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

Little research has explored the perceptions of military medical providers in the deployed environment and how their perceptions may change over time across an extended military conflict. To our knowledge, no studies have examined military medical providers’ opinions on readiness for their roles in the post-9/11 contingency operations. What has been published indicates that, during the height of Operation Iraqi Freedom, military medical providers often deployed with little notice and minimal formal training. The present report examines data obtained from multiple cohorts of military medical providers (N = 321) deployed to Iraq between 2005 and 2009. Despite varying degrees of support from the U.S. public, our findings indicate that U.S. Air Force military medical providers’ support for the people of Iraq, their belief in the mission, and their ability to influence change did not vary with time. [ABSTRACT FROM AUTHOR]

The interest in flying wings dates as far as the early years of the aviation age. Early investigations of the feasibility of the concept demonstrated increased aerodynamic efficiency and reduced fuel consumption. However, structural, engine integration, and stability and control issues prevented further development. In the 1990s, a new concept, the blended wing body (BWB), was created to alleviate some of the concerns of flying wings while maintaining increased efficiency and adding further benefits, such as reduced pollutant and noise emissions. Despite the promise, technical hurdles once again proved to be a deal breaker and, as of 2024, the only successful flying wing is the B-2 Spirit, an extremely complex and expensive aircraft. Nowadays, with the world quickly transitioning towards cleaner energy, the interest in the BWB has been renewed. The latest technological advancements in the aerospace industry should make its development more plausible; however, passenger comfort issues remain. Surprisingly, the BWB development may come from an unexpected application, as a tanker aircraft. As the U.S. Air Force is seeking a replacement to hundreds of aging tankers, a startup company was recently funded to develop the concept and build a prototype. In this study, we explore the history of blended designs from its early days, highlighting its opportunities and challenges—and why the design is an intriguing fit for application as a tanker aircraft. [ABSTRACT FROM AUTHOR]

U.S. service members are at an enhanced risk for developing mental disorders. To address these challenges, while promoting operational readiness and improving mental health outcomes, the Department of Defense directed each service component to develop and implement universal resilience enhancing programs. This paper provides a review of theoretical approaches conceptualizing resilience to trauma, including the theoretical foundations of programs currently in place. The resilience programs of U.S. Army, U.S. Air Force, U.S. Navy and U.S. Marine Corps are described, and available program effectiveness data are reviewed. Gaps between theory and practice are identified and an alternative method of assessing psychological readiness in Army units that is informed by resilience theory is offered as one way to address these gaps and scientific concerns. By comprehensively assessing the stressors affecting Soldiers at regular intervals, military leaders may be able to better identify and mitigate stressors in a systematic way that bolsters individual and unit psychological fitness. An enhanced psychological readiness metric stands to strengthen the validity of current resilience programs, bring clarity to the mechanisms of resilience, and provide a novel way for leaders to promote readiness in their units. Application of this metric within the infrastructure of existing reporting systems stands to improve mental health outcomes for Service Members, enhance the psychological readiness of the force, and reduce healthcare costs over time. [ABSTRACT FROM AUTHOR]

Introduction Military physicians must be prepared to lead health care teams across complex landscapes of war during future small- and large-scale combat operations. This preparation optimally begins in medical school so that early career physicians are fully ready for their first deployment. Past qualitative research has suggested that military physicians who attended civilian medical school are not as well prepared for the operational environment as physicians who attended the Uniformed Services University (USU), our nation's military medical school. However, there is a lack of larger-scale quantitative research comparing the readiness differences between the two medical school pathways. The purpose of this study, therefore, was to quantify any differences in first deployment preparation between students attending USU and civilian medical schools through the Health Professions Scholarship Program (HPSP). Materials and Methods We compared USU and HPSP graduates' first deployment experiences by distributing a 14-item Likert survey to active duty military physicians in the U.S. Army, U.S. Navy, and U.S. Air Force who graduated within the past 10 years from medical school (USU or civilian). Results The USU graduates rated themselves significantly higher than the HPSP graduates on their readiness for deployment (3.83 vs. 3.24; P  < .001); ability to navigate the operational environment (3.59 vs. 2.99; P  < .001); confidence in communicating with their commanding officer (3.59 vs. 2.99; P  = .002); navigating the combined role as physician and officer (3.33 vs. 2.84; P  = .004); leading a health care team (3.94 vs. 3.43; P  = .001); preparation by a medical school (3.78 vs. 2.52; P  < .001); and overall readiness compared to peers (4.20 vs. 3.49; P  < .001). There was no significant difference between the two pathways regarding their stress level at the beginning of deployment (2.74 vs. 2.68; P  = .683); clinical preparation (3.94 vs. 3.76; P  = .202); and success of first deployment (3.87 vs. 3.91; P  = .792). The largest effect size of the difference between the two pathways was noted on the question "How well did medical school prepare you for your first deployment" (Cohen's d  = 1.02). Conclusions While both groups believed that they were prepared for their first deployment, USU graduates consistently reported being more prepared by medical school for their first deployment than HPSP graduates. To close this readiness gap, supplemental military unique curricula may help to optimize HPSP students' readiness. [ABSTRACT FROM AUTHOR]

Introduction The U.S. Air Force's Intercontinental Ballistic Missile (ICBM) force stands ready to launch weapons 365 days per year. Since its inception, missileers vigilantly operate launch consoles on a 3-day cycle: minimum 24-hour alert-shift/24-hour travel-admin/24-hour off, leading to concerns that health, morale, and alertness are chronically impacted. In 2020, a Missileer Occupational Health Assessment (OHA) revealed 76% of respondents struggle with being rested for duty and 29% of respondents never feel adequately rested for duty. Later that year, 20th Air Force initiated long-duration operations to safeguard from the SARS CoV-2 (COVID-19) Pandemic, resulting in increased operations tempo, and exacerbating crew fatigue. 341st Operations Group and 341st Medical Group at Malmstrom Air Force Base enacted interventions to mitigate crew fatigue and support continued readiness during pandemic operations. They recorded, analyzed, and compiled findings in this report, including recommendations for long-term ICBM operations at Missile Wings. Materials and Methods All participants were Nuclear and Missile Operations Officers, or missileers, were continuously evaluated with qualitative and quantitative measures to ensure safety of the force during a period of unprecedented change. Interventions implemented and evaluated during the 9-month period included: environmental modifications, scheduling changes, and crew education on fatigue management, nutrition, anticipatory sleep preparation, and fitness. Most notably, the 341st Operations Group examined various 3-person and 4-person shift-length and alert duration schedules. Psychomotor vigilance testing results validated safety of operators and delta between pre- and post-shift measurements. Crew force readiness trends were analyzed for force-health awareness. Pre- and post-OHA results were compared for subjective changes. Fatigue and health-related outcomes were collected from a safety monitoring effort during standard and COVID-19 operations at 341st Missile Wing. Results Findings from qualitative and quantitative data indicate the optimal schedule is a 3-week cycle: 7-day alert/7-day recovery/7-day training-administrative utilizing 4-member or 3-member crews for low tempo operations. Crews experimented with shift-lengths of 24hrs-on/24hrs-off, 16hrs-on/8hrs-off, and 12hrs-on/12hrs-off. Maximum safe alert duration is 7 days due to task fatigue onset between 8 and 10 days. Short and long duration Duties Not to Include Flight (DNIF) (also known as Duties Not to Include Alert (DNIA) among missileers) rates decreased from the first to last month of the period by 74.6% and 79.2%, respectively. The number of alerts missed per month decreased 86% from baseline. The 2021 OHA found a 7% decline in members seeking separation, and absence of sleep, fatigue, and physical or mental health as missileer concerns. Conclusions This analysis has identified a sustainable alert rotation of 7/7/7 with emphasis on protected recovery and training time and has been continued after concluding pandemic operations, creating consistent schedule stability where there once was none. If executed properly, this alert rotation, regardless of shift-length selected, has potential to improve trust between crews and leadership, provides adequate recovery time between alerts to maintain health, and improves wellness, family stability, morale, unit cohesion, and crew force retention. Notably, all Air Force Global Strike Missile Operations Groups adjusted scheduling practices to align with these findings. [ABSTRACT FROM AUTHOR]

On August 23, 1958, three hundred Chinese Communist field guns fired over 40,000 rounds against the Nationalist- held offshore islands of Quemoy and Matsu. (1) For the next five days, [...]

There are no published studies on pregnancy-related concerns, worries, and fears (CWFs) in primiparous and multiparous women and men in U.S. Air Force (USAF) families. Reflecting a biopsychosocial model of behavioral health, women's and men's pregnancy-related CWF Questionnaires were developed. Usable data were obtained from 260 women and 243 men in USAF families. Similarities and differences in pregnancy-related CWFs were found when USAF and general population data were compared. The present findings can inform not only the general provision of pregnancy health-related services but also USAF secondary prevention pregnancy-related programs (e.g., USAF nurse home visiting programs for first-time parents). If CWF Questionnaires are individually administered, the information can be used to tailor services to individual client needs. [ABSTRACT FROM AUTHOR]

Introduction The US Army Burn Center, the only burn center in the Department of Defense provides comprehensive burn care. The Burn Flight Team (BFT) provides specialized burn care during transcontinental evacuation. During Operations Iraqi and Enduring Freedom, burn injuries accounted for approximately 5% of all injuries in military personnel. To augment BFT capacity, US Air Force Critical Care Air Transport Teams (CCATTs) mobilized to transport burn patients. The purpose of this study was to describe critically ill, burn injured patients transported to the US Army Burn Center by BFT or CCATT, to compare and contrast characteristics, evacuation procedures, in-flight treatments, patient injuries/illnesses, and outcomes between the two groups. Materials and Methods We conducted a retrospective cohort study of CCATT and BFT patients, admitted to the burn ICU between January 1, 2001 and September 30, 2018. Patients with total body surface area burned (TBSA) >30% were evacuated by BFT, while CCATT evacuated patients with ≤ 30% TBSA. Results Ninety-seven patients met inclusion criteria for this study. Of these, 40 (41%) were transported by the BFT and 57 (59%) were transported by CCATTs. Compared with patients transported by CCATTs, patients transferred by the BFT had higher median TBSA and full-thickness burn size, higher prevalence of chest, back and groin burns, and higher prevalence of inhalation injury. BFT patients had increased hospital days (62 vs. 37; P  = .08), ICU days (29 vs. 12; P  = .003) and ventilator days (14 vs. 6; P  < .001). TBSA was the only variable significantly associated with ARDS (aOR = 1.04; 95% CI: 1.01, 1.08; P  = 0.04), renal failure (aOR = 1.07; 95% CI: 1.03, 1.11; P  = .002), and mortality (aOR = 1.08; 95% CI: 1.03, 1.13; P  = .001). Conclusions Evacuation by the BFT was associated with increased ICU and ventilator days, increased mortality, and a greater risk for developing renal failure. The severity of injury/TBSA likely accounted for most of these differences. [ABSTRACT FROM AUTHOR]

US Air Force airfields are partners in airpower with aircraft, but they are also centers of gravity that cannot maneuver at tempo, making them a potential weakness for adversaries to exploit. If the Air Force is to prevail in great power competition, it needs to rethink airfield organization. Systems thinking can help the Air Force reorganize its airfields into maneuverable rhizomatic teams, mitigating the shortfalls of traditionally organized airfields. This study aims to help Air Force decisionmakers guide the development of airfield systems whose potential has remained relatively unexplored. [ABSTRACT FROM AUTHOR]

In this study, we examined active-duty women's experiences with gender microaggressions in the U.S. military and their associations with depressive symptoms. We also tested if rank and coping strategies would moderate the link between gender microaggressions and depressive symptoms. Participants comprised 682 self-identified women from the U.S. Air Force, Army, and Navy. Results from an online survey indicated that active-duty women's experiences with gender microaggressions were positively and significantly associated with their scores on a measure of depressive symptoms. Military rank moderated this association but coping strategies did not. Specifically, among those in lower military ranks (i.e., enlisted service members) we found a stronger association between gender microaggressions and depressive symptoms, whereas higher rank (i.e., officers) served as a buffer. Our results suggest that clinicians should be aware of the potential effects of gender microaggressions on active-duty women's mental health, especially among enlisted women. Commanding officers and military policymakers should consider potential implications of gender microaggressions on unit cohesion, unit performance, and mission effectiveness. [ABSTRACT FROM AUTHOR]

Space weather indices are used to drive forecasts of thermosphere density, which directly affects objects in low‐Earth orbit (LEO) through atmospheric drag force. A set of proxies and indices (drivers), F10.7, S10.7, M10.7, and Y10.7 are used as inputs by the JB2008, (https://doi.org/10.2514/6.2008‐6438) thermosphere density model. The United States Air Force (USAF) operational High Accuracy Satellite Drag Model (HASDM), relies on JB2008, (https://doi.org/10.2514/6.2008‐6438), and forecasts of solar drivers from a linear algorithm. We introduce methods using long short‐term memory (LSTM) model ensembles to improve over the current prediction method as well as a previous univariate approach. We investigate the usage of principal component analysis (PCA) to enhance multivariate forecasting. A novel method, referred to as striped sampling, is created to produce statistically consistent machine learning data sets. We also investigate forecasting performance and uncertainty estimation by varying the training loss function and by investigating novel weighting methods. Results show that stacked neural network model ensembles make multivariate driver forecasts which outperform the operational linear method. When using MV‐MLE (multivariate multi‐lookback ensemble), we see an improvement of RMSE for F10.7, S10.7, M10.7, and Y10.7 of 17.7%, 12.3%, 13.8%, 13.7% respectively, over the operational method. We provide the first probabilistic forecasting method for S10.7, M10.7, and Y10.7. Ensemble approaches are leveraged to provide a distribution of predicted values, allowing an investigation into robustness and reliability (R&R) of uncertainty estimates. Uncertainty was also investigated through the use of calibration error score (CES), with the MV‐MLE providing an average CES of 5.63%, across all drivers. Plain Language Summary: Objects in low‐Earth orbit, are affected by atmospheric drag, which depends on density. A currently used thermosphere density model, JB2008, (https://doi.org/10.2514/6.2008‐6438), relies on a collection of space weather solar drivers as inputs. Currently, these drivers rely on a linear forecasting algorithm, which supplies single point forecasts for 6 days. No current methods exist for providing probabilistic forecasts and uncertainty estimates for three of the drivers. In this work, we introduce a machine learning approach which provides a probabilistic forecast of all solar drivers used by JB2008, (https://doi.org/10.2514/6.2008‐6438). The new approach uses a combination of individual predictions, which can be combined to produce less error than the current operational method. This new approach provides improvement over single point forecasting made by the operational method and provides a measure of confidence in the forecasted values. Key Points: A new striped sampling approach is developed to achieve improved performance on limited dataEnsemble methods show promise for short term forecasting of JB2008 solar drivers and provide robust and reliable uncertainty estimatesStacked neural network ensemble methods provide the best short‐term solar driver forecasts [ABSTRACT FROM AUTHOR]

The use of games to model and understand complex systems has an extensive history in military circles. Gaming is used by commanders at all levels to inform their understanding of the operational environment, evaluate disparate courses of action, and refine future concepts of operation. The current article examines the use of gaming by the U.S. Air Force to mature and promote its Agile Combat Employment operational concept. The case is made that this approach is extensible to allow leaders with varying problem sets a tool to develop a deeper understanding of their leadership options. [ABSTRACT FROM AUTHOR]

In recent years, scholars have grappled with the risks and conditions of nuclear-conventional entanglement. One of the examples of entanglement discussed in the academic literature is U.S. nuclear command and control satellites, which have historically served both nuclear and conventional missions. From 2017 to 2019, the U.S. Air Force made a series of programmatic decisions that would, at least in part, reverse this entanglement, separating nuclear from non-nuclear spacecraft. This reversal of nuclear-conventional entanglement in outer space poses strategic consequences, but it was less a strategic choice made by U.S. leadership than the result of acquisition reforms and bureaucratic dynamics. [ABSTRACT FROM AUTHOR]

This document discusses the implementation of a new takeoff, climb, and departure procedure for T-38 aircraft in order to reduce bird strikes. The team conducting the research developed a bird strike probability tool using data collected by a bird radar on the aerodrome. The new procedure aims to reduce the time spent in the bird zone and has been implemented in conjunction with reducing flying during times of higher bird strike probability. The team expects to see a 90% reduction in bird strikes, although it is too early to determine the exact impact. [Extracted from the article]

INTRODUCTION: Migraine is a common condition that can carry considerable risk to aeromedical duties. Because randomized controlled trials are not an appropriate method to evaluate flight safety risk for medical conditions that may cause subtle or sudden incapacitation, the determination of fitness-to-fly must be based on risk assessments informed by extrapolated evidence. Therefore, we conducted a review of current literature to provide background information to inform the aeromedical risk assessment of migraine using a risk matrix approach. METHODS: We identified studies on topics pertinent to conducting an aeromedical risk assessment of migraine. We generated an overview of the literature synthesizing the findings of articles retrieved from searches of Scopus, Ovid, PubMed, and the Cochrane Library published in English from all years, in both general and aircrew populations. International headache and neurology guidelines, as well as headache policies from the U.S. Air Force, were also reviewed. RESULTS: This review includes information on the following topics relevant to conducting an evidence-based risk assessment of migraine: diagnosis, prevalence, incidence, natural course, clinical presentation, triggers, comorbidities, neuroimaging, implications of family history, and efficacy of pharmacological and nonpharmacological therapies. DISCUSSION: This review summarizes current literature on migraine for use in a risk matrix approach to the aeromedical assessment of migraine in prospective and current aircrew. Awareness of the most current epidemiological data related to a variety of migraine parameters facilitates an evidence-based risk assessment of migraine in aircrew and requires iterative updates as new information becomes available. [ABSTRACT FROM AUTHOR]

Since the successful development of the airplane in the early twentieth century, aircraft have become not only part of our daily life, but also a key part of many nations' [...]

On April 17, 1975, the Khmer Rouge seized Cambodia and two weeks later, Communist forces overran South Vietnam. Concurrently, the Laotian Government fell to the Pathet Lao, and 'United States [...]