Special Warfare Research Articles

Impact of an Integrated Human Performance Support Group: Evaluation of Air Force Special Warfare Candidate Training and Musculoskeletal Injury Outcomes Over Eight Fiscal Years.

The Special Warfare Training Wing and Special Warfare Human Performance Support Group (HPSG; all-co-authors) were established in fiscal year (FY) 2019 to consolidate and oversee all Air Force Special Warfare (AFSPECWAR) training and provide embedded medical and human performance support to candidates with the goal of improving graduation rates and the longevity of the AFSPECWAR operator. The purpose of this manuscript is to assess the impact of the HPSG on AFSPECWAR graduation rates, musculoskeletal injury (MSKI) incidence, and cost. Graduation rates, MSKI incidence (including incidence density and cumulative incidence probability), and MSKI-related health care costs were assessed across all AFSPECWAR training pipelines spanning 8 FYs 2015-22, including Indoctrination, Assessment, and Selection Courses (Selection); Tactical Air Control Party (TACP); Special Tactics (ST), and Guardian Angel (GA). A total of 5,728 distinct candidates were assessed over the time frame. There were significant decreases in attrition when comparing the HPSG era (FY 19-22) with the prior 4-year period for the ST (47% vs. 82% graduates) and TACP (34% vs. 41% graduates) training pipelines. The corresponding Selection (36% graduates) and GA (80% graduates) pipeline attrition rates remained stable. MSKI incidence rates (both incidence density and cumulative incidence probability) overall were not significantly different when comparing the pre-HPSG and HPSG time frames; however, they varied between the two time frames by course. GA candidates had a decrease in MSKI during the apprentice course in the HPSG era compared with the pre-HPSG era (2.4-1.0 cases per 100 trainee weeks; P < .001), which corresponds to a nearly 20% reduction in the cumulative incidence probability (i.e., proportion of trainees injured) after 10 weeks of course. For ST and TACP courses, however, significantly increased incidence of MSKI was observed when comparing the two time frames (P < .001), while for Selection courses, the rates remained stable. A significant reduction in the cost of MSKI-related management (62% total relative value units, 83% total costs) was observed. The impact of the HPSG on attrition, MSKI incidence, and cost-of-care was not consistent across all training pipelines; however, taken together, there were no increases in attrition, and the cost of MSKI management was significantly lower.

Anthropomorphic and Physical Fitness Characteristics of United States Air Force Basic Military Training: Special Warfare Versus Nonspecial Warfare Recruits, Fiscal Year 2019-2023.

Each year, thousands of individuals enlist in the Department of the Air Force (DAF), with some seeking to become DAF Special Warfare (SW) candidates. This study aimed to compare the anthropomorphic and physical fitness characteristics between these groups during fiscal years (FYs) 2019-2023. The sample includes male candidates below the age of 30 who attended the DAF basic military training (BMT) from FY2019 to 2023 (N = 119,415). Initial physical fitness testing was conducted during week 1 of BMT. Physical fitness results, height, weight, and body mass index (BMI) were compared between the two cohorts. A two-way analysis of variance was performed to analyze the effects of group (SWand non-SW) and FY on mean anthropomorphic and physical fitness test variables. Dependent variables were evaluated for homogeneity of variance using Levene's test and for normality using the Shapiro-Wilktest. The Tukey-Kramer test was employed for post hoc analyses with a threshold for statistical significance of α < 0.05. The cohort of SW recruits displayed superior physical fitness results across all FYs (p < 0.001) with the exception of FY2021. They were significantly taller and heavier, and had a higher BMI when compared to non-SW DAF BMT recruits (p < 0.001). Mean values for maximum push-ups and sit-ups for SW recruits were significantly lower in FY2021 (p < 0.001) and not significantly different from non-SW recruits. Additionally, run times for both SW- and non-SW-bound recruits during FY2022 and FY2023 were significantly slower than previous years. These findings can be used to establish a baseline for anthropometric and physical fitness profiles of incoming SW and non-SW DAF BMT recruits that may inform clinicians, human performance professionals, and military training leaders with information necessary to guide future research and physical fitness policy.

Incidence and Risk Factors for Bone Stress Injuries in United States Air Force Special Warfare Trainees.

To determine (1) the incidence rate of lower extremity (LE) bone stress injuries (BSIs) in United States Air Force Special Warfare (AFSPECWAR) trainees during the first 120 days of training, and (2) factors associated with sustaining a LE BSI. Retrospective cohort study. AFSPECWAR Airmen (n = 2,290, mean age = 23.7 ± 3.6 years) entering an intensive 8-week preparatory course "SW-Prep" between October 2017 and May 2021. We compared anthropometric measurements, previous musculoskeletal injury (MSKI), fitness measures, and prior high-impact sports participation in those that did and did not suffer a BSI during the 120-day observation period using independent t-tests and chi-square tests. A multivariable binary logistic regression was used to determine factors associated with suffering a BSI. A total of 124 AFSPECWAR trainees suffered a BSI during the surveillance period, yielding an incidence proportion of 5.41% and an incidence rate of 1.4 BSIs per 100 person-months. The multivariate logistic regression revealed that lower 2-minute sit-up scores, no prior history of participation in a high-impact high-school sport, and a history of prior LE MSKI were associated with suffering a BSI. A receiver operator characteristic curve analysis yielded an area under the curve (AUC) of 0.727. BSI incidence proportion for our sample was similar to those seen in other military settings. Military trainees without a history of high-impact sports participation who achieve lower scores on sit-ups tests and have a history of LE MSKI have a higher risk for developing a LE BSI during the first 120 days of AFSPECWAR training.

Doxycycline Prophylaxis for Skin and Soft Tissue Infections in Naval Special Warfare Trainees, United States1.

In 2015, several severe cases of skin and soft tissue infection (SSTI) among US Naval Special Warfare trainees prompted the introduction of doxycycline prophylaxis during the highest-risk portion of training, Hell Week. We performed a retrospective analysis of the effect of this intervention on SSTI incidence and resulting hospital admissions during 2013-2020. In total, 3,371 trainees underwent Hell Week training during the study period; 284 SSTIs were diagnosed overall, 29 of which led to hospitalization. After doxycycline prophylaxis was introduced, admission rates for SSTI decreased from 1.37 to 0.64 admissions/100 trainees (p = 0.036). Overall SSTI rates remained stable at 7.42 to 8.86 SSTIs/100 trainees (p = 0.185). Hospitalization rates per diagnosed SSTI decreased from 18.4% to 7.2% (p = 0.009). Average length of hospitalization decreased from 9.01 days to 4.33 days (p = 0.034). Doxycycline prophylaxis was associated with decreased frequency and severity of hospitalization for SSTIs among this population.

Выезд на учебу как продленная утечка мозгов: «стремление к» или «бегство от»?

In the context of the problem of the dynamics of intellectual losses in Russia, the structure of the main flows of outbound educational migration is determined on the basis of quarterly data from the FSB border service for the period from 2010 to the second quarter of 2023, broken down by goals and host countries. Aggregated statistics do not allow us to isolate the shares of different age groups or holders of different levels of formal education among those leaving the country, to determine returnable and irrevocable migration losses. However, the assessment of the stability or variability of the quantitative and qualitative aspects of outbound migration flows allowed us to test the null hypothesis of the absence of significant changes before and after the start of the special warfare. In the first quarter of 2022, the inertia of Russians’ orientation towards European education was still preserved, the blocked access to which during the pandemic created a situation of deferred demand. Germany and the United Kingdom maintained leading positions among foreign countries in terms of the number of Russians who left. Over the past year and a half, the flow to European countries has dried up, Turkey, the UAE and Kazakhstan have taken the first places, and the intensity of outflow to the leading country, measured on average per quarter, has increased 1.5 times. Accordingly, migration flows are transformed as a result of changes in the geopolitical situation after the start of special warfare, not only in quantitative terms, but also in qualitative terms (at the level of the composition of recipient countries), which indicates the dominance of non-academic motivation to leave the country.

Musculoskeletal injuries in US Air Force Tactical Air Control Party trainees: an 11-year longitudinal retrospective cohort study and presentation of a musculoskeletal injury classification matrix

IntroductionLittle is known of the epidemiology of musculoskeletal injuries (MSKIs) in US Air Force Special Warfare (AFSPECWAR) Tactical Air Control Party trainees. The purpose of this longitudinal retrospective cohort study...

Applied research of equipment management solutions with alliance blockchain technology

This paper is based on the general consideration of equipment management schemes under the alliance blockchain technology. It is sought that the state of mission, according to the pre-existing equipment management scheme, leads to a variety of conditions. To better adapt the existing scheme to the new situation of equipment mission requirements, it is urgent to update the management scheme by using new technological means. According to the equipment construction development plan, focus on the development of special warfare anti-terrorism equipment management and business needs, based on the existing equipment management foundation and technology development, be sure to simplify business processes, and improve the timeliness of equipment management program relevance.

Heat stroke burden and validity of wearable-derived core temperature estimation during elite military training

ABSTRACT Objectives Exertional heat stroke (EHS) remains a significant health concern while training in hot environments, prompting the development of noninvasive wearable technology for monitoring estimated core temperature (ECT). The objective of this study was to review the effectiveness of an ECT device during elite military training by providing a case series of individuals who developed EHS. Methods This is a retrospective study of EHS cases during high-intensity training while wearing the ECT device, Zephyr BioharnessTM. Data was collected from January 2021 through September 2021 at the Air Force Special Warfare Training pipeline in San Antonio, TX. Rectal temperatures of EHS diagnoses, defined by central nervous system (CNS) dysfunction and rectal temperature approaching or >40°C (104°F), were compared to ECT reading via Zephyr BioharnessTM. Incidence rates and psychometric properties were calculated using R package. Results A total of 47,058 daily peak ECT measurements were collected among 1,364 trainees. A total of 499 trainees flagged as potential EHS by Zephyr BioharnessTM reading >39.7°C (103.5°F). The incidence of confirmed EHS was 0.8/1000 person-months. Of the 10 confirmed EHS cases (9 males, 1 female; age = 23.4 ± 2.7 yrs; BMI = 25 ± 2; body fat = 13 ± 5%), 8 trainees had a peak ECT reading below 39.7°C which resulted in a sensitivity of 20%, specificity of 98.9%, positive likelihood ratio (LR) of 18.93 (95% Confidence Interval [CI] 5.5–65.6), and a negative LR of 0.81 (95% CI 0.6–1.1). Conclusion ECT had substantial false positive and negative rates. Further studies are needed to validate this technology in other populations, and the algorithm used in this device needs to be refined to better capture the environmental and physical requirements in the special operations population.

Management of a Special Warfare Trainee With Repeat Exertional Heat Stroke: A Case Study.

Exertional heat stroke (EHS) is the most deadly form the exertional heat illness with a higher incidence among active duty US military members than in the general population. Current guidelines on EHS recovery timelines and return to duty vary among the military branches. In some cases, individuals experience prolonged heat and exercise intolerance with repeat exertional heat illness events, which can complicate the recovery process. Management and rehabilitation of such individuals is unclear. This manuscript addresses the case and management of a US Air Force Special Warfare trainee who experienced 2 episodes of EHS, despite early recognition, gold standard treatment, and undergoing 4weeks of a stepwise recovery after an initial EHS. After the second episode, a 3-step process was utilized, consisting of a prolonged and personalized recovery period, heat tolerance testing using Israeli Defense Force advanced modeling, and stepwise reacclimatization. This process allowed the trainee to successfully recover from repeat EHS and return to duty, and set a framework for future repeat EHS treatment guidelines. In individuals with repeat EHS, a prolonged recovery period followed by heat tolerance testing can be used to demonstrate appropriate thermotolerance and safely clear an individual to begin stepwise reacclimatization. Overall, patient care and military readiness may be improved by unified Department of Defense guidelines for return to duty after EHS.

Physical profile of Air Force Special Warfare trainees

Physical profile of Air Force Special Warfare trainees

Epidemiology of Musculoskeletal Injuries Among Naval Special Warfare Personnel.

Musculoskeletal injuries (MSIs) are an important cause of morbidity in the military, especially among Special Forces. The aim of this analysis was to describe MSIs among two groups of Naval Special Warfare (NSW) personnel-Special Warfare Combatant-Craft Crewman (SWCC) Operators and Crewman Qualification Training (CQT) students. In this cross-sectional study, we describe self-reported MSIs that occurred during a one-year period and the calculated financial costs of MSIs. Group comparisons were conducted using Fisher's exact tests and independent samples t tests. Data were available for 142 SWCC Operators (26.9 ± 5.9 years, 1.8 ± 0.1 meters, 85.4 ± 10.4 kilograms) and 187 CQT students (22.8 ± 3.2 years, 1.8 ± 0.2 meters, 81.4 ± 8.9 kilograms). The one-year cumulative MSI incidence was significantly lower among SWCC Operators (21.1%) compared to CQT students (37.4%, p = 0.002). The most common anatomic location for MSIs was the lower extremity (SWCC: 50.0% of MSIs, CQT: 66.3%). Physical training was the predominant activity when MSIs occurred (SWCC: 31.6%, CQT: 77.6%). The lifetime cost of all the MSIs included in the analysis was approximately $580,000 among 142 SWCC Operators and $1.2 million among 187 CQT students. MSIs, especially those affecting the lower extremity and occurring during physical training, cause considerable morbidity and financial burden among NSW personnel. Many of the musculoskeletal injuries are to musculotendinous tissue, which typically results from tissue overload or inadequate recovery. Further investigation of the preventable causes of these MSIs and development of a customized, evidence-based MSI prevention program is required to reduce the burden of these MSIs.

1380. Impact of Doxycycline Prophylaxis on Skin and Soft Tissue Infections in Naval Special Warfare Trainees

Abstract Background Several severe cases of SSTIs caused by salt-water associated Gram-negative pathogens (mainly Shewanella algae) among U.S. Naval Special Warfare (NSW) trainees prompted introduction of doxycycline prophylaxis during the highest risk portion of training, “Hell Week”. We present analysis of this intervention’s impact on disease incidence and hospital admission for serious SSTI. Necrotizing fasciitis caused by Vibrio harveyi in an NSW trainee during “Hell Week” prior to introduction of doxycycline prophylaxis. Methods We performed a retrospective cohort study examining data from hospital admissions for SSTI in trainees between 2013-2020. We assessed hospital admission rates for SSTIs, hospitalization rates per SSTI diagnosed at the clinic level, overall rates of SSTI, length of hospital stays and blood and wound culture data. We then compared data from pre- and post-intervention cohorts. Results 3371 NSW trainees participated in “Hell Week” training during the study period with 284 SSTIs diagnosed overall, 29 of which led to hospital admission. After introduction of doxycycline prophylaxis, admission rates for SSTI decreased from 1.37 to 0.64 admissions per 100 trainees (p=0.036). Overall SSTI rates diagnosed at the clinic level remained stable from 7.42 to 8.86 SSTI per 100 trainees (p=0.185). Hospitalization rates per diagnosed SSTI decreased from 18.4% to 7.2% (p=0.009). Average length of hospitalization decreased from 9.01 days to 4.33 days (p=0.034). Blood and wound culture data showed a notable decrease in SSTI from salt-water associated Gram-negative rods (Shewanella algae and Vibrio spp.). Total number of SSTI diagnosed at Naval Special Warfare Center (NSWCEN) medical clinic each “Hell Week” training period with corresponding percentage of NSW trainees diagnosed with SSTI in each class. Date of doxycycline prophylaxis initiation labeled for reference. Wound and blood culture (Cx) data from the pre-intervention and post-intervention cohorts Conclusion Doxycycline prophylaxis during “Hell Week” training for NSW trainees was associated with decreased frequency and severity of hospitalization for SSTI, as well as near elimination of infection with invasive salt-water associated pathogens. Disclosures All Authors: No reported disclosures.

Incidence of Respiratory Pathogens in Naval Special Warfare Sea, Air, and Land Team Candidates With Swimming-Induced Pulmonary Edema

Swimming-induced pulmonary edema (SIPE) is a respiratory condition frequently seen among Naval Special Warfare (NSW) trainees. The incidence of positive respiratory panel (RP) findings in trainees with a diagnosis of SIPE currently is unknown. Does a significant difference exist in the incidence of respiratory pathogens in nasopharyngeal samples of NSW candidates with SIPE and a control group? Retrospective analysis of clinical information from NSW Sea, Air, and Land (SEAL) team candidates with a diagnosis of SIPE over a 12-month period. Candidates who demonstrated the common signs and symptoms of SIPE underwent a nasopharyngeal swab and RP test for common respiratory pathogens. SIPE diagnoses were supported by two-view chest radiography. RP tests were obtained for a selected control group of first-phase trainees without SIPE. Forty-five of 1,048 SEAL team candidates received a diagnosis of SIPE (4.3%). Five had superimposed pneumonia. Thirty-six of 45 showed positive results for at least one microorganism on the RP (80%). In the study group, human rhinovirus/enterovirus (RV/EV) was the most frequently detected organism (37.8%), followed by coronavirus OC43 (17.8%), and parainfluenza virus type 3 (17.8%). Sixteen of 68 candidates from the control group showed positive RP (24%) findings. Patients with SIPE and positive RP results reported dyspnea (94%), pink frothy sputum (44%), and hemoptysis (22%) more frequently than the control participants with positive RP results. Those who reported respiratory infection symptoms in both the study and control groups showed higher incidences of positive RP results (P= .046). We observed that 80%of trainees with a diagnosis of SIPE showed positive results on a point-of-care RP. This positivity rate was significantly higher than that of RP test results from the control cohort. These findings suggest an association between colonization with a respiratory pathogen and the development of SIPE in NSW candidates.

Force plate vertical jump scans are not a valid proxy for physical fitness in US special warfare trainees.

Background: The United States Air Force Special Warfare Training Wing (SWTW) administers a comprehensive physical fitness test to active duty Airmen entering the Special Warfare training pipeline. The Sparta Science™ system utilizes proprietary software to analyze the force-time curve of a vertical jump and purports to serve as a proxy for traditional military fitness tests. The Sparta Science™ system produces four proprietary metrics, including the Sparta™ Score, which is correlated to high magnitudes of force production purportedly performance. This study investigated how Sparta™ Jump Scans correlate to components of a physical fitness test utilized within the SW training pipeline. Methods: At the entry and exit of an 8-week Special Warfare Training Wing preparatory course (SW PREP), 643 trainees completed both an initial and final Sparta™ Jump Scan and a Candidate Fitness Test (CFT). The Candidate Fitness Test consists of eight components and tests several different domains of fitness including strength, power, muscular endurance, swimming proficiency, and cardiovascular fitness. Paired t-tests were used to determine if Sparta™ Jump Scan metrics and CFT components changed during SW PREP. Sparta™ Score's correlation was assessed against every other Sparta™ Jump Scan metric and all CFT fitness measures. Results: This study found that the Sparta™ Jump Scan metrics decline slightly over SW PREP (p < 0.05; negligible-small effect size), while most CFT measures improve (p < 0.05; small-medium effect size). Changes in Sparta™ Jump Scan metrics did not reflect the changes in CFT performance over SW PREP (r 2: 0.00-0.03). Conclusion: The Sparta™ Score was not correlated to the most tactically-relevant fitness measures (rucking and swimming), and only weakly correlated with the only jumping measure on the fitness test, the standing broad jump.

Neuroendocrine, inflammatory, and extracellular vesicle responses during the Navy Special Warfare Screener Selection Course.

Military operational stress is known to increase adrenal hormones and inflammatory cytokines, while decreasing hormones associated with the anabolic milieu and neuroendocrine system. Less is known about the role of extracellular vesicles (EVs), a form of cell-to-cell communication, in military operational stress and their relationship to circulating hormones. The purpose of this study was to characterize the neuroendocrine, cytokine, and EV response to an intense. 24-h selection course known as the Naval Special Warfare (NSW) Screener and identify associations between EVs and cytokines. Blood samples were collected the morning of and following the NSW Screener in 29 men (18-26 yr). Samples were analyzed for concentrations of cortisol, insulin-like growth factor I (IGF-I), neuropeptide-Y (NPY), brain-derived neurotrophic factor (BDNF), α-klotho, tumor necrosis factor-α (TNFα), and interleukins (IL) -1β, -6, and -10. EVs stained with markers associated with exosomes (CD63), microvesicles (VAMP3), and apoptotic bodies (THSD1) were characterized using imaging flow cytometry and vesicle flow cytometry. The selection event induced significant changes in circulating BDNF (-43.2%), IGF-I (-24.6%), TNFα (+17.7%), and IL-6 (+13.6%) accompanied by increases in intensities of THSD1+ and VAMP3+ EVs (all P < 0.05). Higher concentrations of IL-1β and IL-10 were positively associated with THSD1+ EVs (P < 0.05). Military operational stress altered the EV profile. Surface markers associated with apoptotic bodies were positively correlated with an inflammatory response. Future studies should consider a multiomics assessment of EV cargo to discern canonical pathways that may be mediated by EVs during military stress.

The Effectiveness of Cognitive Behavioral Therapy to Improve Resilience of Frog Troop Command School Students in Kodiklatal

The Indonesian Navy's Frog Troop Command Soldiers are special personnel designed to deal with difficult situations and special naval warfare missions. The dynamics of forming as a candidate for Kopaska personnel and the pressure of education at the Frog Troop Command School were so heavy that some students were unable to adapt well, stressed and lacked confidence, so they were unable to continue their education. Resilience is the ability of each individual to cope and adapt to problems that occur in life. Resilience is needed by students to be able to survive while carrying out education at the Frog Troop Command School. Several studies have found that resilience can be increased by using a Cognitive Behavior Therapy approach. This study aims to determine the effectiveness of the CBT intervention on increasing resilience in the Frog Troop Command School students. The use of the CBT method is expected to be able to increase the resilience of students when under pressure during education at the Frog Troop Command School. Therefore, in order to increase the readiness of students to face the heavy educational pressures and stress that arises during their education at the Frog Troop Command School, it is necessary to know how the use of this CBT method and its effect on them. This therapy session intends to explore the use of the CBT method to control oneself in order to be able to face the pressures of education at the Frog Troop Command School

The Use of Force Plate Vertical Jump Scans to Identify Special Warfare Trainees at Risk for Musculoskeletal Injury: A Large Cohort Study

Background: Vertical jump scans from commercially available force plate systems are increasingly used in military settings to screen for musculoskeletal injury (MSKI) risk. However, to date, no studies have determined the ability of these tools to identify tactical athletes at elevated risk for MSKI. Purpose: To (1) determine associations between scores from a force plate vertical jump test and the likelihood of experiencing an MSKI and to (2) establish the test-retest reliability of the output scores from the force plate system used. Study Design: Cohort study; Level of evidence, 3. Methods: A total of 823 male Air Force Special Warfare trainees underwent force plate vertical jump screenings before entering an 8-week training course at US Air Force Special Warfare Training Wing. MSKI data were collected for the 8-week surveillance period for each trainee. Logistic regression analyses were used to identify associations between baseline force plate jump scores and the likelihood of MSKI (any region) or a lower extremity MSKI (significance level, P = .05). The test-retest portion of the study collected force plate output scores from 12 trainees performing 3 trials of the standard test procedures. The reliability of 5 output scores was assessed with intraclass correlation coefficients (ICCs) using a single rater. Results: All force plate output scores demonstrated excellent test-retest reliability (ICC >0.90). Overall 308 (36.4%) trainees had an MSKI during the surveillance period. However, no significant associations were found between the proprietary force plate vertical jump scan output scores and the likelihood of experiencing either an MSKI or a lower extremity MSKI. Conclusion: Output scores from this commercially available force plate system did not identify Air Force Special Warfare trainees at elevated risk of experiencing an MSKI.

Health conditions among Navy divers at end of service: a retrospective cohort study

Purpose: To identify the most prevalent health conditions among divers during their last year of Navy service. Methods: For this retrospective descriptive study we used data from the Dive Jump Reporting System to identify 4,623 active-duty divers who separated between 2008 and 2018. Medical records, dive histories, and personnel files were merged, linked and analyzed at the individual level. Results: On average, 420 divers separated each year. Among the separating divers, 99% were male, 26% were aged 25 to 29 years old with a mean age of 35 (SD = 9, range 18 to 65). The major medical categories with the highest numbers of divers affected were: musculoskeletal system diseases (prevalence rate (PR) = 515.2 per 1,000 divers/year); nervous system (PR = 411.9); injury and poisonings (PR = 249.8); and mental disorders (PR = 237.3). Of the 50 specific conditions that affected the most divers the top four were joint disorders (PR = 34.5), disorders of refraction and accommodation (PR = 30.1), back disorders (PR = 26.8) and organic sleep disorders (PR = 21.6). Compared to divers with fewer than 29 dives, divers with 49-plus dives were about twice as likely to have diagnoses related to symptoms involving head and neck. Conclusions: The study found high rates of conditions such as musculoskeletal disorders, joint and back disorders, and some mental health related disorders. Special warfare divers have high rates of hearing loss, and other disorders of ear. The results show the need and to develop and implement group-specific mitigation programs.

The Hungarian Theory of Just War Based on the Idea of the Holy Crown: A Historical Case of Just Mission

ABSTRACT Warfare ideologies are as old as human civilization. By now, they have grown into an important and extended research field, including works analyzing the justification of war in ancient Indian epic literature, empire-building techniques in Chinese antiquity, and the warfare ideologies of Islam or Buddhism in Sri Lanka. Similar works concerning Hungarian historical ideologies exist, but a comprehensive survey remains to be seen. In this article, I present a special Hungarian warfare ideology which is based on the idea of the Holy Crown, with the help of the concepts of just war theory. Thereby, I throw light on a particular way in which just war thinking has been used and developed in Europe.

Association Between Markerless Motion Capture Screenings and Musculoskeletal Injury Risk for Military Trainees: A Large Cohort and Reliability Study.

Background:Markerless motion capture (MMC) systems used to screen for musculoskeletal injury (MSKI) risk have become popular in military and collegiate athletic settings. However, little is known regarding the test-retest reliability or, more importantly, the ability of these systems to accurately identify individuals at risk for MSKI.Purpose:To determine the association between scores from a proprietary MMC movement screen test and the likelihood of suffering a subsequent MSKI and establish the test-retest reliability of the MMC system used.Study Design:Cohort study; Level of evidence, 3.Methods:Trainees for the Air Force Special Warfare program underwent MMC screenings immediately before entering the 8-week training course. MSKI data were extracted from a database for the surveillance period for each trainee. Logistic regression analyses were performed to identify associations between baseline MMC scores and the likelihood of suffering any MSKI or, specifically, a lower extremity MSKI. The test-retest portion of the study collected MMC scores from 10 separate participants performing 4 trials of the standard test procedures. Reliability was assessed using intraclass correlation coefficients by a single rater.Results:Overall, 1570 trainees, of whom 800 (51%) suffered an MSKI, were included in the analysis. MMC scores poorly predicted the likelihood of any or a lower extremity MSKI (odds ratio, 1.01-1.02). Further, receiver operating characteristic curve analyses demonstrated poor sensitivity and specificity for prediction of MSKI with MMC scores (area under the curve = 0.53). Finally, intraclass correlation coefficients from the test-retest analysis of MMC scores ranged from 0.157 to 0.602.Conclusion:This MMC system displayed poor to moderate test-retest reliability and did not demonstrate the ability to discriminate between individuals who were and were not likely to suffer an MSKI.