acute nature of the illness-often diagnosed and treated without confirmatory stool testing-this virus was not found in high prevalence in these wastewater samples. Among adenoviruses, F serotype 41 predominated, suggesting a role in gastrointestinal infections among the cadet population. Phylogenetic investigation of adenovirus and norovirus exposed common variants with seasonal distributions. These findings may prompt correlational studies to assess the clinical predictive capability of VirCapSeq-VERT and to determine the utility of wastewater monitoring as an outbreak early warning system.

The Complexity of Military Force Readiness to Respond to Changes in the Electromagnetic Environment

The Complexity of Military Force Readiness to Respond to Changes in the Electromagnetic Environment

Molecular Characterization of Noroviruses Causing Acute Gastroenteritis Outbreaks among US Military Recruits, 2013-2023.

Norovirus is the leading cause of acute gastroenteritis (AGE) worldwide. Norovirus outbreaks at military facilities can cause loss of training and working days and increased healthcare utilization, affecting force readiness. During 2013-2023, we enrolled 2,304 US military recruits from 4 basic training facilities to investigate AGE outbreaks among this population. Among enrollees, we detected norovirus in 433 (18.8%) AGE cases, and norovirus caused 49 AGE outbreaks during our longitudinal study. On average, each norovirus case-patient missed 1.2 training days due to illness, and 6.2% required infusion care. Whole-genome sequencing of selected samples from each outbreak produced full-length genomes (6,989-7,787 bp) for 39 samples. Norovirus GII.4 Sydney was the most (12/39, 30.8%) identified genotype over the study period. Phylogenetic and comparative genomic analyses revealed that several outbreak strains were responsible for causing >1 outbreak, even across different training sites. Our findings can inform infection control practices at military installations and overall norovirus vaccine development.

Development and Implementation of an Algorithm for Predicting the Intensity of Sorption of Hazardous Gaseous Materials

An algorithm for predicting the intensity of sorption of gaseous materials released into the atmosphere as a result of an accident is proposed. The algorithm consists of three hierarchical levels: monitoring the parameters of gaseous material emission, predicting the consequences of gaseous material emission before and after sorption, and making a management decision. The first hierarchical level includes 4 blocks: obtaining information from the chemical reconnaissance group and the facility representative on the type, amount of hazardous gaseous materials, release intensity and scale of the accident; obtaining information from the hydrometeorological service on temperature, atmospheric pressure, wind direction and speed in the accident area; processing the information received; information on the availability of forces and means for sorption of hazardous gaseous materials. The second hierarchical level also includes 4 blocks: readiness of forces and means for sorption of hazardous gaseous materials; calculation with sorption; calculation without sorption; determination of the boundaries of the chemical damage zone according to the established criteria. At the third hierarchical level, there is 1 block: making a management decision. The software implementation of the proposed algorithm was carried out. The use of the developed algorithm and its software implementation will increase the speed and accuracy of predicting the consequences of the release of hazardous gaseous materials in an accident.

Analisa Strategis Kesiapan Operasional TNI Angkatan Laut dalam Menghadapi Dinamika Lingkungan Maritim

Indonesia, as the largest archipelagic nation globally, faces significant strategic challenges in its maritime domain. The Indonesian Navy's preparedness is paramount in safeguarding the nation's interests amid evolving geopolitical dynamics, resource competition, and maritime security threats such as piracy and terrorism. This paper examines the role and importance of the Operational Ready Force (ORF) within Indonesia's maritime defence strategy. By employing strategic analysis, the study evaluates the Navy's operational readiness, focusing on resource allocation, technological advancements, and international cooperation necessary to enhance the ORF's effectiveness. The research utilizes a comprehensive methodology, including literature review, official documents, and expert interviews, to provide an in-depth understanding of the Indonesian Navy's readiness to address dynamic maritime environments. The paper also explores the strategic implications of global, regional, and national maritime developments, emphasizing the necessity for an adaptive and resilient maritime strategy. The findings suggest that ORF is crucial in bolstering the Indonesian Navy's capabilities, enabling rapid and effective responses to maritime threats while protecting national sovereignty. The study concludes with recommendations for further development of ORF, ensuring Indonesia's continued maritime security and regional stability through integrated technology, strengthened international collaboration, and adaptive threat response strategies.

A Clean You Can Trust: Using an Evidence-Based Bundle to Transform Point-of-Use Treatment for Reusable Medical Devices at a Military Treatment Facility

ABSTRACT Introduction Throughout surgical and invasive procedures, reusable instruments and flexible endoscopes become soiled with organic and inorganic materials. When these substances are permitted to dry, a matrix of microbial cells, called biofilm, forms on the surface of devices, irreversibly binding and subsequently impeding the disinfection and sterilization process. To prevent biofilm formation from occurring, devices must be continuously flushed and wiped with water throughout the procedure and at the end of the case. This process, known as point-of-use treatment (POUT), is the critical first step in the decontamination of medical devices. Poor compliance with POUT can increase patient morbidity and mortality and result in failing hospital accreditation. Materials and Methods An interdisciplinary team used the Plan-Do-Study-Act (PDSA) to develop and implement an audit assessing 29 evidence-based criteria for POUT treatment. Each PDSA cycle supported evidence-based opportunities addressing feedback, workflow analysis, policy development, competency assessment creation, training module development, and infection prevention grand rounds. Four audits were performed over ten months to achieve improved organizational POUT compliance. Results Implementing recurrent PDSA cycles that included audits with feedback led to an evidence-based bundle of policies, competencies, and training for 34 different clinical areas. These interventions resulted in a 26% compliance increase (66% to 92%). Program-specific improvements included flexible endoscopes (+4%) and reusable instruments (+20%). Conclusions Multimodal evidence-based initiatives to improve compliance with workflow processes is a translatable POUT evidence-based practice project for similar Defense Health Agengy facilities. Workflow processes can be vetted and distributed using interdisciplinary teams to ensure viability, sustainability, and conformity with organizational requirements, resulting in a more ready force.

BMI changes among U.S. Navy and Marine Corps active-duty service members during the COVID-19 pandemic, 2019–2021

BackgroundThe COVID-19 pandemic disrupted the daily life and routines of Americans across the United States (U.S.), including those of our active-duty service members (ADSMs). Limited movement orders enacted during this time to promote social distancing prohibited access to fitness and dining facilities for ADSMs. This study aims to expand on previous work identifying changes in body mass index (BMI) among U.S. Army service members by identifying changes in body mass index (BMI) among active-duty service members from both the Navy and Marine Corps during the same time period.MethodsWe conducted a retrospective cohort study of active-duty service members from the Navy and Marine Corps using data from the Military Health System Data Repository. BMI was calculated and categorized according to CDC guidelines both before (February 2019 - January 2020) and during the pandemic (September 2020 - June 2021). Women who were pregnant or delivered during and one year prior to the study periods were excluded. Statistical analyses included paired t-tests evaluating mean BMI, percent change, and the Stuart-Maxwell test for marginal homogeneity.ResultsWe identified 98,330 active-duty Sailors and 55,298 active-duty Marines for inclusion in this study. During the pandemic period the percentage of Sailors with Underweight decreased by 11%, Healthy weight decreased by 11.1%, Overweight increased by 2.1%, and the percentage of Sailors with Obesity increased by 16.5%. During this same time period, Marines with Underweight decreased by 1%, Healthy weight decreased by 16%, Overweight increased by 3.0%, and Marines with Obesity increased by 51%. The largest increases in service members with overweight and obesity observed among both cohorts were among female service members, service members under age 20, and service members with a Junior Enlisted rank.ConclusionsSignificant increases in obesity were observed amongst active-duty United States Navy and Marine Corps service members during DoD pandemic mitigation efforts. Increased rates of obesity likely effected fitness and force readiness. Future interventions should be targeted at younger, Junior-Enlisted Marines and Sailors to promote healthy lifestyles and provide education on nutrition, appropriate exercise, sleep hygiene, and stress management.

Assessment of Navy Provider Knowledge of Women's Mental Health Services, Treatment Practices, and Training.

As female active duty populations increase in all military environments, it is critical that women's health be addressed in a comprehensive manner. The study's results will be utilized to assist Navy health care leaders in addressing female force readiness policies, treatment gaps, and training specific to women's mental health. In total, 212 active duty participants were recruited from the Navy's mental health specialties. The survey was hosted on the U.S. Government's MAX.gov survey website and received Institutional Review Board and Survey Review Board approval per Navy and Defense Health Agency requirements. Participants recorded their experiences with various patient presentations using Likert scale assessments, indicated their comfort in prescribing medication to patients with 11 distinct presenting concerns, and responded to six questions regarding their training and clinical experience in the field of women's mental health. Differences were noted for provider gender, treatment setting, patient sex, provider rank, and years of independent practice. Female providers were more likely than males to report that their female patients presented with 15 of the 21 measured issues. Providers located at MTFs were significantly more likely than providers in operational billets to report female patients presenting with certain conditions and reported being more comfortable prescribing medication. Eighty percent of respondents authorized to prescribe medicine rated themselves as very or extremely comfortable prescribing medications to their patients for all specified conditions except two: women who are breastfeeding and women who are pregnant. Senior officers reported the most comfort prescribing medication to women who are planning to become pregnant and women who have experienced perinatal loss. Only a minority of providers (20%, female; 33%, males) reported receiving women's mental health education during their training. Of those who did receive training, it was limited to post-partum and pregnancy. Most participants (93%) agreed that women's mental health should be incorporated into training programs for military providers. This exploratory study highlights that provider variables impact assessment and treatment of and for patients. The study highlights the interplay of gender, treatment setting, experiences, and level of comfort are associated with provider assessment of presenting concerns. The authors hope this study will help in prioritizing women's mental health practices, mental health training, and research, and in informing policy and decision-making.

Tactical Network Bandwidth Analysis: Application of the Wearables Model‐Based Systems Engineering ‐ System Architecture (MBSE‐SA)

AbstractWarfighters are often exposed to harsh environmental conditions, and experience high rates of physical and cognitive stress, fatigue, and infections, resulting in the degradation of their health and physical performance. This degradation can have a profound effect on the readiness of military forces. Wearable sensor systems can be used to monitor warfighter physiological and cognitive data, providing insight into their health status during routine military training and deployed operations; however, to enable a real‐time, tactical health and performance monitoring capability, wearable sensor systems must integrate into existing tactical military information networks without compromising network function. We extended our existing Wearables Model‐Based System Engineering – System Architecture (MBSE‐SA) to include a bandwidth simulation to analyze the effects wearable sensor systems have on overall network function specifically for military use cases. Our Wearables MBSE‐SA enabled us to model many notional and existing architectures, which represent the wide range of wearable sensor devices, communication protocols, end user devices, and tactical network nodes typically present in operational environments. By taking advantage of the existing Wearables MBSE‐SA framework and architectures, the resulting bandwidth simulation rapidly assessed several existing military network architectures for wearable sensor system integration and identified where network changes were required. Validating the flexibility of the Wearables MBSE‐SA to incorporate new analyses was critical for the military's ability to explore wearable sensor system trades and evaluate architectures in the quickly changing wearable systems technology domain.

Neuromuscular Strength and Power Predict Musculoskeletal Injury and Attrition During Marine Corps Recruit Training.

Elevated rates of musculoskeletal injuries (MSIs) and attrition are documented in military recruit training. By identifying and addressing modifiable risk factors, the rate of successful training completion and military readiness can be enhanced. Despite their impact, the causes of MSIs and attrition among U.S. Marine Corps (USMC) recruits remain underexplored. This study investigates demographic, psychological, and physiological predictors of MSIs and attrition among USMC recruits. In this prospective cohort study, we evaluated USMC recruits at Marine Corps Recruit Depot, Parris Island and San Diego. Recruits were briefed and invited to volunteer. All recruits who were medically cleared to participate in recruit training were eligible to participate in the study. We gathered baseline data on potential predictors at the start of training, with follow-up data on MSIs and attrition collected post-training. Analyzed predictors encompassed dynamic and static strength measures from countermovement jumps, isometric mid-thigh pulls; and participant surveys. We employed multiple logistic regression to discern risk factors for MSI and attrition. Our study comprised 584 USMC recruits (183 female recruits, 19.49 ± 1.88 years, 160.10 ± 7.17 cm, 61.19 ± 8.05 kg; 401 males, 18.94 ± 1.92 years, 172.97 ± 7.26 cm, 73.86 ± 11.04 kg). We observed 193 MSIs in 135 recruits, with 80.31% affecting the lower extremity (LE). Notably, lower relative peak power (odds ratio [OR] 0.91 [0.89, 0.94], P < .001) and shorter eccentric deceleration duration (OR 0.99 [0.99, 1.00], P = .005) were significant predictors of MSIs. Specifically, for LE MSIs, similar trends were noted for relative peak power and eccentric deceleration duration, with additional risks associated with lower body mass index (OR 0.93 [0.86, 0.99], P = .036) and previous LE MSIs (OR 2.25 [1.18, 4.27], P = .013). Attrition was more likely with a reduced eccentric deceleration impulse (OR 0.98 [0.97, 0.99], P < .001) and prolonged time to peak force (OR 1.36 [1.17, 1.59], P < .001) and cigarette use (OR 2.12 [1.01, 4.43], P = .046). MSIs and attrition during USMC recruit training significantly undermine force readiness and escalate costs. Our research has pinpointed several modifiable risk factors, chiefly reduced muscular power and cigarette smoking. We advocate for neuromuscular training programs to bolster strength and power, integrated nutrition and exercise strategies for optimal body composition, and support for smoking cessation to alleviate the incidence of MSIs and curtail attrition. Initiating training with a gradual increase in activity intensity can provide a critical window to correct pre-existing neuromuscular imbalances and weaknesses, particularly those stemming from prior MSIs. Effectively addressing these risk factors is pivotal for diminishing the rates of MSIs and attrition among recruits, thereby enhancing overall military readiness and operational efficiency.

Establishing Effective Reserve Components: Lessons Learned from Russia

This research uses a qualitative approach with a case study method to explore lessons that can be drawn from Russia's experience in building an effective military reserve component. The article discusses the importance of establishing a robust and effective reserve force in Indonesia, drawing lessons from Russia's experiences and strategies employed by other nations. It emphasizes the need for a well-structured organization, clear command structures, efficient hierarchies, and regular training programs. The integration of technology and information systems, as well as the provision of welfare and incentives, is also highlighted as essential components for enhancing the effectiveness and readiness of Indonesia's reserve forces. The document also emphasizes the necessity of clear regulations and policies to provide a strong legal framework, ensuring the operational effectiveness and integrity of Indonesia's reserve forces. Additionally, it underscores the importance of integrating reserve components with regular forces through joint exercises, standardized doctrines, and operational procedures. The document concludes by emphasizing the opportunity for Indonesia to design a resilient reserve force by learning from Russia's challenges and strategies employed by other nations, ensuring the creation of a large, effective, well-trained, and deployable reserve force to balance and strengthen the overall national defense system.

A Conceptual Model of Individual Clinical Readiness.

Force readiness is a priority among senior leaders across all branches of the Department of Defense. Units that do not achieve readiness benchmarks are considered non-deployable until the unit achieves the requisite benchmarks. Because military units are made up of individuals, the unit cannot be ready if the individuals within the unit are not ready. For medical personnel, this refers to one's ability to competently provide patient care in a deployed setting or their individual clinical readiness (ICR). A review of the literature found no conceptual model of ICR. Other potential concepts, such as individual medical readiness, were identified but used inconsistently. Therefore, the purpose of this article is to define ICR and propose a conceptual model to inform future efforts to achieve ICR and facilitate future study of the concept. Model development occurred using a 3-step theoretical model synthesis process. The process included specification of key concepts, identification of related factors and relationships, and organizing them into an integrated network of ideas. ICR is the clinically oriented service members' (COSM) ability to meet the demands of the militarily relevant, assigned clinical mission. ICR leads to one's "individual clinical performance," a key concept distinct from ICR. To understand ICR, one must account for "individual characteristics," as well as one's "education," "training," and "exposure." ICR and individual clinical performance are influenced by the "quality of exposure" and the "patient care environment." One's "individual clinical performance" also reciprocally influences the patient care environment, as well as the "team's clinical performance." These factors (individual clinical performance, team clinical performance, and the patient care environment) influence "patient outcomes." In the proposed model, patient outcomes are an indirect result of ICR and its antecedents (personal characteristics, education, training, and exposure); one's individual clinical performance may not be consistent with their ICR. Patient outcomes are also influenced by the "patient environment" (external to the health care environment) and "patient characteristics"; these elements of the model do not influence ICR or individual clinical performance. Force readiness is a Department of Defense priority. In order for military units to be deployment ready, so too must their personnel be deployment ready. For COSMs, this includes one's ability to competently provide patient care in a deployed setting or their ICR. This article defines ICR, as well as identifies another key concept and other factors associated with ICR. The proposed model is a tool for military medical leaders to communicate with and influence non-medical military leaders in the Department of Defense. Future research is needed to further refine the proposed model, determine the strength of the proposed relationships, and identify interventions to improve ICR.

Pelvic Floor Disorders Among U.S. Military Active-Duty Females

Importance Women are a growing cohort within the U.S. military. Pelvic floor health is a component of health maintenance for which support needs vary by sex. The American Journal of Obstetrics &amp; Gynecology reports that 1 in 4 women is affected by moderate to severe pelvic floor dysfunction (PFD). Understanding the specific experience of female service members is warranted for health care optimization and preservation of force readiness. Objective We aimed to identify the prevalence, incidence, and risk factors associated with incident PFD in active-duty females during an 11-year window. Study Design We used the Medical Assessment and Readiness System at Womack Army Medical Center, which includes medical record and personnel data from 2011 to 2022. Pelvic floor dysfunction diagnoses were identified using diagnosis codes and analyzed with respect to demographic parameters. Results Between 2011 and 2022, 32,996 of 550,303 active-duty females were diagnosed with PFD (period prevalence: 6.00%). Using 2011–2012 as a washout period, 27,046 of 486,558 participants were diagnosed during 1,879,990.90 person-years of follow-up (incidence rate: 14.39 cases per 1,000 person-years). The incidence rate of PFD increased in both new and established active-duty females. Increasing time since service entry was the strongest, statistically significant independent predictor of PFD. Three or more deployments and specific physical fitness scoring were also predictors of PFD. Conclusions The incidence rate of PFD among female service members is increasing, and multiple military-specific factors predict PFD. As the percentage of women in active-duty service continues to grow, additional investigation is needed to confirm PFD trends, illuminate other predictors, and prevent adverse outcomes.

Common Data Elements and Databases Essential for the Study of Musculoskeletal Injuries in Military Personnel.

Injuries are the leading cause of medical encounters with over 2 million medical encounters for musculoskeletal (MSK) conditions and over 700,000 acute injuries per year. Musculoskeletal injuries (MSKIs) are by far the leading health and readiness problem of the U.S. Military. The Proceedings of the International Collaborative Effort on Injury Statistics published a list of 12 data elements deemed necessary for injury prevention in the civilian population; however, there are no standardized list of common data elements (CDEs) across the DoD specifically designed to study MSKIs in the Military Health System (MHS). This study aims to address this gap in knowledge by defining CDEs across the DoD for MSKIs, establishing a CDE dictionary, and compiling other necessary information to quantify MSKI disease burden in the MHS. Between November 2022 and March 2023, we conducted an environmental scan of current MSKI data metrics across the DoD. We used snowball sampling with active engagement of groups housing datasets that contained MSKI data elements to determine CDEs as well as information on readiness databases across the DoD containing up-to-date personnel information on disease, hospitalizations, limited duty days (LDDs), and deployability status for all military personnel, as well as MSKI-specific measures from the MHS Dashboard which tracks key performance measures. We identified 8 unique databases: 5 containing demographic and diagnostic information (Defense Medical Surveillance System, Medical Assessment and Readiness Systems, Military Health System Data Repository, Person-Data Environment, and Soldier Performance, Health, and Readiness Database); and 3 containing LDD information (Aeromedical Services Information Management System, eProfile, and Limited Duty Sailor Marines Readiness Tracker). Nine CDEs were identified: DoD number, sex, race, ethnicity, branch of service, rank, diagnosis, Common Procedural Terminology coding, and cause codes, as they may be captured in any database that is a derivative of the Military Health System Data Repository. Medical Assessment and Readiness Systems contained most variables of interest, excluding injury/place of region and time in service. The Limited Duty Sailor Marines Readiness Tracker contains a variable corresponding to "days on limited duty." The Aeromedical Services Information Management System uses the "release date" and "profile date" to calculate LDDs. The eProfile system determines LDDs by the difference between the "expiration date" and "approved date." In addition, we identified 2 measures on the MHS Dashboard. One measures the percentage of service members (SMs) who are on limited duty for longer than 90 days because of an MSKI and the other tracks the percentage of SMs that are not medically ready for deployment because of a deployment-limiting medical condition. This article identifies core data elements needed to understand and prevent MSKIs and where these data elements can be found. These elements should inform researchers and result in evidence-informed policy decisions supporting SM health to optimize military force readiness.

Refocusing the Military Health System to support Role 4 definitive care in future large-scale combat operations.

The last 20 years of sustained combat operations during the Global War on Terror generated significant advancements in combat casualty care. Improvements in point-of-injury care, en route care, and forward surgical care appropriately aligned with the survival, evacuation, and return to duty needs of the small-scale unconventional conflict. However, casualty numbers in large-scale combat operations have brought into focus the critical need for modernized casualty receiving and convalescence: Role 4 definitive care. Historically, World War II was the most recent conflict in which the United States fought in multiple operational theaters, with hundreds of thousands of combat casualties returned to the continental United States. These numbers necessitated the establishment of a "Zone of the Interior," which integrated military and civilian health care networks for definitive treatment and rehabilitation of casualties. Current security threats demand refocusing and bolstering the Military Health System's definitive care capabilities to maximize its force regeneration capacity in a similar fashion. Medical force generation, medical force sustainment and readiness, and integrated casualty care capabilities are three pillars that must be developed for Military Health System readiness of Role 4 definitive care in future large-scale contingencies against near-peer/peer adversaries.

162 The New Military Neurosurgeon Readiness Metric to Assess Surgical Readiness and Deployability

INTRODUCTION: The US Military Health System includes military treatment facilities (MTFs) and deployable medical providers that have a dual mission to provide a “medically ready force and a ready medical force”. During wartime, the surge in casualties provides abundant surgical case volume to train and sustain a ready medical force. In contrast, peacetime poses a major challenge to military provider readiness, where lessons learned are quickly forgotten and advancements in trauma and combat surgical care decelerate; a phenomenon coined the “Walker dip”. As such, the Defense Health Agency in 2019 mandated critical wartime specialties develop specialty-specific readiness metrics to measure and maintain skills and competencies, named Knowledge, Skills, and Abilities (KSA). The neurosurgery KSA metric was released in early 2023. METHODS: Case counts and associated KSA values were obtained for active duty (AD) military neurosurgeons and neurosurgery-capable MTFs over the last 12 months. RESULTS: The neurosurgery KSA metric is a point-based system that assigns case valuations based on five categories: cranial (70 points), spine (45), peripheral (15), endovascular (5) and minor (5). The threshold KSA value per provider is set at 8000 points annually, or 667 monthly. Threshold was selected as the average between the KSA of a typical level II trauma center annual case volume and initial ABNS certification caseload requirements. Of 51 AD neurosurgeons from 16 MTFs over a 12-month period, only three providers have monthly KSA values above threshold; all of which have duty assignments at civilian institutions. CONCLUSIONS: Less than 10% of AD military neurosurgeons are meeting readiness thresholds per the KSA metric. However, no internal/external validation has been performed. Future validation studies will be pivotal in determining metric accuracy and guide adjustments to ensure a medically capable military force.

Cumulative Blast Impulse Is Predictive for Changes in Chronic Neurobehavioral Symptoms Following Low Level Blast Exposure during Military Training.

Cumulative low-level blast exposure during military training may be a significant occupational hazard, increasing the risk of poor long-term outcomes in brain function. US Public Law 116-92 section717 mandates that US Department of Defense agencies document the blast exposure of each Service member to help inform later disability and health care decisions. However, which empirical measures of training blast exposure, such as the number of incidents, peak overpressure, or impulse, best inform changes in the neurobehavioral symptoms reflecting brain health have not been established. This study was approved by the US Army Special Operations Command, the University of North Carolina at Chapel Hill, and the VA Puget Sound Health Care System. Using methods easily deployable across different organizational structures, this study sought to identify and measure candidate risk factors related to career occupational blast exposure predictive of changes in neurobehavioral symptom burden. Blast dosimetry-symptom relationships were first evaluated in mice and then tested in a military training environment. In mice, the righting time neurobehavioral response was measured after exposure to a repetitive low-level blast paradigm modeled after Special Operations training. In the military training environment, 23 trainees enrolled in a 6-week explosive breaching training course, 13 instructors, and 10 Service member controls without blast exposure participated in the study (46 total). All participants provided weekly Neurobehavioral Symptom Inventory (NSI) surveys. Peak blast overpressure, impulse, total number of blasts, Time in Low-Level Blast Occupation, and Time in Service were analyzed by Bayesian analysis of regression modeling to determine their probability of influence on the post-training symptoms reported by participants. We tested the hypothesis that cumulative measures of low-level blast exposure were predictive of changes in neurobehavioral symptoms. In mice, repetitive blast resulted in reduced righting times correlated with cumulative blast impulse. In Service members, peak blast overpressure, impulse, total number of blasts, Time in Low-Level Blast Occupation, and Time in Service all showed strong evidence of influence on NSI scores after blast exposure. However, only models including baseline NSI scores and cumulative blast impulse provided significant predictive value following validation. These results indicate that measures of cumulative blast impulse may have utility in predicting changes in NSI scores. Such paired dosimetry-symptom measures are expected to be an important tool in safely guiding Service members' occupational exposure and optimizing force readiness and lethality.

Prevalence of Urogenital Mycoplasma genitalium Infection at 2 US Army Medical Facilities.

Sexually transmitted infections (STIs) have a high incidence in the US Armed Forces and can adversely impact service members' ability to perform their duties. Better knowledge of Mycoplasma genitalium (MG) epidemiology in the military is needed to understand the potential impact of this emerging pathogen on force readiness. We conducted cross-sectional analyses of data from US Army service members and other Military Health System beneficiaries participating in a trial of an STI/HIV behavioral intervention at Fort Liberty, NC, and Joint Base Lewis-McChord, WA. At enrollment, participants completed questionnaires and provided biological specimens for nucleic acid amplification testing for MG, Chlamydia trachomatis (CT), and Neisseria gonorrhoeae (NG). We used principal component analysis and robust Poisson regression to examine associations between participant characteristics and prevalent urogenital MG. Among 432 participants enrolled between November 2020 and February 2023, 43 had MG (prevalence, 10.0%), of whom 13 had coinfection with another bacterial STI (all 13 were positive for CT, with 1 also positive for NG). The prevalence of MG was significantly higher among female (13.5%) versus male (7.6%; P = 0.048) participants and non-Hispanic Black (14.9%) versus non-Hispanic White participants (6.6%; P = 0.045). Single relationship status and increased number of recent sexual partners were correlated, and their component was associated with higher MG prevalence (adjusted prevalence ratio, 2.11; 95% confidence interval, 1.29-3.48). The high prevalence of urogenital MG among Military Health System beneficiaries highlights the importance of understanding the potential clinical sequelae of MG and conducting additional epidemiologic research in military settings.