United States Air Force Research Articles

Abstract 601: Effects Of Cyclic Peptide Lxw7 Coating On Short Term Vascular Graft Patency Using A Porcine ( Sus Scrofa) Model

Introduction: We previously identified LXW7, a specific integrin αvβ3 targeting ligand capable of selectively capturing endothelial progenitor cells (EPCs) and endothelial cells (ECs), and developed a parylene-based conformal coating technology to covalently bind LXW7 to prosthetic materials. LXW7-coated grafts have demonstrated successful capture of EPCs and ECs, which then promotes endothelialization of prosthetic materials. This study aims to assess the function of LXW7 coating on interposition polytetrafluoroethylene (ePTFE) graft thrombus formation and patency in a large animal model. Methods: 8 Yorkshire pigs underwent implantation of bilateral iliac artery interposition bypasses using control ePTFE grafts and LXW7-coated ePTFE grafts. Each animal served as its own control and the implanting surgeon and experimental team were blinded to treatment and evaluations. Computed Tomography Angiogram (CTA) immediately post-operatively, 3 weeks, and 6 weeks post-implantation. After final CTA, animals were sacrificed and grafts were harvested. The project proceeded following the approval of United States Air Force, David Grant Medical Center Institutional Animal Care & Use Committee. Results: 6 animals were included in final analysis, with 2 excluded due to complications during their surgical and post-operative course requiring euthanasia. Native artery diameter was 4.08mm for the control grafts and 4.17mm for LXW7-coated grafts (p=0.296). Post-procedure CTA demonstrated procedural success for all 6 pigs with no evidence of thrombus or stenosis. At 3 week imaging, all grafts remained patent. 6 week imaging, all LXW7-coated grafts were patent without evidence of thrombus or stenosis while 4 of the 6 control grafts were either fully or partially thrombosed. Repeated measures mixed effects analysis demonstrated significantly improved patency over time with LXW7 coated grafts (p<0.001). Conclusion: This is the first study investigating LXW7-coating on prosthetic vascular graft patency in a large animal model. We demonstrate significantly improved graft patency use of LXW7-coating, suggesting promise as an adjunct for prosthetic grafts in vascular bypass applications.

Aircraft pilot healthcare avoidance due to fear for aeromedical certificate loss and implications for neurology care of the pilot patient (P4-7.004)

<h3>Objective:</h3> The learner will describe: - Healthcare avoidance and three factors that influence pilot healthcare seeking behavior and disclosure - Implications of pilot healthcare avoidance in the care of the pilot patient with a neurological complaint - Methods to mitigate the impact of pilot healthcare avoidance <h3>Background:</h3> Aircraft pilots are required to meet certain medical standards in order to maintain an active flying status. If a pilot discloses a new symptom or condition during routine aeromedical screening, they run the risk of temporality or permanently losing their ability to fly. This can result in occupational, social and professional repercussions to the pilot. For this reason, it has been proposed that pilots face a barrier to seeking medical care that results in delayed presentation to care and healthcare avoidance. Select interventions for neurological diseases are limited by the duration of symptoms and a delay in care can result in poor health outcomes. <h3>Design/Methods:</h3> A cross sectional survey of 3,650 pilots in the United States showed that 56.1% of pilots reported a history of healthcare avoidance due to fear for aeromedical certificate loss. A subanalysis of military pilots, showed that 72% of US active duty military pilots had a history of healthcare avoidance due to fear for loss of flying status. <h3>Results:</h3> Pilots may delay presentation to care and/or participate in healthcare avoidance due to fear for aeromedical certificate loss. Select neurological interventions are limited by duration of symptoms (i.e. thrombolysis, etc). It is imperative for neurologists to be aware this phenomena. To achieve the same outcome, evaluation and intervention may be required more rapidly compared to non-pilot patients. This presentation will review select mitigation strategies to address pilot healthcare avoidance. <h3>Conclusions:</h3> A proportion of pilots participate in healthcare avoidance. Evaluation and intervention of pilots with a neurological complaints may be required more rapidly compared to non-pilot patients. <b>Disclosure:</b> The institution of Dr. Hoffman has received research support from United States Air Force.

Modernizing Identification of Non-Convulsive Seizures and Status Epilepticus: Neurologists’ Experience at a Level 1 Trauma Center (P9-1.007)

<h3>Objective:</h3> We hypothesized that utilization of the Ceribell Rapid Response EEG (RR-EEG) can reduce time to diagnosis in a level one trauma center in the Department of Defense. A secondary aim was to evaluate utilization practices and cost savings. <h3>Background:</h3> Non-convulsive seizures (NCS) and non-convulsive status epilepticus (NCSE) have been found in up to 27% of patients that are critically ill and often go unrecognized or have delays in recognition. Electroencephalography (EEG) is the gold standard diagnostic tool but is a limited resource, requires trained technicians and specialized neurologists, thereby potentially leading to delays in diagnosis and treatment. <h3>Design/Methods:</h3> We obtained 50 rr-EEG headsets from the manufacturer Ceribell Inc as part of quality improvement effort. From September 2021 through April 2022, Neurology residents triaged consults concerning for NCS or NCSE and based on clinical suspicion performed rr-EEG or ordered conventional EEG. Data was collected to include time of consult, time of initiation, time of interpretation, provider’s clinical impressions, and final diagnosis of seizure or not. <h3>Results:</h3> Average time to initiation of data collection for rr-EEG was 48.94 minutes compared to 128.05 minutes for conventional EEG (<i>p</i>-value &lt;0.001). Average time to interpretation of rr-EEG was 58.59 minutes compared to 246.29 minutes time of interpretation after downloading the conventional EEG. We compared time of interpretation of the rr-EEG (58.59 minutes) to the initiation of the conventional EEG (128.05 minutes) due to delays associated with work-flow and formal reading of the EEGs. This yielded a <i>p</i>-value of &lt;0.001. <h3>Conclusions:</h3> rr-EEG reduced time to initiation and interpretation by over 50% compared to conventional EEG as utilized by neurologists at a busy Level 1 trauma center. rr-EEG also reduced cost per EEG while increasing utilization and availability of EEG technology. <b>Disclosure:</b> Dr. Luster has nothing to disclose. Dr. Tchopev has nothing to disclose. The institution of Dr. Hoffman has received research support from United States Air Force. Dr. Jacobus has nothing to disclose. The institution of Dr. Willis has received research support from Air Force. Dr. Willis has received intellectual property interests from a discovery or technology relating to health care.

Invited Commentary: Total War: A Succinct Surgical Overview and Why Civilian Surgeons Should Care.

Bethesda, MD Acknowledgment: The author gratefully acknowledges the insightful comments provided by Michael J. Sutherland, MD, MBA, FACS and Steven J. Kovach III, MD, FACS on an earlier version of this manuscript. Disclosure information: Nothing to disclose. Disclaimer: The opinions and assertions expressed herein are those of the author and do not reflect the official policy or position of the Uniformed Services University of the Health Sciences, the United States Air Force, or the Department of Defense.

Comparison of a Presbyopia-Correcting Supplementary Intraocular Lens Combination and a Capsular-Bag Lens: An In Vitro Study

We evaluated the optical quality of two approaches to trifocality: polypseudophakia versus monopseudophakia. The combination (polypseudophakia) of a monofocal Basis Z B1AWY0 and AddOn Trifocal A4DW0M intraocular lens (IOL) was compared to using one Basis Z Trifocal B1EWYN IOL, all from 1stQ GmbH. In both approaches, we measured modulation transfer function (MTF) and Strehl Ratio (SR) values at 3.0 and 4.5 mm pupil sizes. We determined the through-focus (TF) MTF at 25, 50 and 100 lp/mm for the 3 mm aperture. United States Air Force (USAF) target images were recorded. MTF measurement of the trifocal lens and the combined monofocal and trifocal AddOn IOL showed good performance at the far and near focus for the 3 mm aperture. For the 4.5 mm aperture the MTF improved for the far focus but decreased for the intermediate and near focus. TF MTF showed better contrast at the far focus for the polypseudophakic setup but at the expense of the efficiency at the near focus. However, the USAF chart images revealed only minimal differences between both approaches. The optical quality of the polypseudophakic approach was not affected by the presence of two IOLs instead of one and proved to be comparable with the performance of one capsular-bag-fixated trifocal IOL. Differences between the single vs. two-lens approach seen in the TF MTF analysis could be attributed to the optical design that varied between the trifocal models.

When should bone mineral density testing be repeated in patients with osteopenia not on bisphosphonate therapy?

Nellis Air Force Base Family Medicine Residency, Nellis Air Force Base, NV The corresponding author is Adriana Carpenter; [email protected] The authors declare no conflicts of interest. The opinions and assertions contained herein are those of the authors and are not to be construed as official or as reflecting the views of the US Air Force Medical Department, the Air Force at large, or the Department of Defense.

Comparison of Finger, Hand, and Wrist Injuries in the US Air Force to US Workers.

Fingers, hands, and wrists (FHW) are the most frequently injured body parts in work-related injuries. This study described and compared FHW injuries among enlisted, officer, and civilian US Air Force (USAF) personnel to those in the US workforce. All work-related, noncombat FHW injuries (≥1 lost workday) and demographics among USAF personnel and US workforce (2008-2018) were included. The USAF FHW injury rates were age adjusted to the US employment and compared by sex, source, event, and nature of the injuries. Finger, hand, and wrist injuries were significantly lower among the USAF personnel and among females. In both populations, FHW injuries from falls were higher and increased with age group among females. Males had higher overall FHW injuries from contact with objects and equipment. Prevention efforts should focus on understanding risk factors and sharing successful prevention activities.

Real-world Big-data: Strengths and weaknesses of ASCO's CancerLinQ® discovery multiple myeloma dataset.

None of the authors have any financial or non-financial conflicts of interest to disclose. The opinions and assertions expressed herein are those of the authors and do not necessarily reflect the official policy or position of the US Air Force or the Department of Defense. None

Patterns of contamination and burden of lead and arsenic in rooftop harvested rainwater collected in Arizona environmental justice communities

As climate change exacerbates water scarcity, rainwater harvesting for household irrigation and gardening becomes an increasingly common practice. However, the use and quality of harvested rainwater are not well studied, and the potential pollutant exposures associated with its use are generally unknown. There are currently no federal standards in the United States to assess metal(loid)s in harvested rainwater. Project Harvest, a community science research project, was created to address this knowledge gap and study the quality of harvested rainwater, primarily used for irrigation, in four environmental justice communities in Arizona, USA. Community scientists collected 577 unique rooftop harvested rainwater samples from 2017 to 2020, which were analyzed for metal(loid)s, where arsenic (As) concentrations ranged from 0.108 to 120 μg L−1 and lead (Pb) concentrations ranged from 0.013 to 350 μg L−1 and compared to relevant federal/state standards/recommendations. Community As and Pb concentrations decreased as: Hayden/Winkelman > Tucson > Globe/Miami > Dewey-Humboldt. Linear mixed models were used to analyze rooftop harvested rainwater data and results indicated that concentrations of As and Pb in the summer monsoon were significantly greater than winter; and contamination was significantly greater closer to extractive industrial sites in three of the four study communities (ASARCO Hayden Plant Superfund Alternative site in Hayden/Winkelman, Davis-Monthan United States Air Force Base in Tucson - Pb only, and Freeport McMoRan Copper and Gold Mine in Globe/Miami). Based on models, infrastructure such as proximity to roadway, roof material, presence of a cistern screen, and first-flush systems were not significant with respect to As and Pb when controlling for relevant spatiotemporal variables; whereas, cistern age was associated with Pb concentrations. These results however, indicate that concentrations vary seasonally and by proximity to industrial activity, not by decisions made regarding collection system infrastructures at the individual home level. This study shows that generally, individuals are not responsible for environmental contamination of rooftop harvested rainwater, rather activities and decisions of government and corporate industries control contaminant release.

Assured Access: A History of the US Air Force Space Launch Enterprise, 1945–2020 by David N. Spires

Reviewed by: Assured Access: A History of the US Air Force Space Launch Enterprise, 1945–2020 by David N. Spires Michael W. Hankins (bio) Assured Access: A History of the US Air Force Space Launch Enterprise, 1945–2020 By David N. Spires. Maxwell Air Force Base: Air University Press, 2022. Pp. 505. The establishment of the United States Space Force in December 2019 initiated a wide public discourse on the militarization of space. What much of that discourse failed to acknowledge was that space had been militarized long before the popular crewed space programs of the 1960s. This history of U.S. Air Force (USAF) involvement in space is the subject of Assured Access, the latest work from David Spires, who has previously published several books documenting the service's activities in the final frontier. Based almost entirely on secondary sources, Assured Access offers little new information but does present a useful single-volume overview of the evolution of USAF space launch capabilities over a broad timespan. Spires traces how the USAF's quest to control the space domain in the years immediately after World War II brought it into sharp rivalry with the U.S. Army and Navy and, later, the National Aeronautics and Space Administration (NASA). Readers who may not be familiar with the level of Defense Department participation in NASA programs—for example, the heavy influence the Air Force had on the space shuttle's design—will find Spires's coverage excellent. The key turning point in Spires's narrative is the 1986 Challenger explosion, in which seven astronauts tragically lost their lives. This event caused the USAF to focus on its own fleet of Evolved Expendable Launch Vehicles built by United Launch Alliance (ULA), a joint venture between Lockheed Martin and Boeing. ULA soon had competition from companies such as SpaceX and Blue Origin, as the USAF sought "on demand" launches to lift payloads into orbit with increasingly short timeframes. One of the book's major themes is the USAF's reluctance to make major investments in the space domain. "Air Force leaders were less than enthusiastic about human spaceflight and frequently ambivalent about space in general" (p. 215), Spires says of the space shuttle era. This ambivalence continued into the twenty-first century, as Spires describes how the U.S. Space Force was created largely because Congress became frustrated with "Air Force stewardship of space and what they [Congress] perceived as the secondary role of space in a service dominated by air interests" (p. 350). Spires argues [End Page 629] that events such as the creation of the space shuttle program and the Space Force were powerful motivators in spurring the USAF to action in space and that the service has achieved its goals there. Published by the Air Force, Assured Access has some of the limitations common to institutional histories. Specifically, there is little historical argument present. There is also an almost exclusive focus on hardware, and the text often resorts to lengthy lists of specifications of particular systems. Broader connections to culture and society are mostly unexplored. This is not meant as a criticism: Spires's approach presents a valuable resource for collecting detailed specifications in one volume, and the fact that Air University Press offers the book as a free, searchable PDF adds to its usefulness. What is missing from the book is a clearer explanation of what the Air Force was trying to accomplish in space operationally. Spires frequently describes the purpose of these launches as "classified reconnaissance" missions with no elaboration. In fairness, some of the more recent programs might still be classified. Still, the reader is left with little idea of what all these Air Force satellites were doing and how their missions related to broader Air Force operations. Also, little mention is made of the Soviet and Chinese space efforts, some of which undoubtedly influenced USAF decision-making. These critiques do not detract from the value of Spires's work as a resource for contextualizing the evolution of Air Force space capabilities throughout the Cold War and beyond. Assured Access deserves a place on the shelves, or, as it were, in the browser bookmarks lists, of historians of...

Whistler‐Mode Transmission Experiments in the Radiation Belts: DSX TNT Circuit Simulation and Data Analysis

AbstractHigh‐power transmission experiments in the very low frequency (VLF) mode have been conducted by the US Air Force Research Laboratory’s Demonstration and Science Experiments (DSX) satellite in the radiation belts using a novel transmitter that automatically tunes to find the resonance frequency of the transmitter circuit including the antenna. The resulting voltage–frequency curves are used to derive antenna impedance at the resonance. The analysis shows that the antenna reactance is far less than that of a dipole antenna in free space. The derived radiation resistance is up to several tens of kilo Ohms. Most interestingly, it is found that the radiation resistance is inversely proportional to the square of transmission wave frequency. The transmitted power can be up to 80 W for the DSX transmitter with an 82‐m long tip‐to‐tip antenna, showing that the high‐power VLF transmission is feasible. Whistler wave transmission inside the higher‐density plasmasphere is more efficient. Data analysis indicates that the antenna impedance does not vary systematically with the antenna orientation angle relative to the ambient magnetic field. The previous dominant theoretical studies yield not only incorrect values of the impedance but a completely different frequency dependence than that derived from DSX experiments. Instead, the recent theories correctly capture both the antenna impedance magnitude and the frequency dependence.

US Air Force to study nuclear missile base lymphomas.

US Air Force to study nuclear missile base lymphomas.

Military occupation and testicular germ cell tumour risk among US Air Force servicemen

ObjectivesTesticular germ cell tumours (TGCTs) are the most commonly diagnosed malignancy among active duty US military servicemen. Occupational risk factors may play a role in TGCT aetiology, although the evidence...

Gamma Scientific Sets High Standards for Light Measurement

Gamma Scientific Sets High Standards for Light Measurement

Thirty-Year Airfield Pavement Behavioral and Economic Simulation to Improve Budget Allocation for the US Air Force Network

Based on internal estimates, the US Air Force (USAF) has a deferred infrastructure maintenance backlog for its real property portfolio of over $33 billion (about 10% is airfield pavements). Without an increase in funding, divestiture of excess infrastructure, or change in strategy, this backlog is estimated to climb to over $50 billion by 2030. Reversing the growing infrastructure backlog trend requires new methods and strategies to rethink how the USAF invests in its infrastructure. This paper studied three areas aimed at improving network-level budget allocation. The algorithm behavioral and economic airfield simulation tool (BEAST), developed herein, creates a simulation tool capable of modeling behaviors and decisions of 109 organizations managing a global network of airfield pavements over 30 years. The BEAST is used to forecast outcomes of USAF investment decisions utilizing its current management strategies and historical behaviors. Analysis findings are compared to outcomes using a lowest life cycle cost tool, known as rapid asset modeling of pavement sustainment strategies (RAMPSS). The USAF’s current strategy is unsustainable; however, switching to recommendations from BEAST and RAMPSS provides a potentially significant course correction.

A social-ecological examination of sleep among Airmen in technical training

ABSTRACT Inadequate sleep is an on-going risk to the health and mission readiness of U.S. Armed Forces, with estimates of sleep problems high above U.S. civilian populations. Intervening early in the career of active duty Air Force personnel (or “Airmen”) with education and the establishment of healthy behaviors may prevent short and long term-detriments of sleep problems. This paper describes the results of a qualitative study seeking to understand the facilitators and barriers to achieving good sleep in a technical training school during the first year of entry into the United States Air Force. Using the social ecological framework and content analysis, three focus groups with Airmen were conducted to explore themes at the individual, social, environmental, and organizational/policy level. Overall, results indicated a cohort motivated to achieve good sleep, and also struggling with a number of barriers across each level. This paper highlights opportunities for population health interventions during technical training aimed at supporting Airmen in developing healthy sleep behaviors early in the course of their career.

Identifying Host Cell Gene Expression Modulation as Potential Markers for SARS-CoV2 Infection

Background The SARSCoV2 emergence in 2019 has caused health, safety, and socioeconomic issues around the world. Current testing prioritizes viral RNA detection, requiring specialized techniques, training, and time periods, resulting in significant testing limitations. Viral infection can cause changes in host cell gene expression, which vary from virus to virus. Recent research suggests SARSCoV2-induced gene expression modulations in infected human cells may be differentiated from expressions elicited by other acute respiratory illnesses. Data in this study highlight specific genes that are differentially expressed during SARSCoV2 infection. This novel application of individual sample analysis in connection with global databases, provides robust data for genes that are specifically modulated during SARSCoV2 infection. This expression profile would be valuable for SARSCoV2 testing, prevention, treatment, and basic virology research. Methods Previously collected COVID-19 surveillance-testing samples from cadets at the United States Air Force Academy were used to quantify the expression of 19 target genes using direct primer-mediated qRTPCR. Additionally, samples were analyzed with RNA-seq to assess the different transcriptomes between uninfected and SARSCoV2-infected samples. Results were compared with national databases to confirm agreement with the results. Results 19 genes were identified to be altered during SARSCoV2 infection using in-lab experimental results. This expression profile matches previous research and may uniquely describe SARSCoV2 infection. The genes expected to be upregulated according to previous research, IL1B, IFI44L, ACE2 &amp; DUX3, were all upregulated. RNA-seq data confirms these results and identified 122 other genes that are significantly different between uninfected and SARSCoV2 infected samples. The results have a 93% agreement rate with national databases. Conclusion Despite the availability of vaccines for SARSCoV2, the continual mutation and evolution of the virus, the emergence of novel and increasingly infectious strains, and the anti-vaccine sentiment increase the need for safe and rapid testing alternative options. The expression profile of altered host genes during SARSCoV2 infection could be extremely advantageous to detect and prevent infection, as well as further research efforts for treatment and understanding SARSCoV2 infection.

Effects of image-sharpening algorithm on surgical field visibility during 3D heads-up surgery for vitreoretinal diseases

We conducted clinical and experimental studies to investigate the effects of image-sharpening algorithms and color adjustments, which enabled real-time processing of live surgical images with a delay of 0.004 s. The images were processed with image-sharpening intensities of 0%, 12.5%, 25%, and 50% during cataract surgery, vitrectomy, peeling of epiretinal membrane, and peeling of internal limiting membrane (ILM) with the Ngenuity 3D visualization system. In addition, the images obtained with a yellow filter during the ILM peeling were processed with color adjustments. Five vitreoretinal surgeons scored the clarity of the images on a 10-point scale. The images of a 1951 United States Air Force grating target placed in no fluid (control), saline, and 0.1% and 1% milk solution were evaluated. The results showed that the mean visibility score increased significantly from 5.0 ± 0.6 at 0% to 6.4 ± 0.6 at 12.5%, 7.3 ± 0.7 at 25%, and 7.5 ± 0.9 at 50% (P < 0.001). The visibility scores during ILM peeling improved significantly with color adjustments (P = 0.005). In the experimental study, the contrast of the grating targets blurred by the 0.1% and 1% milk solution increased significantly by the image-sharpening procedure. We conclude that the image-sharpening algorithms and color adjustments improved the intraoperative visibility of 3D heads-up surgery.

Nightmare disorder in active-duty US military personnel

Study objectivesMilitary personnel experience high rates of traumatic experiences. Despite this, few studies have examined the presence of nightmare disorder in military personnel. The primary aim of this study was to examine diagnoses of nightmare disorder across the 4 largest branches of the active-duty US military. Design & participantsData and service branch densities used to derive the expected rates of diagnoses of nightmare disorder were drawn from the Defense Medical Epidemiology Database. The branches examined included all active-duty services members in the US Army, Navy, Marine Corps, and Air Force, who served between 2016 and 2021. Single-sample chi-square goodness of fit tests were conducted to examine within-variable differences for military relevant variables. ResultsBetween 2016 and 2019, the incidence rates of nightmare disorder (per 10,000 service members) in the US Department of Defense ranged from 11.3 in 2016 to a low of 6.9 in 2018. Service members who were classified as non-white, female, over the age of 35, married, in the Army, and/or a noncommissioned officer, were diagnosed at greater rates relative to their representation in the military population (p < .001). ConclusionOur findings of higher than expected rates of nightmare disorder in older, senior service members as well as those in the Army align with the known precipitant of nightmares, and trauma. However, the reason for the finding that female and Black service members have higher than expected rates is not readily apparent.

Motives of Tobacco Use Among Young Adults in the United States Air Force.

Research has focused on cigarette use motives and have not included military personnel. The current study assessed tobacco use motives for different products, and differences within males and females and those with different racial identities given historical disparities in tobacco use. A cross-sectional survey about tobacco use was administered from October 2019 to February 2022. Four Technical Training bases in the US. Air Force Airmen who used tobacco (N = 3243). Questions were about sociodemographic characteristics, tobacco use, and the Tobacco Motives Inventory (representing affect regulation, boredom, enhancement, and social motives). Linear regressions assessed associations between overall tobacco use and motives. Stratified analyses assessed associations between tobacco use and motives among males and females, and individuals from different racial backgrounds. Logistic regressions assessed differences in motives and use of different tobacco products between "some day" and "everyday" users. Overall, boredom (B = .09, SE = .01) and affect regulation (B = .05, SE = .00) motives were associated with higher tobacco use. Males and females and individuals from different racial backgrounds endorsed different motives, but all endorsed boredom as a motive for higher tobacco use. Individuals who used cigarettes, e-cigarettes, or smokeless tobacco "some days" endorsed higher social motives than everyday users, but everyday users endorsed different motives across products. There are motives differentiating between "some day" and "everyday" users of tobacco products, which may need to be differentially targeted in intervention programs. Additionally, there are some overlapping motives (affect regulation, boredom) that may be beneficial to address with all tobacco users.