The Effects of Chemical / Biological Protective Patient Wraps on Simulated Physiological Responses of Soldiers

http://www.dtic.mil/cgi-bin/GetTRDoc?AD=ADA524741&Location=U2&doc=GetTRDoc.pdf

The Effects of Chemical/Biological Protective Patient Wraps on Simulated Physiological Responses of Soldiers


This study used a thermoregulatory model to examine the thermal burden imposed by a new U.S. Army protective patient wrap (PPW) design. The model simulations were conducted for typical desert, jungle, and temperate conditions with and without direct sun. Five PPW configurations (the current baseline, and laminated and non-laminated versions of the PPW with and without fan ventilation) were tested. The results suggested that soldiers would be likely to experience heat illness in < 6 hours when exposed to direct sun light in all simulated environments. Shade is effective in delaying or preventing soldiers from becoming heat casualties.

Altitude Preexposure Recommendations for Inducing Acclimatization

http://www.dtic.mil/cgi-bin/GetTRDoc?AD=ADA524281&Location=U2&doc=GetTRDoc.pdf

MISC. 10-19
Altitude Preexposure Recommendations
for Inducing Acclimatization

Muza, Stephen R., Beth A. Beidleman, and Charles S Fuco.
Altitude preexposure recommendations for inducing acclimatization. High Alt. Med.Biol. 11:87–92, 2010.—For many low-altitude (<1500>2400 m) altitudes without having the time to develop an adequate degree of altitude acclimatization. Prior to departing on these trips, low-altitude residents can induce some degree of altitude acclimatization by ascending to moderate (>1500 m) or high altitudes during either continuous or intermittent altitude preexposures. Generally, the degree of altitude acclimatization developed is proportional to the altitude attained and the duration of exposure. The available evidence suggests that continuous residence at 2200m or higher for 1 to 2 days or daily 1.5- to 4-h exposures to >4000m induce ventilatory acclimatization. Six days at 2200m substantially decreases acute mountain sickness (AMS) and improves work performance after rapid ascent to 4300 m. There is evidence that 5 or more days above 3000m within the last 2 months will significantly decrease AMS during a subsequent rapid ascent to 4500 m. Exercise training during the altitude preexposures may augment improvement in physical performance. The persistence of altitude acclimatization after return to low altitude appears to be proportional to the degree of acclimatization developed. The subsequent ascent to high altitude should be scheduled as soon as possible after the last altitude preexposure.

Analysis of Helmet Impact Velocity Experimental Data and Statistical Tolerance Design

http://www-nrd.nhtsa.dot.gov/Pubs/811305.PDF


Analysis of Helmet Impact Velocity Experimental Data and Statistical Tolerance Design
Report Date April 2010


Jingshu Wu, Ph.D., P.E., Charles Fleming, Claudia Covell

Helmet impact velocity experimental data is analyzed and various factors that influence the impact velocity are studied. One of the main goals of this report is to verify whether a tolerance of +/- 3 percent of mean velocity is feasible and will allow at least 95 percent of impacts to fall within the proposed impact velocity range. Statistical methods are applied to the design of impact velocity tolerances. Calibration procedures and data variances from several laboratories are also incorporated into this analysis.

Skin Temperature Modifies the Impact of Hypohydration on Aerobic Performance

http://www.dtic.mil/cgi-bin/GetTRDoc?AD=ADA523508&Location=U2&doc=GetTRDoc.pdf



Skin Temperature Modifies the Impact of Hypohydration on Aerobic
Performance
R.W. Kenefick, S.N. Cheuvront, L.J. Palombo, B.R. Ely, M.N. Sawka

Injury Reduction Effectiveness of Assigning Running Shoes Based on Plantar Shape in Marine Corps Basic Training

http://www.dtic.mil/cgi-bin/GetTRDoc?AD=ADA523392&Location=U2&doc=GetTRDoc.pdf


Injury Reduction Effectiveness of Assigning
Running Shoes Based on Plantar Shape in
Marine Corps Basic Training
Joseph J. Knapik:t ScD, Daniel W. Trone,* PhD(c), David I. Swedler et al


Background: Shoe manufacturers market motion control. stability, and cushioned shoes for plantar shapes defined as ,low, normal, and high, respectively. This assignment procedure is presumed to reduce injuries by compensating for differences in running mechanics.
Hypothesis: Assigning running shoes based on plantar shape will not reduce injury risk in Marine Corps basic training.
Study Design: Randomized controlled clinical trial; Level of evidence, 1.
Methods: After foot examinations, Marine Corps recruits in an experimental group (E: 408 men, 314 women) were provided motion control, stability, or cushioned shoes for plantar shapes indicative of low, medium, or high arches, respectively. A control group (C: 432 men, 257 women) received a stability shoe regardless of plantar shape. Injuries during the 12 weeks of training were determined from outpatient visits obtained from the Defense Medical Surveillance System. Other known injury risk factors (eg, fitness, smoking, prior physical activity) were obtained from a questionnaire, existing databases, or the training units.
Results: Cox regression indicated little difference in injury risk between the E and C groups among men (hazard ratio [E/C] = 1.01; 95% confidence interval. 0.82-1.24) or women (hazard ratio [ElC] = 0.88; 95% confidence interval, 0.70-1.10).
Conclusion: This prospective study demonstrated that assigning shoes based on the shape of the plantar foot surface had little influence on injuries even after considering other injury risk factors.

AIRCREW FATIGUE MANAGEMENT

http://www.flyawake.org/documents/Watt%20Aircrew%20Fatigue%20Amended%20for%20Release.pdf


AIRCREW FATIGUE MANAGEMENT

Christian G. Watt, Lt Col, USAF


AIR WAR COLLEGE
AIR UNIVERSITY
A Research Report Submitted to the Faculty
In Partial Fulfillment of the Graduation Requirements
10 February 2009


The purpose of this paper is to examine the problem of aircrew fatigue management and provide recommendations based on the latest advances on the subject. My research method included literature research and interviews with field professionals. Much of my research led to literature written by medical professionals and aerospace physiologists, with relatively little by aviators. This paper is intended to complement the plethora of existing information on the subject from an aircrew perspective.
Research shows that aircrew fatigue is still a significant concern. The author believes that aircrew fatigue will become even more important to manage due to the increased cognitive requirements of the net-centric warrior. Further, management will become increasingly problematic as the number of air assets available to respond to 24/7 tasking and to maintain 24/7 pressure on the enemy decreases.
Research also shows that while pharmacological options are available, they are recommended by most authors as a last resort when other methods to mitigate fatigue have been exhausted. Recommendations for "sound scheduling practices" permeate the literature. Unfortunately, there is little written on "how" to do that—no readily available model for unit-level schedulers to emulate.
New technology and scheduling concepts are available to compliment the pharmacological options. These new methods address the root cause and only cure for fatigue—sleep—verses just the symptoms. The author recommends that the 335th "scheduled sleep" model be tested with actigraphs, formalized in doctrine, and integrated with a computerized program, perhaps the new Flyawake program, to make sound scheduling truly attainable at the unit level

Feasibility of using urinary biomarkers to identify occupational musculoskeletal disorders of the lower limbs

http://www.hse.gov.uk/research/rrpdf/rr773.pdf

Feasibility of using urinary biomarkers to identify occupational musculoskeletal disorders of the lower limbs

Objectives
This project was initiated as a pilot study to investigate whether non-invasive urinary biomarkers may have value as objective measures of early, occupational musculoskeletal disorders of the lower limbs (LLMSDs).
Background
Interest has developed in biomarkers in body fluids, which are indicative of degradation of bone, cartilage and synovial tissue. These are currently being investigated in the clinical context in terms of diagnosis, prognosis and efficacy of treatment for rheumatoid and osteo-arthritis. There is also interest in the use of such biomarkers in sports medicine and now occupational medicine. The cause of occupational LLMSDs may involve complex multifactorial issues, such as psychological, and organisational factors as well as abnormal biological processes caused by over-use or abnormal loading of the knees, hips and ankles during various work activities. There is an interest in whether non-invasive biomarkers of bone, cartilage and synovium metabolism may add to other tools by objectively identifying the involvement and extent of specific abnormal biological processes in those who present with lower limb problems. Such biomarkers could be cost-effective tools in studying the efficacy of various intervention strategies in controlling the risk and incidence of occupationally related LLMSDs.

Diving helmet impact testing to EN397

http://www.hse.gov.uk/research/rrpdf/rr762.pdf

Diving helmet impact testing to EN397

Duncan Webb & Nick Bailey
Health and Safety Laboratory Harpur Hill Buxton Derbyshire SK17 9JN


Objectives To carry out impact testing on industry standard diving helmets to BS EN 397 and BS EN 812, which is a normative reference, included in BS EN 15333.
Main Findings
The helmet’s shell provides protection within the requirements of BS EN 397 and BS EN 812 and provides Class A protection in accordance with BS EN 15333.



Diving helmets used today by the majority of commercial divers in the UK are developed from the Standard Diving Dress of over 40 years ago. These brass helmets provided a large space around the head and fitted onto a yoke on the diver’s shoulders. Any impact would have been taken on the shoulders rather than onto the head and neck. Commercial divers regularly work on sites where lifting operations are being conducted and these pose a head impact hazard both on the surface and underwater. However, most, if not all, diving helmets have not been tested to determine the level of head protection they provide. The recent introduction of the standard BS EN 15333 for Surface Supplied Diving Apparatus requires that helmets made to this standard should be classified as offering head protection to one of three classes:

Class A: Head protection to BS EN397: the current European Standard for the Specification for
Industrial Safety Helmets.

Class B: Bump protection to BS EN812: the current Bump Hat Standard.

Class C: No protection.


The aim of this research project was to investigate the level of protection current commercial diving helmets provide. The number of helmets available for this was limited to three from the same manufacturer. However, the results are considered to be broadly representative of helmets used in the diving industry today as one manufacturer makes most of the helmets used in the industry. Testing was carried out using the calibrated Rosand drop rig of the HSL Mechanical Engineering Section and filmed using high-speed video cameras of HSL Visual Presentation Services Section.
This report and the work it describes were funded by the Health and Safety Executive (HSE). Its contents, including any opinions and/or conclusions expressed, are those of the authors alone and do not necessarily reflect HSE policy.

A review of the management of crowd safety at outdoor street / special events

http://www.hse.gov.uk/research/rrpdf/rr790.pdf

A review of the management of crowd safety at outdoor street/special events
Professor Chris Kemp Teresa Moore
Buckinghamshire New University High Wycombe Campus Queen Alexandra Road High Wycombe Buckinghamshire HP11 2JZ

Objectives
The focus of the study was the safety of the crowd and the identification of factors that enabled this, including the planning that goes into effective crowd management, the organisational arrangements that need to be in place and the operation of the plans to ensure that, on the day, the crowd experiences a safe event.
The researchers studied four distinctive, well known events that took place on streets and/or other public open spaces: Flaming ‘Tar Barrels’ at Ottery St Mary, ‘Hogmanay’ in Edinburgh, ‘Cheese Rolling’ at Cooper’s Hill in Gloucestershire and Notting Hill ‘Carnival’ in London. These four very different events provided a wealth of information and gave a useful indication of significant factors in crowd safety. Good practice identified at the events formed the basis of a generic checklist to assist in supporting the safe management of special outdoor events.


HSE, in collaboration with the event industry and other key stakeholders, is about to begin the revision of the existing Events Safety Guide, HSG 195. This report will contribute to the body of information to be considered during revision of those parts of the guide relating to crowd management. The findings of the report will also be considered during revision of related HSE guidance and will assist in identifying the need for new guidance in this area.
This report contains the results of a study of the management of crowd safety at four outdoor events in England and Scotland. These were traditional annual events that took place at different times of year and in different public open space settings.
Each event was visited by the research team, where observations were made, in-depth interviews were conducted with key players connected with crowd safety for the events and questionnaires were carried out with members of the public attending the events. The results were written up as case studies.
The examination of the events focussed on the identification of factors that contributed to crowd safety. These aspects included how the events were organised and roles and responsibilities of those involved. Specific hazards, such as fire, electricity and slips and trips were examined and how they were managed was scrutinised. Other factors were also researched that could be included for specific types of events, to enhance crowd safety. The findings from the case studies were amalgamated to produce a basic checklist containing aspects that seemed to make a significant contribution to crowd safety at a range of events.
This project was carried out by Buckinghamshire New University on behalf of the Royal Borough of Kensington and Chelsea. The report and the work it describes were funded by the Health and Safety Executive. Its contents, including any opinions and/or conclusions expressed, are those of the authors alone and do not necessarily reflect HSE policy. RR790
www.hse.gov.uk

Aviation Safety

http://www.gao.gov/new.items/d10678.pdf

July 2010
AVIATION SAFETY
Improved Planning Could Help FAA Address Challenges Related to Winter Weather Operations
GAO-10-678


Ice formation on aircraft can disrupt the smooth flow of air over the wings and prevent the aircraft from taking off or decrease the pilot’s ability to maintain control of the aircraft. Takeoff and landing operations can also be risky in winter weather. Despite persistent efforts by the Federal Aviation Administration (FAA) and others to mitigate icing risks, icing remains a serious concern. GAO reviewed (1) the extent to which commercial airplanes have experienced accidents and incidents related to icing, (2) FAA’s inspection and enforcement activities related to icing, (3) the efforts of FAA and others to improve safety in winter weather, and (4) the challenges that continue to affect aviation safety in winter weather. GAO analyzed data obtained from FAA, the National Transportation Safety Board (NTSB), the National Aeronautics and Space Administration (NASA), and others. Further, GAO obtained information from FAA and NTSB officials and representatives of key aviation industry stakeholders.
What GAO Recommends
To help facilitate FAA’s efforts to address challenges to improving safety in winter weather conditions, GAO recommends that FAA develop a plan focused on winter operations holistically that includes detailed goals and milestones. In response, the Department of Transportation agreed to consider GAO’s recommendation and provided technical comments, which were incorporated as appropriate

NEXT GENERATION AIR TRANSPORTATION SYSTEM

http://www.gao.gov/new.items/d10824.pdf


NEXT GENERATION AIR TRANSPORTATION SYSTEM


To address challenges to the aviation industry’s economic health and safety, the Federal Aviation Administration (FAA) is collaborating with the National Aeronautics and Space Administration (NASA) and other federal partners to plan and implement the Next Generation Air Transportation System (NextGen). NextGen will transform the current radar-based air traffic control system into a satellite-based system. Pilot and air traffic controller roles and responsibilities are expected to become more automated, thereby requiring an understanding of human factors, which studies how humans’ abilities, characteristics, and limitations interact with the design of the equipment they use, environments in which they function, and jobs they perform. FAA and NASA are tasked with incorporating human factors issues into NextGen.
As requested, this report discusses the extent to which FAA’s and NASA’s human factors research (1) is coordinated and (2) supports NextGen. To address these issues, GAO reviewed coordination mechanisms and planning documents and synthesized the views of nine aviation human factors experts.
What GAO Recommends

Research on the Transmission of Disease in Airports and on Aircraft

http://onlinepubs.trb.org/onlinepubs/conf/CP47.pdf


Transportation Research Board Conference Proceedings 47


Research on the Transmission of Disease in Airports and on Aircraft
Summary of a Symposium

Injury and Fitness Outcomes During Implementation of Physical Readiness Training

http://www.dtic.mil/cgi-bin/GetTRDoc?AD=ADA523652&Location=U2&doc=GetTRDoc.pdf

Injury and Fitness Outcomes During Implementation of Physical
Readiness Training


J. J. Knapik
K. G. Hauret
S. Arnold
M. Canham-Chervak
A. J. Mansfield
E. l. Hoedebecke
D. McMillian
US Army Center for Health Promotion and Preventive
Medicine,Aberdeen Proving Ground,MD

This study examined injury and physical fitness outcomes in Basic Combat Training (BCT) during implementation of Physical Readiness Training (PRT). PRT is the U.S. Army’s emerging physical fitness training program. An experimental group (EG n = 1284), which implemented the PRT program, was compared to a control group (CG, n = 1296), which used a traditional BCT physical training program during the 9-week BCT cycle. Injury cases were obtained from recruit medical records and physical fitness was measured using the U.S. Army Physical Fitness Test (APFTc, onsisting of push-ups, sit -ups and a two-mile run). Injury rates were examined using Cox regression after controlled for initial group differences in demographics, fitness and other variables

Monitoring Cosmic Radiation Risk: Comparisons between Observations and Predictive Codes for Naval Aviation

http://www.dtic.mil/cgi-bin/GetTRDoc?AD=ADA524084&Location=U2&doc=GetTRDoc.pdf
Monitoring Cosmic Radiation Risk: Comparisons between Observations
and Predictive Codes for Naval Aviation

U.S.N.A. --- Trident Scholar project report; no. 377 (2009)

Midshipman 1/c Jacob P. Dobisesky


Utilizing a unique, Far West Technology Tissue Equivalent Proportional Counter
(TEPC)-based system called the HAWK, the atmospheric radiation exposures of commercial air
travelers and naval personnel were compared to the quantity predicted by commercially available radiation codes. The HAWK simulates a two micron-diameter somatic cell, measuring the lineal energy, absorbed dose, and dose equivalent based on the International Commission on
Radiological Protection (ICRP)-60 recommendations. Prior to the flights, the HAWK detector
response was modeled with MCNP5 and GEANT4. Later, the data were analyzed both to
produce a dose rate as well as a total dose for the flight’s duration. Over 40 hours of flight data was obtained on commercial aircraft in addition to several experiments on military and private aircraft. Flights were conducted across the continental United States, from Massachusetts to California. The military flights were conducted on an EA-6B Prowler from the Navy’s VX-23 Squadron in Patuxent River, Maryland. Commercial aircraft altitudes reached a ceiling of approximately 38,000 feet while typical military operations were around 25,000 feet. During the flight, data including dose and dose equivalent rates were collected along with corresponding GPS data such as geodetic latitude, longitude, and altitude.
The GPS data were then utilized as inputs for several commercially available radiation codes for
assessing atmospheric radiation risk. These codes included CARI-6, developed by the US
Federal Aviation Administration (FAA), EPCARD developed by Germany’s GSF – National
Research Center for Environment and Health, and EXPACS, developed by Japan’s Atomic
Energy Agency. Analysis of the code outputs yielded several conclusions. First, EXPACS
predicts radiation doses very close to CARI-6 and could be developed into a more user-friendly
and adaptable code for the Navy given its EXCEL-based platform and multiple input variables.
Second, radiation dose predictions on the EA-6B Prowler and commercial aircraft at altitudes
below 15,000 feet begin to break down and the codes no longer accurately predict radiation. In
addition, pilots, aircrew, and frequent fliers may exceed the one milli-Sievert per year limit for
the general public depending on their destinations and duration at high altitudes. Finally, these
commercial codes provide a conservative, accurate method to predict and estimate the radiation
risk of naval pilots and aircrew.

Visual scan adaptation during repeated visual search

http://www.dtic.mil/cgi-bin/GetTRDoc?AD=ADA523996&Location=U2&doc=GetTRDoc.pdf
Visual scan adaptation during repeated visual search

Christopher W. Myers
Wayne D. Gray


There is no consensus as to how to characterize eye fixations during visual search. On the one hand, J. M. Wolfe, G. A. Alvarez, and T. S. Horowitz (2000) have described them as a haphazard sequence of fixations. On the other hand is research that shows systematic repetition of visual patterns when freely viewing a scene (T. Foulsham & G. Underwood, 2008; D. Noton & L. W. Stark, 1971a). Two experiments are reported that demonstrate the repetition and adaptation of
visual scans during visual search, supporting an adaptive scanning hypothesis. When trials were repeated in a simple search task, visual scan similarity and search efficiency increased. These increments in similarity and efficiency demonstrate the systematic and adaptive nature of visual scans to the characteristics of the visual environment during search.

U.S. Army Annual Injury Epidemiology Report 2008

http://www.dtic.mil/cgi-bin/GetTRDoc?AD=ADA523368&Location=U2&doc=GetTRDoc.pdf
U.S. Army Annual Injury Epidemiology Report 2008

Esther Dada-Laseinde, Michelle Canham-Chervak, Bruce H. Jones


Injuries are a leading cause of death, disability, and medical encounters among Active Duty U.S. Army personnel. Medical surveillance data provide a useful tool for defining the magnitude of the Army injury problem, injury rates and trends, and causes of injuries. This report summarizes injuries among Active Duty, nondeployed U.S. Army Soldiers in 2008 using available medical surveillance data. In 2008, over 900,000 medical encounters were due to injury. Among Army Soldiers, the 2008 injury visit rate was 2,341 injury visits/1,000 Soldiers, or 2.3 visits/Soldier. Injury visit rates increased 28.6 percent from 2005 to 2008, while trainee rates from 2003 to 2008 declined by 37.8 percent. Injuries accounted for 16.9 percent of all hospitalizations and 28.1 percent of all outpatient visits. Leading causes of hospitalizations were falls or near-falls (18.4 percent), land transport accidents (18.4 percent), and athletics/sports (9.3 percent). Leading types of acute injuries were sprains/strains, contusions/superficial wounds, and fractures. Leading chronic injury conditions were inflammation and pain associated with overuse and joint derangements. These results provide important indicators of potential injury prevention targets and research priorities. Summaries of Injury Prevention Program analyses, field investigations, and evaluations completed in 2008 are also presented

Efficacy of Nutritional Ergogenic Aids in Hot Environments

http://www.dtic.mil/cgi-bin/GetTRDoc?AD=ADA523505&Location=U2&doc=GetTRDoc.pdf

Efficacy of Nutritional Ergogenic Aids in Hot Environments


B.R. Ely, S.N. Cheuvront


Many athletes seeking a competitive edge rely on nutritional ergogenic aids to improve performance. Carbohydrate (CHO) and caffeine (CAF) supplementation appear efficacious at enhancing endurancc exercise performance when studied under ideal circumstances, but the unique challcnges imposed by environmental strcssors such as heat may minimize or negate these effects. Similar to findings in temperate or cool environments, CHO intake during endurance exercise in hot environments produces a consistent performance benefit. But in contrast to the benefits observed in moderate environments. CAF affords no apparent
performance advantage in the heat. These findings raise interesting questions about nutritional ergogenic mechanisms of action and other direction for future research.

THE EFFECTS OF EXERCISE ON BRAIN INFLAMMATION

http://www.dtic.mil/cgi-bin/GetTRDoc?AD=ADA524163&Location=U2&doc=GetTRDoc.pdf
THE EFFECTS OF EXERCISE ON BRAIN INFLAMMATION

Megan Durbin

AFRL-RH-WP-TN-2010-0001


ABSTRACT
Exercise is evolving as a therapeutic measure for both general health and brain health. Exercise reduces the risk of many systemic diseases and has been shown to improve cognition and memory. The mechanisms through which exercise achieves these positive neurologic results is unclear, but may involve the inflammatory cascade in the brain. This paper reviews the effects of exercise on the inflammatory cascade within the brain.

Motivational Interventions to Reduce Alcohol Use in a Military Population

http://www.dtic.mil/cgi-bin/GetTRDoc?AD=ADA524152&Location=U2&doc=GetTRDoc.pdf

U.S. Army Medical Research
and Materiel Command
Fort Detrick, MD 21702-5012 11. SPONSOR

Motivational Interventions to Reduce Alcohol Use in a Military
Population

Janice M. Brown

The overriding objective of this research was to reduce hazardous drinking in a military sample by implementing two motivational interventions and comparing them to a treatment-as-usual (substance abuse awareness seminar) condition. Personnel referred to the Air Force Alcohol and Drug Abuse Prevention and Treatment (ADAPT) program as the result of an alcohol incident or who were self-referred were consented and then randomly assigned to one of three interventions: (1) group motivational interviewing (GMI), (2) individual motivational interviewing (IMI), or (3) a substance abuse awareness seminar (SAAS) group. Participants provided data regarding drinking and related problems at baseline and at 3, 6, and 12 months
following the baseline. Analyses focused on (1) determining the effectiveness of the interventions in reducing alcohol use and alcohol-related problems, (2) testing factors that may mediate or moderate responses to the interventions, and (3) determining the cost of treatment. Results indicated that the IMI was the most effective in reducing substance use. In addition, the average
implementation costs were highest for SAAS ($148 per client), followed by IMI ($84) and GMI ($70). Finally, increased heavy episodic drinking at baseline predicted a more negative outcome at 3-month follow-up.

A Forehead-Mounted Measure of O2 Saturation: The Potential for in Cockpit Hypoxia Early Detection and Warning

http://www.dtic.mil/cgi-bin/GetTRDoc?AD=ADA523516&Location=U2&doc=GetTRDoc.pdf

A Forehead-Mounted Measure of O2 Saturation: The Potential for in Cockpit
Hypoxia Early Detection and Warning

Rita G. Simmons, Joseph F. Chandler & Dain S. Horning



NAMRL 10-26

Sponsoring agency USAARL

Symptoms of hypoxia have been documented among rotary-wing pilots and aircrew. An automated hypoxia warning system would be the optimal warning system, but currently no military aviation platform is outfitted with a physiological monitoring system to alert pilots and aircrew of impending hypoxic episodes. The objectives of this experiment were to compare the sensitivity of, and agreement between, a forehead-mounted pulse oximeter (Forehead) and finger-mounted pulse oximeter (Finger) for application in an early warning detection system. Military personnel donned an aviation flight mask connected to the Reduced Oxygen Breathing Device (ROBD), and were instrumented with the Forehead and Finger oximeters. Following instrumentation, subjects breathed ambient air through the ROBD, followed with one of two
counterbalanced ascent profiles used to model exposure to altitude, while data were collected from both sensors.
Results indicate an exceptionally strong agreement between the Forehead and Finger sensors. The sensitivity analyses revealed that the Forehead sensor was significantly faster when responding to rapid changes in SpO2 than the Finger. While the data may seem to suggest that the Forehead sensor is accurate and sensitive to altitude induced changes in SpO2, major
drawbacks exist for the technology utilized in the current study. Reflectance technology remains promising, but significant improvements aimed at diminishing noise, curbing motion artifact, and improving reliability are required to reduce errant measurements before it can be considered for aviation applications.

The Impact of Moderate-Altitude Staging on Pulmonary Arterial Hemodynamics after Ascent to High Altitude

http://www.dtic.mil/cgi-bin/GetTRDoc?AD=ADA524408&Location=U2&doc=GetTRDoc.pdf

The Impact of Moderate-Altitude Staging on Pulmonary Arterial
Hemodynamics After Ascent to High Altitude


A.L. Baggish, C.S. Fulco, S.R. MUla, P.B. Rock, B.A. Beidleman, A.
Cymennan, K. Yared, P. Fagenholz. D. Systrom, M.1. Wood, A.E. Weyman.
M.H. Picard. N.S. Harris


Staged ascent (SA), temporary residence at moderate altitude en route to high altitude, reduces
the incidence and severity of noncardiopulmonary altitude illness such as acute mountain sickness. To date, the impact of SA on pulmonary arterial pressure (PAP) is unknown. We tested the hypothesis that SA would attenuate the PAP increase that occurs during rapid, direct ascent (DA). Transthoracic echocardiography was used to estimate mean PAP in 10 healthy males at sea level (SL, PB&760 torr), after DA to simulated high altitude (hypobaric chamber, PB&460 torr), and at 2 times points (90 min and 4 days) during exposure to terrestrial high altitude (PB&460 torr) after SA (7 days, moderate altitude, PB&548 torr). Alveolar oxygen pressure (Pao2) and arterial oxygenation saturation (Sao2) were measured at each time point. Compared to mean PAP at SL (mean SD, 14 3mmHg), mean PAP increased after DA to 37 8mmHg (D¼24 10mmHg, p<0.001) and was negatively correlated with both Pao2 (r2¼0.57, p¼0.011) and Sao2 (r2¼0.64, p¼0.005). In comparison, estimated mean PAP after SA increased to only 25 4mmHg (D¼11 6mmHg, p<0.001), remained unchanged after 4 days
of high altitude residence (24 5mmHg, p¼not significant, or NS), and did not correlate with either parameter of oxygenation. SA significantly attenuated the PAP increase associated with continuous direct ascent to high altitude and appeared to uncouple PAP from both alveolar hypoxia and arterial hypoxemia.

Altitude Preexposure Recommendations for Inducing Acclimatization

http://www.dtic.mil/cgi-bin/GetTRDoc?AD=ADA524281&Location=U2&doc=GetTRDoc.pdf

Altitude Preexposure Recommendations for Inducing Acclimatization

S.R. Muza, B.A. Beidleman, C.S. Fulco


For many low-altitude (<1500>2400 m) altitudes without having the time to develop an adequate degree of altitude acclimatization. Prior to departing on these trips, low-altitude residents can induce
some degree of altitude acclimatization by ascending to moderate (>1500 m) or high altitudes during either continuous or intermittent altitude preexposures. Generally, the degree of altitude acclimatization developed is proportional to the altitude attained and the duration of exposure. The available evidence suggests that continuous residence at 2200m or higher for 1 to 2 days or daily 1.5- to 4-h exposures to >4000m induce ventilatory acclimatization. Six days at 2200m substantially decreases acute mountain sickness (AMS) and improves work performance after rapid ascent to 4300 m. There is evidence that 5 or more days above 3000m within the last 2
months will significantly decrease AMS during a subsequent rapid ascent to 4500 m. Exercise training during the altitude preexposures may augment improvement in physical performance. The persistence of altitude acclimatization after return to low altitude appears to be proportional to the degree of acclimatization developed. The subsequent ascent to high altitude should be scheduled as soon as possible after the last altitude preexposure.
Key Words: altitude acclimatization; acute mountain sickness; high altitude
Introduction
Lowland (<1500 m) residents rapidly ascending to
high (>2400 m) and especially very high (>3500 m) or
extreme (>5500 m) altitudes are at risk of developing high
altitude illness (Gallagher and Hackett, 2004) and experiencing
substantial impairment of their physical and cognitive
work performance (Fulco et al., 1998). Altitude acclimatization
is a series of physiological adjustments that compensates
for the reduction in ambient oxygen. Altitude acclimatization
is the best strategy for the prevention of acute mountain sickness
(AMS) (Forgey, 2006) and allows people to achieve the
maximum physical and cognitive work performancs possible
for the altitude to which they are acclimatized (Fulco et al.,
2000; Banderet et al., 2002). A gradual or staged ascent with a
first-night sleeping altitude of no more than 2400m and daily
altitude gain limited to 300 to 600m is the recommended
strategy for induction of altitude acclimatization (Forgey, 2006).
However, for many climbers and trekkers on a tight schedule,
there may be insufficient time to develop an adequate degree of
U.S. Army Research Institute of Environmental Medicine, Thermal and Mountain Medicine Division, Natick, Massachusetts, USA.
HIGH ALTITUDE MEDICINE & BIOLOGY
Volume 11, Number 2, 2010
ª Mary Ann Liebert, Inc.
DOI: 10.1089/ham.2010.1006
87

Risk factors associated with self-reported training-related injury before arrival at the US Army Ordnance School

http://www.dtic.mil/cgi-bin/GetTRDoc?AD=ADA523887&Location=U2&doc=GetTRDoc.pdf
Risk factors associated with self-reported training-related injury before arrival at the US army ordnance school

Objective: This study examined risk factors for self-reported injury incurred before arrival at
Ordnance School for advanced individual training (AIT).
Study design: During AIT in-processing, soldiers (n ¼ 27,289 men and 3856 women)
completed a questionnaire that collected demographic and lifestyle information, and
asked if the soldier currently had an injury that would affect their AIT performance.
Methods: Potential risk factors for self-reported injury were explored using logistic
regression.
Results: For men, self-reported injury was associated with older age [odds ratio (OR)
30years/17e19 years ¼ 1.9], race (OR Black/Caucasian ¼ 1.2), basic combat training (BCT)
site (OR Fort Benning/Fort Jackson ¼ 1.7; OR Fort Leonard Wood/Fort Jackson ¼ 1.6, OR Fort Knox/Fort Jackson ¼ 1.3), smoking on 20 or more days in the 30 days prior to BCT (OR
smoker/non-smoker ¼ 1.2) and current illness (OR ill/not ill ¼ 6.2). For women, increased
self-reported injury was associated with older age (OR 30years/17e19 years ¼ 2.0), BCT
site (OR Fort Leonard Wood/Fort Jackson ¼ 1.5) and current illness (OR ill/not ill ¼ 5.8).
Conclusions: Certain demographic characteristics and lifestyle behaviours may be identified
as injury risk factors on arrival at Ordnance AIT.

Does Current Army Physical Fitness Training Doctrine Adequately Prepare Soldiers for War?

http://www.dtic.mil/cgi-bin/GetTRDoc?AD=ADA524239&Location=U2&doc=GetTRDoc.pdf

Does Current Army Physical Fitness Training Doctrine Adequately Prepare Soldiers for War?

thesis presented to the Faculty of the U.S. Army
Command and General Staff College in partial
fulfillment of the requirements for the
degree
MASTER OF MILITARY ART AND SCIENCE
General Studies
by

Major C. Thomas Lowman

The U.S. Army has continually adjusted its fitness regimen to best prepare Soldiers for combat. This paper attempts to answer a critical question: Does the current U.S. Army physical fitness training doctrine adequately prepare soldiers for war? Since 1941, FM 21-20, Physical Training, has been the sole source for fitness training. Outdated, it was replaced in March of 2010 by Army Physical Readiness Training (PRT). FM 21-20 does, however, contain building blocks of successful fitness programs. These will be used to compare the new PRT program with 2 alternative programs. The 3 programs will also be compared on the basis of muscle recruitment to execute 10 movements identified as critical by Training and Doctrine Command (TRADOC). Through this combined analysis, this paper will demonstrate which program best meets the evaluation criteria and trains the requisite muscles to execute the 10 movements. In conclusion, the reader will know whether the current U.S. physical fitness training doctrine best prepares soldiers for war.

Cognitive Effects of Hypoxia Exposure Persist Following Restoration of Blood Oxygen Saturation

Cognitive Effects of Hypoxia Exposure Persist Following Restoration of
Blood Oxygen Saturation

http://www.dtic.mil/cgi-bin/GetTRDoc?AD=ADA523501&Location=U2&doc=GetTRDoc.pdf

Jeffrey Phillips


Hypoxia is a major physiological threat to Navy pilots and aircrew. The insidious nature of onset and the significant variability in individual symptoms make recognition and corrective action difficult. The time required for individuals to return to normal cognitive function following a moderate exposure is unclear. Results of two recent experiments suggest that restoration of executive function and multitasking performance lags significantly behind the restoration of blood oxygen saturation to normal levels. The observed slow recovery of these higher-order cognitive processes following a hypoxia exposure may pose a risk to the aviation community. Because full recovery was not observed in either experiment, the actual time required for cognitive ability to return to pre-exposure levels remains unknown. Without further
investigation, specific guidelines can not be given regarding the amount of time required for pilots and flight crew to fully regain cognitive ability following a moderate hypoxic exposure.

Army Health Promotion, Risk Reduction Suicide Prevention Report 2010

http://usarmy.vo.llnwd.net/e1/HPRRSP/HP-RR-SPReport2010_v00.pdf

Army Heatlh Promotion, Risk Reduction Suicide Prevention Report 2010

This report reflects a year’s worth of work at the direction of the Army’s Senior Leadership to provide a "directed telescope" on the alarming rate of suicides in the Army. It represents both initial findings of the Army Suicide Prevention Task Force and informs the future of Suicide Prevention within the Army. Suicide is a devastating event. What was once considered a private affair or family matter now threatens our Army’s readiness. Equally alarming to the rising rate of suicide in the Army is an increasing number of Soldiers who engage in high risk behavior. Equivocal deaths,1 deaths by drug toxicity, accidental deaths, attempted suicides, and drug overdoses are reducing the ranks and negatively effecting the Army’s ability to engage in contingency operations in Iraq and Afghanistan. These deaths further strain efforts to sustain institutional operations. No one could have foreseen the impact of nine years of war on our leaders and Soldiers. As a result of the protracted and intense operational tempo, the Army has lost its former situational awareness and understanding of good order and discipline within its ranks.
This report’s comprehensive review exposes gaps in how we see, identify, engage and mitigate high risk Soldiers. These gaps exist in our systems and processes due in part to Army Transformation and nearly a decade of war. Policy, process, structure and programs have not kept pace with the expanding needs of our strained Army. While leadership schools emphasize battlefield skills, leaders are not as adept at negotiating the art of leadership in a garrison environment as they were prior to OEF and OIF. Failure to execute policies designed to ensure good order and discipline in garrison sends a message of permissive complacency. Failure to refer a Soldier with a drug positive urinalysis to the Army Substance Abuse Program (ASAP); initiate administrative separation for positive urinalysis; administratively separate Soldiers committing multiple instances of misconduct; and report unlawful activity all contribute to a breakdown in good order and discipline. This, in turn, has led to an increasing population of high risk Soldiers whose transmittable behavior can erode Army values and unit readiness.
Additionally, our units, Soldiers and Families are feeling the strain and stress of nine years of conflict. The cumulative effect of transitions borne of institutional requirements (professional military education, PCS moves, promotions) coupled with family expectations/obligations (marriage, child birth, aging parents) and compounded by deployments is, on one hand, building a resilient force while on the other, pushing some units, Soldiers and Families to the brink.

Individual Susceptibility to Hypobaric Environments: an update

http://ntrs.nasa.gov/archive/nasa/casi.ntrs.nasa.gov/20100024382_2010026581.pdf

Individual Susceptibility to Hypobaric Environments: An Update

Jennifer Law, M.D.

Sharmi Watkins, M.D., M.P.H.

Astronauts are at risk for developing decompression sickness (DCS) while exposed to the hypobaric environment of the extravehicular suit in space, in terrestrial hypobaric chambers, and during ascent from neutral buoyancy training dives. There is increasing recognition that DCS risk is different between diving and altitude exposures, with many individual parameters and environmental factors implicated as risk factors for development of DCS in divers but are not recognized as risk factors in altitude exposures.
Much of the literature to date has focused on patent foramen ovale (PFO), which has long been
considered a major risk factor for DCS in diving exposures, but its link to serious DCS in altitude
exposures remains unclear. Knowledge of those risk factors specific to hypobaric DCS may help identify susceptible individuals and aid in astronaut selection, crew assignment, and mission planning. This paper reviews the current literature pertaining to these risk factors, including PFO, anthropometric parameters, gender, menstrual cycle, lifetime diving experience, physical fitness, biochemical levels, complement activation, cigarette smoking, fluid balance, and ambient temperature. Further research to evaluate pertinent risk factors for DCS in altitude exposures is recommended.