Troop Readiness Research Articles

Efficient Digital Workflow to Replace a Missing Denture Tooth for Complete Denture Repair.

Debonded denture teeth is a common complication on a fixed or removable dental prosthesis when denture teeth are fabricated separately from the denture base and bonded together. Missing denture teeth can alter a person's appearance, speech, or ability to eat. Traditionally, denture teeth repair can be a challenge for clinicians or dental laboratory technicians to find the identical tooth mould to meet esthetic and functional demands. This case report describes a digital workflow to scan, design, and mill a well-fitting and esthetic denture tooth to expedite treatment, improve patient satisfaction, and increase troop readiness when traditional methods may not be feasible.

Development of the Troop Readiness Evaluation With Augmented Reality Return-to-Duty (Troop READY) Platform to Aid in the Detection and Treatment of Military Mild Traumatic Brain Injury.

Mild traumatic brain injury (mTBI) is prevalent in service members (SMs); however, there is a lack of consensus on the appropriate approach to return to duty (RTD). Head-mounted augmented reality technology, such as the HoloLens 2, can create immersive, salient environments to more effectively evaluate relevant military task performance. The Troop Readiness Evaluation with Augmented Reality Return-to-Duty (READY) platform was developed to objectively quantify cognitive and motor performance during military-specific activities to create a comprehensive approach to aid in mTBI detection and facilitate appropriate RTD. The aim of this project was to detail the technical development of the Troop READY platform, the outcomes, and its potential role in the aiding detection and RTD decision-making post mTBI. The secondary aim included evaluating the safety, feasibility, and SM usability of the Troop READY platform. The Troop READY platform comprises three assessment modules of progressing complexity: (1) Static and Dynamic Mobility, (2) Rifle Qualification Test, and (3) Small Unit Operations Capacity-Room Breach/Clearing Exercise. The modules were completed by 137 active duty SMs. Safety was assessed through monitoring of adverse events. Feasibility was assessed using the self-directed module completion rate. Usability was measured using the Systems Usability Scale. No adverse events occurred. Completion rates of the three modules ranged from 98 to 100%. In terms of usability, the mean Systems Usability Scale score of all participants was 83.92 (13.95), placing the Troop READY platform in the good-to-excellent category. Objective motor and cognitive outcomes were generated for each module. The Troop READY platform delivers self-directed, salient assessment modules to quantify single-task, dual-task, and unit-based performance in SMs. The resultant data provide insight into SM performance through objective outcomes and identify specific areas of executive or motor function that may be slow to recover following mTBI.

Present Trends, Emergencies and Their Impact on Supply Chain Security

The article examines the impact of recent geopolitical, economic, and security changes on logistics support capabilities in EU and NATO member states. The study analyzes the effects of the COVID-19 pandemic and the armed conflict in Ukraine on logistics supply chains, considering environmental, social, and security concerns. The research questions focus on identifying the main changes and assessing their implications for commercial, military, and humanitarian logistics. The prolongation of the conflict in Ukraine and the economic sanctions imposed on Russia have been found to have a significant impact on logistics capabilities, perceptions of the structure of supply chains and the risks arising from this. The impact of these events is also producing third-country poverty and dehumanizing the UN SDG goals. On the other hand, improvements in NATO troop readiness and weaponry have been noted. The study highlights the need for further research to investigate specific threats for different types of supply chains and to consider the complex and evolving nature of the issue. Ultimately, this research provides insights into the challenges and opportunities facing logistics capabilities in the context of ongoing geopolitical and environmental changes.

Antimicrobial resistance of enteric pathogens in the Military Health System, 2009 - 2019.

Acute diarrhea (AD) can have significant impacts on military troop readiness. Medical providers must understand current trends of enteropathogen antimicrobial resistance (AMR) in service members (SMs) to inform proper, timely treatment options. However, little is known of enteric pathogen profiles across the Military Health System (MHS). The primary objectives of this study were to identify gaps in enteric pathogen surveillance within the MHS, describe the epidemiology of AMR in enteric pathogens, and identify trends across the MHS both within the Continental United States (CONUS) and outside of the Continental United States (OCONUS). Health Level 7 (HL7)-formatted laboratory data were queried for all specimens where Salmonella, Shigella, and Campylobacter species, as well as Shiga toxin-producing Escherichia coli (E. coli) (STEC) were isolated and certified between 1 January 2009 - 31 December 2019. Antibiotic susceptibility testing (AST) results were queried and summarized where available. Descriptive statistics were calculated for each organism by specimen source, year, and susceptibility testing availability. Among a total of 13,852 enteric bacterial isolates, 11,877 (86%) were submitted from CONUS locations. Out of 1479 Shigella spp. and 6755 Salmonella spp. isolates, 1221 (83%) and 5019 (74%), respectively, reported any susceptibility results through the MHS. Overall, only 15% of STEC and 4% of Campylobacter spp. specimens had AST results available. Comparing AST reporting at CONUS versus OCONUS locations, AST was reported for 1175 (83%) and 46 (78%) of Shigella isolates at CONUS and OCONUS locations, respectively, and for 4591 (76%) and 428 (63%) of Salmonella isolates at CONUS and OCONUS locations, respectively. This study revealed inconsistent enteropathogen AST conducted across the MHS, with differing trends between CONUS and OCONUS locations. Additional work is needed to assess pathogen-specific gaps in testing and reporting to develop optimal surveillance that supports the health of the force.

Risk factors for musculoskeletal injuries in the military: a qualitative systematic review of the literature from the past two decades and a new prioritizing injury model

BackgroundMusculoskeletal injuries (MSkIs) are a leading cause of health care utilization, as well as limited duty and disability in the US military and other armed forces. MSkIs affect members of the military during initial training, operational training, and deployment and have a direct negative impact on overall troop readiness. Currently, a systematic overview of all risk factors for MSkIs in the military is not available.MethodsA systematic literature search was carried out using the PubMed, Ovid/Medline, and Web of Science databases from January 1, 2000 to September 10, 2019. Additionally, a reference list scan was performed (using the “snowball method”). Thereafter, an international, multidisciplinary expert panel scored the level of evidence per risk factor, and a classification of modifiable/non-modifiable was made.ResultsIn total, 176 original papers and 3 meta-analyses were included in the review. A list of 57 reported potential risk factors was formed. For 21 risk factors, the level of evidence was considered moderate or strong. Based on this literature review and an in-depth analysis, the expert panel developed a model to display the most relevant risk factors identified, introducing the idea of the “order of importance” and including concepts that are modifiable/non-modifiable, as well as extrinsic/intrinsic risk factors.ConclusionsThis is the qualitative systematic review of studies on risk factors for MSkIs in the military that has attempted to be all-inclusive. A total of 57 different potential risk factors were identified, and a new, prioritizing injury model was developed. This model may help us to understand risk factors that can be addressed, and in which order they should be prioritized when planning intervention strategies within military groups.

Cancer Previvors in an Active Duty Service Women Population: An Opportunity for Prevention and Increased Force Readiness.

BackgroundThe majority of active duty service women (ADS) are young, have access to healthcare, and meet fitness standards set by the U.S. military, suggesting that ADS represent a healthy population at low risk of cancer. Breast cancer is, however, the most common cancer in ADS and may have a significant effect on troop readiness with lengthy absence during treatment and inability to return to duty after the treatment. The identification of unaffected ADS who carry germline mutations in cancer predisposition genes (“previvors”) would provide the opportunity to prevent or detect cancer at an early stage, thus minimizing effects on troop readiness. In this study, we determined (1) how many high-risk ADS without cancer pursued genetic testing, (2) how many previvors employed risk-reducing strategies, and (3) the number of undiagnosed previvors within an ADS population.MethodsThe Clinical Breast Care Project (protocol WRNMMC IRB #20704) database of the Murtha Cancer Center/Walter Reed National Military Medical Center was queried to identify all ADS with no current or previous history of cancer. Classification as high genetic risk was calculated using National Comprehensive Cancer Network 2019 guidelines for genetic testing for breast, ovary, colon, and gastric cancer. The history of clinical genetic testing and risk-reducing strategies was extracted from the database. Genomic DNA from ADS with blood specimens available for research purposes were subjected to next-generation sequencing technologies using a cancer predisposition gene panel.ResultsOf the 336 cancer-free ADS enrolled in the Clinical Breast Care Project, 77 had a family history that met National Comprehensive Cancer Network criteria for genetic testing for BRCA1/2 and 2 had a family history of colon cancer meeting the criteria for genetic testing for Lynch syndrome. Of the 28 (35%) high-risk women who underwent clinical genetic testing, 11 had pathogenic mutations in the breast cancer genes BRCA1 (n = 5), BRCA2 (n = 5), or CHEK2 (n = 1). Five of the six ADS who had a relative with a known pathogenic mutation were carriers of the tested mutation. All of the women who had pathogenic mutations detected through clinical genetic testing underwent prophylactic double mastectomy, and three also had risk-reducing salpingo-oophorectomy. Two (6%) of the 33 high-risk ADS tested only in the research setting had a family history of breast/ovarian cancer and carried pathogenic mutations: one carried a BRCA2 mutation, whereas the other carried a mutation in the colon cancer predisposition gene PMS2. No mutations were detected in the 177 low-risk women tested in the research setting.DiscussionWithin this unaffected cohort of ADS, 23% were classified as high risk. Although all of the previvors engaged in risk-reduction strategies, only one-third of the high-risk women sought genetic testing. These data suggest that detailed family histories of cancer should be collected in ADS and genetic testing should be encouraged in those at high risk. The identification of previvors and concomitant use of risk-reduction strategies may improve health in the ADS and optimize military readiness by decreasing cancer incidence.

Combat Readiness, Harm Aversion, and Promotion Eligibility: A Qualitative Study of U.S. Servicemembers Views on Tobacco Use and Control in the Military.

More than half a century after the first Surgeon General's Report on Smoking and Tobacco Use, tobacco use remains the leading cause of preventable disease for the U.S. military. Military tobacco use impairs troop readiness, decreases productivity, reduces servicemember physical performance, and leads to chronic illness in veterans. The Department of Defense (DoD) spends considerable effort to maintain a combat ready force, and tobacco use is contradictory to these efforts. U.S. servicemember tobacco use is estimated to cost the federal government more than $6.5 billion annually. The uniqueness of military culture allows for innovative means of tobacco regulation and prevention. Our study examines the U.S. Navy cultural and servicemember perceptions to inform future tobacco control research and policies. We developed a behavioral model of tobacco use from existing literature. Using this model as a theoretical framework, our study qualitatively examined tobacco use in the active duty Navy population stationed in Okinawa, Japan. Thirty one-on-one interviews were conducted with active duty servicemembers. Sessions were recorded, transcribed, and analyzed in MAXQDA12. Multiple military-specific themes were identified. Themes: (1) tobacco use is a "right," (2) the military may limit active duty servicemembers' rights, (3) tobacco restrictions are justified if they prevent harm to others, (4) tobacco restrictions are not widely enforced, (5) smoke breaks are viewed as a legitimate reason to rest at work, and (6) the benefit of tobacco is as a stimulant. Novel tobacco cessation techniques suggested by our study include: (1) expand the buddy system to create an artificial support network for tobacco cessation and (2) tie promotion eligibility to tobacco use. This qualitative study identifies military-specific themes from the tobacco user perspective that help to guide research and policy in reducing tobacco use among military servicemembers. Possible interventions suggested by our findings may include replacing tobacco breaks with fitness breaks to relieve workplace stress and support the culture of fitness, expanding the use of pharmacologic stimulants to replace tobacco when used to maintain alertness, and gathering social support for tobacco cessation from non-healthcare unit members. Further study is needed to elucidate the effectiveness of proposed interventions suggested by our findings, with the ultimate aim of policy changes within the military to optimize health and military readiness, while decreasing long-term health effects and costs of tobacco use.

Evolving Constraints in Military Applications Using Wireless Sensor Networks

WSNs consist of a large number of small sensor nodes. These nodes are very cheap in terms of cost. In military operations, there is always a threat of being attacked by enemies. So, the use of these cheap sensor nodes will help to reduce the loss. In this paper, we analyze the existing literature of using WSNs for military applications. We will discuss the available scenarios of using sensor nodes in the military uses. Provided suitable sensors the system can detect identify and classify threads based on the count, number, type weather it is armored vehicles or men in foot, type and amount of weapons they carry, etc., can be detected in advance. This system provides reliable real time war picture and better situational awareness. This will further help to improve the troop readiness and decrease the reaction time. Added using the data collected tactical planning for deploying troops effectively can be done. In case of civil applications economic zones like oil fields, gold mines, can be protected from intruders and attackers. Industrial complex and production facility can be protected with minimized man power and improved efficiency. Basic criteria are which had to be taken into account while deploying wireless sensors for such applications has been discussed. Particularly locating the intruder with respect to the distance from the sensor node to the target in terms of latitude and longitudinal coordinates are discussed here.

Reproductive Health of Active Duty Women in Medically Austere Environments.

One in seven of the approximately 2.2 million Department of Defense active duty military personnel are women. Among active duty servicewomen, about 40% are under 26 years old, and almost half are young, lower ranking enlisted personnel. This article will include a review of the literature on military women's health topics such including contraception access, pregnancy, and pregnancy outcomes after environmental exposures. In these early adult years, contraception use may not be consistent, leading to higher rates of unintended pregnancy that is similar to their civilian counterparts, but it may affect troop readiness. Women who become pregnant after deployment must be evacuated from theater. Complications in pregnancy that require immediate intervention, such as ectopic pregnancy, may be more difficult to diagnose and manage if far away from comprehensive medical services. Environmental exposures may affect the pregnancy outcome, or may produce delayed responses for future childbearing. Women face other gynecologic choices including menstrual suppression while deployed. Many of these issues have not been fully studied, sample sizes are small or methodological flaws exist in the analysis limiting conclusions that can be drawn. Further research with greater rigor, larger sample sizes, and careful design are needed to address many of these questions.

The effectiveness of endodontic solvents to remove endodontic sealers.

Dental emergencies negatively affect troop readiness, especially during combat. Endodontic retreatment, when required, is especially challenging when the removal of endodontic sealer is required. In this study, we investigated the effectiveness of synthetic endodontic solvents to remove endodontic sealers. Fifty capillary tubes (2.7 mm ID×22 mm L), each filled to 15 mm with either Roth 801, AH Plus, MetaSEAL, or gutta-percha, were stored at 75% humidity for 14 days at 37°C. Ten capillary tubes containing each sealer were treated with either chloroform, xylene, EndoSolv R, EndoSolv E, or no solvent, and then penetrated with D3 ProTaper Universal Retreatment file on the same day. The time for the file to penetrate the length of each sealer was recorded, and the data statistically analyzed. Roth 801 failed to set and was not tested. The file took 3.4±0.1, 4.8±0.3, 5.7±0.4, 4.5±0.2, and 10.6±1.0 seconds (mean±SD) to penetrate gutta-percha using chloroform, xylene, EndoSolv R, EndoSolv E, or no solvent, respectively, and was performed by one endodontic resident at one sitting. The time for penetration of gutta-percha with any solvent was significantly faster (p≤0.05) than for AH Plus or MetaSEAL.The time for AH Plus ranged from 23.1±1.0 to 81.5±4.5 seconds. The time for MetaSEAL ranged from 97.2±6.1 to >180 seconds. EndoSolv E was the most effective solvent for AH Plus. It took significantly more time to remove MetaSEAL than AH Plus, regardless of the solvent used. Our study indicated that the use of the proper endodontic solvent makes complete removal of a sealer much more effective during retreatment.

Computational modeling of interventions and protective thresholds to prevent disease transmission in deploying populations.

Military personnel are deployed abroad for missions ranging from humanitarian relief efforts to combat actions; delay or interruption in these activities due to disease transmission can cause operational disruptions, significant economic loss, and stressed or exceeded military medical resources. Deployed troops function in environments favorable to the rapid and efficient transmission of many viruses particularly when levels of protection are suboptimal. When immunity among deployed military populations is low, the risk of vaccine-preventable disease outbreaks increases, impacting troop readiness and achievement of mission objectives. However, targeted vaccination and the optimization of preexisting immunity among deployed populations can decrease the threat of outbreaks among deployed troops. Here we describe methods for the computational modeling of disease transmission to explore how preexisting immunity compares with vaccination at the time of deployment as a means of preventing outbreaks and protecting troops and mission objectives during extended military deployment actions. These methods are illustrated with five modeling case studies for separate diseases common in many parts of the world, to show different approaches required in varying epidemiological settings.

Quantifying the Incidence and Burden of Postinfectious Enteric Sequelae

Evidence continues to reveal that travelers' diarrhea (TD) may be associated with several chronic conditions. We quantified the burden of these TD sequelae (TDS) and compared it to post-traumatic stress disorder (PTSD) and mild traumatic brain injury (mTBI), both well-appreciated long-term health outcomes (LTHO) of deployment. A systematic review of outcome-specific incidence and disability was conducted to estimate years lived with disability (YLDs) allowing for comparisons of disease burden across outcomes. Estimates varied within outcomes across publication year, study design, and data source. YLD estimates showed that although PTSD results in the highest overall disability (1,225 per 100,000), the impact of TDS is similarly elevated with the greatest burden associated with irritable bowel syndrome (627 per 100,000) followed by reactive arthritis (139). Given the significant impact of the acute effects of TD on troop readiness and the growing appreciation for its LTHO, the need for improved primary prevention strategies are evident. Additional study of the pathogen-specific risk of these sequelae and duration and level of disability are needed to further refine our understanding of morbidity and inform evidence-based decisions on policy toward disease mitigation among those put in harm's way.

Navy Commander helps military patients near and far

The Department of Defense (DoD) Pharmacoeconomic Center is a hive of buzzing activity and a melting pot of various health care personnel from the U.S. Army, U.S. Navy, U.S. Air Force, U.S. Public Health Service, DoD civil servants, and private contractors. Located in San Antonio and operating within the Military Health System, pharmacists at the center, affectionately dubbed the PEC, manage numerous facets of a world-class pharmacy benefit program. From helping deployed patients in remote locations, to analyzing a wealth of pharmacy and medication data, to overseeing a standardized formulary that stretches across three points of care, the PEC is a diverse environment for pharmacy practice.

Military Combat Deployments and Substance Use: Review and Future Directions

Iraq and Afghanistan veterans experience extreme stressors and injuries during deployments, witnessing and participating in traumatic events. The military has organized prevention and treatment programs as a result of increasing rates of suicide and posttraumatic stress disorder among troops; however, there is limited research on how to intervene with alcohol misuse and drug use that accompany these problems. This review presents statistics about postdeployment substance use problems and comorbidities, and it discusses the military's dual role (a) in enforcing troop readiness with its alcohol and drug policies and resiliency-building programs and (b) in seeking to provide treatment to troops with combat-acquired problems, including substance abuse.

Unintended Pregnancy and Contraceptive Use Among Women in the U.S. Military: A Systematic Literature Review

U.S. servicewomen's ability to plan pregnancies is of concern to the military in terms of troop readiness and cost and is an important public health issue. Contraception access and use are crucial, particularly given the high prevalence of sexual assault in the military and the benefits of menstrual suppression for deployment. We systematically searched for publications on contraception, unintended pregnancy, and abortion in the military. Pregnancy and unintended pregnancy rates are higher among servicewomen than the general U.S. population. Contraceptive use may be somewhat higher than the nonmilitary population, although use decreases during deployment. Reported use of hormonal methods for menstrual suppression is lower than interest. There are limited data on these topics; more large, representative studies and longitudinal data from all branches are needed, along with qualitative research to explore findings more deeply. Emergency contraception and abortion are particularly underresearched.

Military Medicine Meets Behavioral Pain Science

Injuries among military personnel result in significant, direct medical costs, indirect costs, and have substantial impact on troop availability and readiness to fulfill essential roles (Army Medical Surveillance Activity, 2004). Better combat armor, use of armored vehicles, and improvement of medical care in the field and in the evacuation of casualties, has led to an increased number of military service members with survivable injuries. With improved survival has come the need for wounded personnel to cope and adapt to significant impairments and numerous co-morbid symptoms. The numbers of service personnel injured by combat or non-combat injuries who have been deployed to Iraq and Afghanistan is large and growing. Currently, of the over 23 million military veterans living in the United States, approximately 3 million have served in Operation Enduring Freedom (OEF, Afghanistan) or Operation Iraqi Freedom (OIF). Persistent pain is a prominent symptom associated with most traumatic injuries including combat injuries (Clark, Bair, Buckenmaier, Gironda, & Walker, 2010; Gironda, Clark, Massengale, & Walker, 2006). The triad of persistent pain, posttraumatic stress disorder (PTSD), and post-concussive symptoms have been reported to be extremely prevalent in military personnel who have received injuries during OEF/OIF (Lew et al., 2009). Identification of the problem, however, is only the first step. The critical question remains: ‘‘How can we best treat these individuals?’’ Over the past half century there has been an explosion of research addressing the role of behavioral factors (cognition, emotion, and behavior) in the experience and response to disease, physical injury, the perception of symptoms including pain, and response to treatment (Gatchel, Peng, Peters, Fuchs, & Turk, 2007). Research has demonstrated that psychosocial factors are among the strongest predictors of ratings of pain severity following acute injury and prolonged pain and related disability following injuries. These factors have also been shown to have both direct and indirect influences on physical processes and mechanisms associated with pain reports and the experience of pain (e.g., Ang et al., 2010). Moreover a number of behavioral treatments, some like hypnosis dating back hundreds of year, have been extended or developed specifically to address patients’ with acute and chronic pain.

Tobacco Promotion to Military Personnel: “The Plums Are Here to Be Plucked”

Smoking rates among military personnel are high, damaging health, decreasing short- and long-term troop readiness, and costing the Department of Defense (DOD). The military is an important market for the tobacco industry, which long targeted the military with cigarette promotions. Internal tobacco industry documents were examined to explore tobacco sponsorship of events targeted to military personnel. Evidence was found of more than 1,400 events held between 1980 and 1997. In 1986, the DOD issued a directive forbidding such special promotions; however, with the frequently eager cooperation of military personnel, they continued for more than a decade, apparently ceasing only because of the restrictions of the Master Settlement Agreement. The U.S. military collaborated with the tobacco industry for decades, creating a military culture of smoking. Reversing that process will require strong policy establishing tobacco use as unmilitary.

Unintended pregnancy rates among a US military population

Unintended pregnancy among military women influences their lives and has implications for troop readiness and deployment. The purpose of this study was to identify the prevalence of unintended pregnancy in the US Army and assess the variables associated with unintended pregnancy. Using a cross-sectional design, 212 female soldiers who delivered viable infants at Darnall Army Community Hospital, Fort Hood, Texas from 1 June 1998 to 6 October 1998 completed a self-administered survey on pregnancy intention and sociodemographic factors. Approximately 35% of the infants were intended, 51% were unintended and 14% were ambivalent, resulting in 65% not intended, a rate consistent with the upper level of civilian communities. Factors associated univariably with unintended pregnancy included being unmarried, being in the lower enlisted rank, having less than a college degree, and living in the barracks. This study shows the importance of developing programmes and policies that address pregnancy among military personnel.

No Relief Yet From Medicare Physician Pay Cuts

No Relief Yet From Medicare Physician Pay Cuts

Death at a discount: how the tobacco industry thwarted tobacco control policies in US military commissaries

Background: The US military is perhaps the only retailer consistently losing money on tobacco. Military stores (commissaries and exchanges) have long sold discount-priced cigarettes, while the Department of Defense (DoD)...