Search

BACKGROUND: Healthy young women who engage in an exercise program may lose fat that is not reflected in body weight changes because of concurrent gains in fat-free mass (FFM). OBJECTIVE: This study addressed the question of how well anthropometry-based predictive equations can resolve these changes. DESIGN: Several widely used skinfold-thickness- or circumference-based equations were compared by using dual-energy X-ray absorptiometry to study 150 healthy young women before and after 8 wk of Army basic combat training (average energy expenditure: 11.7 MJ/d). RESULTS: Women lost 1.2 +/- 2.6 kg fat (mean +/- SD) and gained 2.5 +/- 1.5 kg FFM. Fat loss (r = 0.47), but not FFM gain (r = 0.01), correlated with initial fatness. Thus, for many women who lost fat, body weight did not change or increased. Fat loss was associated with a reduction in abdominal circumference but this alone was not a consistent marker of fat loss. One circumference equation and one skinfold-thickness equation yielded the smallest residual SDs (2.0% and 1.9% body fat, respectively) compared with the other equations in predicting body fat. The sensitivity and specificity of the best equations in predicting changes in percentage body fat were not better than 55% and 66%, respectively. CONCLUSIONS: These data suggest that for women, anthropometry can provide better estimates of fatness than body mass index but it is still relatively insensitive to short-term alterations in body composition. Not surprisingly, the circumference equation that includes the most labile sites of female fat deposition (ie, waist and hips instead of upper arm or thigh) proved to be the most reliable. Copyright © 2001 American Society for Clinical Nutrition [ABSTRACT FROM AUTHOR]

PURPOSE: Military recruits and distance runners share a special risk of stress fracture injury. Recent efforts by US and Israeli military-sponsored researchers have uncovered important mechanisms and practical low-cost interventions. This article summarizes key findings relevant to prevention of stress fracture, including simple strategies to identify and to mitigate risk. METHODS: Published research supported through the Bone Health and Military Medical Readiness research program and related military bone research was analyzed for contributions to preventing stress fracture in military recruits and optimizing bone health. RESULTS: Thousands of military recruits helped test hypotheses about predictors of risk, safer exercise regimens, and rest, nutrition, gait training, and technology interventions to reduce stress fracture risk. Concurrent cellular, animal, and human laboratory studies were used to systematically investigate mechanisms of mechanical forces acting on bone and interactions through muscle, hormonal and genetic influences, and metabolism. The iterative and sometimes simultaneous process of basic discovery and field testing produced new knowledge that will provide safer science-based physical training. DISCUSSION: Human training studies evaluating effects on bone require special commitment from investigators and funders due to volunteer compliance and attrition challenges. The findings from multiple studies indicate that measures of bone elasticity, fragility, and geometry are as important as bone mineral density in predicting fracture risk, with applications for new measurement technologies. Risk may be reduced by high intakes of calcium, vitamin D, and possibly protein (e.g., milk products). Prostaglandin E2, insulin-like growth factor 1, and estrogens are important mediators of osteogenesis, indicating reasons to limit the use of certain drugs (e.g., ibuprofen), to avoid excessive food restriction, and to treat hypogonadism. Abnormal gait may be a correctable risk factor. Brief daily vibration may stimulate bone mineral accretion similar to weight-bearing exercise. Genetic factors contribute importantly to bone quality, affecting fracture susceptibility and providing new insights into fracture healing and tissue reengineering. [ABSTRACT FROM AUTHOR]

The Food and Drug Administration's (FDA) obesity drug guidance is set on the basis of body mass index (BMI), with thresholds of either BMI ≥30 or BMI ≥27 kg/m 2 with weight-related comorbidities. While BMI is associated with obesity-related health outcomes, there are known limitations to use as a direct measure of body fat or metabolic health, and the American Medical Association has highlighted limitations of BMI in assessing individual obesity risks. BMI thresholds impose a barrier to treatment. In a sample from the NHANES dataset (n=6,646 men and women), 36% of individuals with metabolic syndrome (MetS) may not be eligible for obesity pharmacotherapy. This analysis provides quantifiable justification for refinement of the BMI treatment criteria with a more holistic assessment of individual obesity-related disease risk., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2024 Chin, Potter and Friedl.)

Few US Marines earn perfect 300 scores on both their Physical Fitness Test (PFT) and Combat Fitness Test (CFT). The number 300 invokes the legendary 300 Spartans that fought at the Battle of Thermopylae, which inspired high physical fitness capabilities for elite ground forces ever since., Purpose: Determine distinguishing characteristics of the "300 Marines" (perfect PFT and CFT scores) that may provide insights into the physical and physiological requirements associated with this capability. These tests have been refined over time to reflect physical capabilities associated with Marine Corps basic rifleman performance., Materials and Methods: Data were analyzed from US Marines, including 497 women (age, 29 ± 7 years; height 1.63 ± 0.07 m; body mass, 67.4 ± 8.4 kg) and 1,224 men (30 ± 8 years; 1.77 ± 0.07 m; 86.1 ± 11.1 kg). Marines were grouped by whether they earned perfect 300 scores on both the PFT and CFT (300 Marines) or not. We analyzed group differences in individual fitness test events and body composition (dual-energy x-ray absorptiometry)., Results: Only 2.5% ( n = 43) of this sample earned perfect PFT and CFT scores ( n = 21 women; n = 22 men). Compared to sex-matched peers, 300 Marines performed more pull-ups, with faster three-mile run, maneuver-under-fire, and movement-to-contact times (each p < 0.001); 300 Marines of both sexes had lower fat mass, body mass index, and percent body fat (each p < 0.001). The lower percent body fat was explained by greater lean mass ( p = 0.041) but similar body mass ( p = 0.085) in women, whereas men had similar lean mass ( p = 0.618), but lower total body mass ( p = 0.025)., Conclusion: Marines earning perfect PFT and CFT scores are most distinguished from their peers by their maneuverability, suggesting speed and agility capabilities. While both sexes had considerably lower percent body fat than their peers, 300 Marine women were relatively more muscular while men were lighter., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2024 Looney, Potter, Schafer, Chapman and Friedl.)

Introduction: Freezing cold injuries (FCI) are a common risk in extreme cold weather operations. Although the risks have long been recognised, injury occurrences tend to be sparse and geographically distributed, with relatively few cases to study in a systematic way. The first challenge to improve FCI medical management is to develop a common nomenclature for FCI classification. This is critical for the development of meaningful epidemiological reports on the magnitude and severity of FCI, for the standardisation of patient inclusion criteria for treatment studies, and for the development of clinical diagnosis and treatment algorithms., Methodology: A scoping review of the literature using PubMed and cross-checked with Google Scholar, using search terms related to freezing cold injury and frostbite, highlighted a paucity of published clinical papers and little agreement on classification schemes., Results: A total of 74 papers were identified, and 28 were included in the review. Published reports and studies can be generally grouped into four different classification schemes that are based on (1) injury morphology; (2) signs and symptoms; (3) pathophysiology; and (4) clinical outcome. The nomenclature in the different classification systems is not coherent and the discrete classification limits are not evidence based., Conclusions: All the classification systems are necessary and relevant to FCI medical management for sustainment of soldier health and performance in cold weather operations and winter warfare. Future FCI reports should clearly characterise the nature of the FCI into existing classification schemes for surveillance (morphology, symptoms, and appearance), identifying risk-factors, clinical guidelines, and agreed inclusion/exclusion criteria for a future treatment trial.

Biomathematical models quantitatively describe human physiological responses to environmental and operational stressors and have been used for planning and real-time prevention of cold injury. These same models can be applied from a military tactical perspective to gain valuable insights into the health status of opponent soldiers. This paper describes a use case for predicting physiological status of Russian soldiers invading Ukraine using open-source information. In March 2022, media outlets reported Russian soldiers in a stalled convoy invading Ukraine were at serious risk of hypothermia and predicted these soldiers would be "freezing to death" within days because of declining temperatures (down to -20°C). Using existing Army models, clothing data and open-source intelligence, modelling and analyses were conducted within hours to quantitatively assess the conditions and provide science-based predictions. These predictions projected a significant increase in risks of frostbite for exposed skin and toes and feet, with a very low (negligible) risk of hypothermia. Several days later, media outlets confirmed these predictions, reporting a steep rise in evacuations for foot frostbite injuries in these Russian forces. This demonstrated what can be done today with the existing mathematical physiology and how models traditionally focused on health risk can be used for tactical intelligence.

After more than 50 years of studying soldiers in the cold, we are well past the phase of defining the unique problems; the research requirements are known but the solutions have been slow in coming. This requires iterative testing of proposed lab-based solutions with soldiers in the real environment. Representing a renewed effort to produce and implement solutions to human biomedical challenges in Arctic operations, this journal supplement highlights presentations from a three-day NATO Human Factors and Medicine panel-sponsored symposium in Washington DC in October 2022. While technology can certainly aid soldiers in extreme environments, it is ultimately training that is the most important factor for ensuring optimal performance and survival. By investing in the development of specialized Arctic forces training and implementing new solutions to protect their health and performance, we can ensure success in the coldest and harshest of environments.

In October 2022, the Human Factors and Medicine (HFM) panel of the NATO Science and Technology Organization convened a review of progress in military biomedical research for cold weather operations. This paper represents a summary of the research presentations and future directions. The importance of realistic training was an overarching theme. Many reported studies took advantage of cold weather training exercises to monitor soldiers' health and performance; these are valuable data, using winter exercises as a platform to gain further knowledge regarding human performance in the cold and represent an excellent extension of controlled laboratory studies. Topics also included prevention of Cold Weather Injuries (CWI); effects of cold weather stressors on cognitive function; field treatment of freezing cold injuries (FCI); and new consideration to injury and trauma care in the cold. Future work programmes re-emphasise development of cold weather training and establishment of consensus diagnostic criteria and treatments for FCI and non-FCI. CWI prevention should take advantage of biomathematical models that predict risk of CWI and provide guidance regarding optimal clothing and equipment and move from group averages to personalised predictions. The publication of selected presentations from the symposium in this special issue increases attention to military cold weather research.

Women's roles in the US military have progressively changed over the past several decades. Previously women were barred from combat roles. Recent change in policy allow women into combat roles in the Marine Corps, and this has led to women being trained for combat specialties., Objectives: This observational cross-sectional study describes body composition and performance values for modern Marine Corps women., Methods: Volunteers were 736 Marine women who were assessed for body composition and physical performance; (age 29.5±7.3 (18-56) years; height 163.6±6.8 (131.0-186.1) cm; body mass 68.3±9.2 (42.0-105.3) kg; years in the military 8.9±6.8 (0.5-37) years-in-service). Body composition measures were obtained using dual-energy X-ray absorptiometry and single-frequency bioelectrical impedance analyses. Performance measures were obtained from official physical and combat fitness test scores (PFT; CFT) as well as from data on measured countermovement jumps (CMJ) on a calibrated force platform., Results: Mean body composition metrics for Marine women were: 47.5±5.7 fat free mass (FFM) (kg), 30.1%±6.4% body fat (%BF), 2.6±0.3 bone mineral content (kg), and 25.5±2.8 body mass index (kg/m 2 ); performance metrics included 43.4±3.2 maximal oxygen uptake (VO2max; mL.kg.min), 22.4±7.1 CMJ height (cm) and 2575±565.2 CMJ peak power (W). Data showed strong correlations (r) (≥0.70) between PFT and VO2max scores (0.75), and moderate correlations (≥0.50) between CFT and VO2max scores (0.57), CFT and PFT scores (0.60), FFM and CMJ peak power (W) (0.68), and %BF to VO2max (-0.52), PFT (-0.54), CMJ-Ht (-0.52) and CMJ relative power (W/kg) (-0.54)., Conclusion: Modern Marine women are both lean and physically high performing. Body composition is a poor predictor of general physical performance., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2023. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

In 1981, the US military adopted body fat standards to promote physical readiness and prevent obesity. Separate circumference-based equations were developed for women and men. Both predictive equations were known to underestimate %BF. However, it was not known how well these abdominal circumference-based methods tracked changes in %BF. This study examined the validity of the circumference-based %BF equations for assessing changes in %BF in young adult recruits during Army Basic Combat Training (BCT). Dual-energy X-ray absorptiometry (DXA) and circumference-based measures of %BF were obtained in women ( n = 481) and men ( n = 926) at the start (pre-BCT) and end (post-BCT) of 8 weeks of BCT. Repeated-measure ANOVAs were used to assess differences between DXA and circumference pre-BCT and for the change during BCT. Pre-BCT, circumferences underestimated %BF relative to DXA, with mean errors of -6.0% ± 4.4% for women and -6.0% ± 3.5% for men (both p < 0.01), and no difference between sexes was observed ( p = 0.77). DXA detected a -4.0% ± 2.4% and -3.3% ± 2.8% change in %BF for women and men in response to BCT, respectively (both p < 0.01), whereas circumference estimates of %BF indicated a 0.0% ± 3.3% ( p = 0.86) change in women and a -2.2% ± 3.3% ( p < 0.01) change in men (sex difference by technique p < 0.01). In conclusion, circumference-based measures underestimated %BF at the start of BCT in both sexes as compared to DXA. Circumference measures underestimated changes in %BF during BCT in men and did not detect changes in women. These findings suggest that circumference-based %BF metrics may not be an appropriate tool to track changes in body composition during short duration training., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2023 Foulis, Friedl, Spiering, Walker, Guerriere, Pecorelli, Zeppetelli, Reynoso, Taylor and Hughes.)

Introduction: Physiological limits imposed by vest-borne loads must be defined for optimal performance monitoring of the modern dismounted warfighter., Purpose: To evaluate how weighted vests affect locomotion economy and relative cardiometabolic strain during military load carriage while identifying key physiological predictors of exhaustion limits., Methods: Fifteen US Army soldiers (4 women, 11 men; age, 26 ± 8 years; height, 173 ± 10 cm; body mass (BM), 79 ± 16 kg) performed four incremental walking tests with different vest loads (0, 22, 44, or 66% BM). We examined the effects of vest-borne loading on peak walking speed, the physiological costs of transport, and relative work intensity. We then sought to determine which of the cardiometabolic indicators (oxygen uptake, heart rate, respiration rate) was most predictive of task failure., Results: Peak walking speed significantly decreased with successively heavier vest loads (p < 0.01). Physiological costs per kilometer walked were significantly higher with added vest loads for each measure (p < 0.05). Relative oxygen uptake and heart rate were significantly higher during the loaded trials than the 0% BM trial (p < 0.01) yet not different from one another (p > 0.07). Conversely, respiration rate was significantly higher with the heavier load in every comparison (p < 0.01). Probability modeling revealed heart rate as the best predictor of task failure (marginal R 2 , 0.587, conditional R 2 , 0.791)., Conclusion: Heavy vest-borne loads cause exceptional losses in performance capabilities and increased physiological strain during walking. Heart rate provides a useful non-invasive indicator of relative intensity and task failure during military load carriage., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Published by Elsevier Ltd.)

Bioelectrical impedance analysis (BIA) provides a practical method of body composition estimation for field research and weight management programmes, with devices and algorithms that have improved in recent years. We compared suitability of a commercial BIA system that uses multi-frequency-based proprietary algorithms (InBody 770, Cerritos, California, USA) and a laboratory-based validated single-frequency system (Quantum IV, RJL Systems, Clinton Township, Michigan, USA) with dual-energy X-ray absorptiometry (DXA) (iDXA, GE Lunar, Madison, Wisconsin, USA). Volunteers included fit non-obese active duty US Marines (480 men; 315 women), assessed by DXA and the two BIA systems. Both RJL and InBody BIA devices predicted DXA-based fat-free mass (FFM) (mean absolute error (MAE) 2.8 and 3.1 kg, respectively) and per cent body fat (%BF) (MAE 3.4% and 3.9%, respectively), with higher correlations from the InBody device (r 2 =0.96 (%BF) and 0.84 (FFM)) versus the RJL (r 2 =0.92 (%BF) and 0.72 (FFM)). InBody overpredicted FFM (bias +2.7, MAE 3.1 kg) and underpredicted %BF (bias -3.4 and MAE 3.9%) versus the RJL. A 3% correction factor applied to the InBody device results provided values very close to the DXA measurements. These findings support the application of modern BIA systems to body composition goals of maximum %BF and minimum lean body mass for both men and women., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2022. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Introduction: This study characterized a sample of the first women to complete elite United States (US) military training., Methods: Twelve female graduates of the US Army Ranger Course and one of the first Marine Corps Infantry Officers Course graduates participated in 3 d of laboratory testing including serum endocrine profiles, aerobic capacity, standing broad jump, common soldiering tasks, Army Combat Fitness Test, and body composition (dual-energy x-ray absorptiometry, three-dimensional body surface scans, and anthropometry)., Results: The women were 6 months to 4 yr postcourse graduation, 30 ± 6 yr (mean ± SD); height, 1.67 ± 0.07 m; body mass, 69.4 ± 8.2 kg; body mass index, 25.0 ± 2.3 kg·m -2 . Dual-energy x-ray absorptiometry relative fat was 20.0% ± 2.0%; fat-free mass, 53.0 ± 5.9 kg; fat-free mass index, 20.0 ± 1.7 kg·m -2 ; bone mineral content, 2.75 ± 0.28 kg; bone mineral density, 1.24 ± 0.07 g·cm -2 ; aerobic capacity, 48.2 ± 4.8 mL·kg -1 ·min -1 ; total Army Combat Fitness Test score 505 ± 27; standing broad jump 2.0 ± 0.2 m; 123 kg casualty drag 0.70 ± 0.20 m·s -1 , and 4 mile 47 kg ruck march 64 ± 6 min. All women were within normal healthy female range for circulating androgens. Physique from three-dimensional scan demonstrated greater circumferences at eight of the 11 sites compared with the standard military female., Conclusions: These pioneering women possessed high strength and aerobic capacity, low %BF; high fat-free mass, fat-free mass index, and bone mass and density; and they were not virilized based on endocrine measures as compared with other reference groups. This group is larger in body size and leaner than the average Army woman. These elite physical performers seem most comparable to female competitive strength athletes., (Copyright © 2022 Written work prepared by employees of the Federal Government as part of their official duties is, under the U.S. Copyright Act, a "œwork of the United States Government"œ for which copyright protection under Title 17 of the United States Code is not available. As such, copyright does not extend to the contributions of employees of the Federal Government.)

Human tolerance to cold environments is extremely limited and responses between individuals is highly variable. Such physiological and morphological predispositions place them at high risk of developing cold weather injuries [CWI; including hypothermia and/or non-freezing (NFCI) and freezing cold injuries (FCI)]. The present manuscript highlights current knowledge on the vulnerability and variability of human cold responses and associated risks of developing CWI. This review 1) defines and categorizes cold stress and CWI, 2) presents cold defense mechanisms including biological adaptations, acute responses and acclimatization/acclimation and, 3) proposes mitigation strategies for CWI. This body of evidence clearly indicates that all humans are at risk of developing CWI without adequate knowledge and protective equipment. In addition, we show that while body mass plays a key role in mitigating risks of hypothermia between individuals and populations, NFCI and FCI depend mainly on changes in peripheral blood flow and associated decrease in skin temperature. Clearly, understanding the large interindividual variability in morphology, insulation, and metabolism is essential to reduce potential risks for CWI between and within populations., Competing Interests: No potential conflict of interest was reported by the author(s)., (© 2022 Her Majesty the Queen in Right of Canada (Department of National Defence).)

Introduction: Existing predictive equations underestimate the metabolic costs of heavy military load carriage. Metabolic costs are specific to each type of military equipment, and backpack loads often impose the most sustained burden on the dismounted warfighter., Purpose: This study aimed to develop and validate an equation for estimating metabolic rates during heavy backpacking for the US Army Load Carriage Decision Aid (LCDA), an integrated software mission planning tool., Methods: Thirty healthy, active military-age adults (3 women, 27 men; age, 25 ± 7 yr; height, 1.74 ± 0.07 m; body mass, 77 ± 15 kg) walked for 6-21 min while carrying backpacks loaded up to 66% body mass at speeds between 0.45 and 1.97 m·s-1. A new predictive model, the LCDA backpacking equation, was developed on metabolic rate data calculated from indirect calorimetry. Model estimation performance was evaluated internally by k-fold cross-validation and externally against seven historical reference data sets. We tested if the 90% confidence interval of the mean paired difference was within equivalence limits equal to 10% of the measured metabolic rate. Estimation accuracy and level of agreement were also evaluated by the bias and concordance correlation coefficient (CCC), respectively., Results: Estimates from the LCDA backpacking equation were statistically equivalent (P < 0.01) to metabolic rates measured in the current study (bias, -0.01 ± 0.62 W·kg-1; CCC, 0.965) and from the seven independent data sets (bias, -0.08 ± 0.59 W·kg-1; CCC, 0.926)., Conclusions: The newly derived LCDA backpacking equation provides close estimates of steady-state metabolic energy expenditure during heavy load carriage. These advances enable further optimization of thermal-work strain monitoring, sports nutrition, and hydration strategies., (Copyright © 2022 Written work prepared by employees of the Federal Government as part of their official duties is, under the U.S. Copyright Act, a “work of the United States Government” for which copyright protection under Title 17 of the United States Code is not available. As such, copyright does not extend to the contributions of employees of the Federal Government.)

Purpose: Body composition assessment methods are dependent on their underlying principles, and assumptions of each method may be affected by age and sex. This study compared an abdominal circumference-focused method of percent body fat estimation (AC %BF) to a criterion method of dual-energy x-ray absorptiometry (DXA), and a comparative assessment with bioelectrical impedance (BIA), in younger (≤30 years) and older (>age 30 years) physically fit (meeting/exceeding annual US Marine Corps fitness testing requirements) men and women. Methods: Fit healthy US Marines (430 men, 179 women; 18-57 years) were assessed for body composition by DXA (iDXA, GE Lunar), anthropometry, and BIA (Quantum IV, RJL Systems). Results: Compared to DXA %BF, male AC %BF underestimated for both ≤30 and >30 years age groups (bias, -2.6 ± 3.7 and -2.5 ± 3.7%); while female AC %BF overestimated for both ≤30 and >30 years age groups (2.3 ± 4.3 and 1.3 ± 4.8%). On an individual basis, lean men and women were overestimated and higher %BF individuals were underestimated. Predictions from BIA were more accurate and reflected less relationship to adiposity for each age and sex group (males: ≤30, 0.4 ± 3.2, >30 years, -0.5 ± 3.5; women: ≤30, 1.4 ± 3.1, >30 years, 0.0 ± 3.3). Total body water (hydration) and bone mineral content (BMC) as a proportion of fat-free mass (FFM) remained consistent across the age range; however, women had a higher proportion of %BMC/FFM than men. Older men and women (>age 30 years) were larger and carried more fat but had similar FFM compared to younger men and women. Conclusion: The AC %BF provides a field expedient method for the US Marine Corps to classify individuals for obesity prevention, but does not provide research-grade quantitative body composition data., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2022 Potter, Tharion, Holden, Pazmino, Looney and Friedl.)

Parkinson's disease (PD) is a chronic movement disorder that produces a variety of characteristic movement abnormalities. The ubiquity of wrist-worn accelerometry suggests a possible sensor modality for early detection of PD symptoms and subsequent tracking of PD symptom severity. As an initial proof of concept for this technological approach, we analyzed the U.K. Biobank data set, consisting of one week of wrist-worn accelerometry from a population with a PD primary diagnosis and an age-matched healthy control population. Measures of movement dispersion were extracted from automatically segmented gait data, and measures of movement dimensionality were extracted from automatically segmented low-movement data. Using machine learning classifiers applied to one week of data, PD was detected with an area under the curve (AUC) of 0.69 on gait data, AUC = 0.84 on low-movement data, and AUC = 0.85 on a fusion of both activities. It was also found that classification accuracy steadily improved across the one-week data collection, suggesting that higher accuracy could be achievable from a longer data collection. These results suggest the viability of using a low-cost and easy-to-use activity sensor for detecting movement abnormalities due to PD and motivate further research on early PD detection and tracking of PD symptom severity.

Goal: The aim of the study herein reported was to review mobile health (mHealth) technologies and explore their use to monitor and mitigate the effects of the COVID-19 pandemic. Methods: A Task Force was assembled by recruiting individuals with expertise in electronic Patient-Reported Outcomes (ePRO), wearable sensors, and digital contact tracing technologies. Its members collected and discussed available information and summarized it in a series of reports. Results: The Task Force identified technologies that could be deployed in response to the COVID-19 pandemic and would likely be suitable for future pandemics. Criteria for their evaluation were agreed upon and applied to these systems. Conclusions: mHealth technologies are viable options to monitor COVID-19 patients and be used to predict symptom escalation for earlier intervention. These technologies could also be utilized to monitor individuals who are presumed non-infected and enable prediction of exposure to SARS-CoV-2, thus facilitating the prioritization of diagnostic testing.

Physiological responses to work in cold water have been well studied but little is known about the effects of exercise in warm water; an overlooked but critical issue for certain military, scientific, recreational, and professional diving operations. This investigation examined core temperature responses to fatiguing, fully-immersed exercise in extremely warm waters. Twenty-one male U.S. Navy divers (body mass, 87.3 ± 12.3 kg) were monitored during rest and fatiguing exercise while fully-immersed in four different water temperatures (Tw): 34.4, 35.8, 37.2, and 38.6°C (Tw 34.4 , Tw 35.8 , Tw 37.2 , and Tw 38.6 respectively). Participants exercised on an underwater cycle ergometer until volitional fatigue or core temperature limits were reached. Core body temperature and heart rate were monitored continuously. Trial performance time decreased significantly as water temperature increased (Tw 34.4 , 174 ± 12 min; Tw 35.8 , 115 ± 13 min; Tw 37.2 , 50 ± 13 min; Tw 38.6 , 34 ± 14 min). Peak core body temperature during work was significantly lower in Tw 34.4 water (38.31 ± 0.49°C) than in warmer temperatures (Tw 35.8 , 38.60 ± 0.55°C; Tw 37.2 , 38.82 ± 0.76°C; Tw 38.6 , 38.97 ± 0.65°C). Core body temperature rate of change increased significantly with warmer water temperature (Tw 34.4 , 0.39 ± 0.28°C·h -1 ; Tw 35.8 , 0.80 ± 0.19°C·h -1 ; Tw 37.2 , 2.02 ± 0.31°C·h -1 ; Tw 38.6 , 3.54 ± 0.41°C·h -1 ). Physically active divers risk severe hyperthermia in warmer waters. Increases in water temperature drastically increase the rate of core body temperature rise during work in warm water. New predictive models for core temperature based on workload and duration of warm water exposure are needed to ensure warm water diving safety.

Transcutaneous electrical nerve stimulation (TENS) allows the artificial excitation of nerve fibres by applying electric-current pulses through electrodes on the skin's surface. This work involves the development of a simulation environment that can be used for studying transcutaneous electrotactile stimulation and its dependence on electrode layout and excitation patterns. Using an eight-electrode array implementation, it is shown how nerves located at different depths and with different orientations respond to specific injected currents, allowing the replication of already reported experimental findings and the creation of new hypotheses about the tactile sensations associated with certain stimulation patterns. The simulation consists of a finite element model of a human finger used to calculate the distribution of the electric potential in the finger tissues neglecting capacitive effects, and a cable model to calculate the excitation/inhibition of action potentials in each nerve., Competing Interests: The authors have declared that no competing interests exist.

Safe performance limits of soldiers and athletes have typically relied on predictive work-rest models of ambient conditions, average work intensity, and characteristics of the population. Bioengineering advances in noninvasive sensor technologies, including miniaturization, reduced cost, power requirements, and comfort, now make it possible to produce individual predictions of safe thermal-work limits. These precision medicine assessments depend on the development of thoughtful algorithms based on physics and physiology. Both physiological telemetry and thermal-strain indexes have been available for >50 years, but greater computing power and better wearable sensors now make it possible to provide actionable information at the individual level. Core temperature can be practically estimated from time series heart rate data and, using an adaptive physiological strain index, provides meaningful predictions of safe work limits that cannot be predicted from only core temperature or heart rate measurements. Early adopters of this technology include specialized occupations where individuals operate in complete encapsulation such as chemical protective suits. Emerging technologies that focus on heat flux measurements at the skin show even greater potential for estimating thermal-work strain using a parsimonious sensor set. Applications of these wearable technologies include many sports and military training venues where inexperienced individuals can learn effective work pacing strategies and train to safe personal limits. The same strategies can also provide a technologically based performance edge for experienced workers and athletes faced with novel and nonintuitive physiological challenges, such as health care providers in full protective clothing treating Ebola patients in West Africa in 2014. NEW & NOTEWORTHY This mini-review details how the application of computational techniques borrowed from signal processing and control theory can provide meaningful advances for the applied physiological problem of real-time thermal-work strain monitoring. The work examines the development of practical core body temperature estimation techniques and how these can be used in combination with current and updated thermal-work strain indexes to provide objective state assessments and to optimize work rest schedules for a given task.

The tantalizing potential of nanotechnology is to fabricate and combine nanoscale approaches and building blocks to make useful tools and, ultimately, interventions for medical science, including nutritional science, at the scale of approximately 1-100 nm. In the past few years, tools and techniques that facilitate studies and interventions in the nanoscale range have become widely available and have drawn widespread attention. Recently, investigators in the food and nutrition sciences have been applying the tools of nanotechnology in their research. The Experimental Biology 2009 symposium entitled "Nanotechnology Research: Applications in Nutritional Sciences" was organized to highlight emerging applications of nanotechnology to the food and nutrition sciences, as well as to suggest ways for further integration of these emerging technologies into nutrition research. Speakers focused on topics that included the problems and possibilities of introducing nanoparticles in clinical or nutrition settings, nanotechnology applications for increasing bioavailability of bioactive food components in new food products, nanotechnology opportunities in food science, as well as emerging safety and regulatory issues in this area, and the basic research applications such as the use of quantum dots to visualize cellular processes and protein-protein interactions. The session highlighted several emerging areas of potential utility in nutrition research. Nutrition scientists are encouraged to leverage ongoing efforts in nanomedicine through collaborations. These efforts could facilitate exploration of previously inaccessible cellular compartments and intracellular pathways and thus uncover strategies for new prevention and therapeutic modalities.

Adult gains in body weight, excess adiposity, and intra-abdominal fat have each been associated with risk for type 2 diabetes mellitus (T2DM), forming the basis for preventive medicine guidelines and actuarial predictions using practical indices of weight (e.g., body mass index [BMI]) and waist circumference (WC). As obesity-related disease spreads beyond affluent western countries, application of WC thresholds to other populations has highlighted issues of their generalizability. For example, U.S. national health goals based on BMI < 25 kg/m(2) and WC < 89 cm (women) and <102 cm (men) differ considerably with a recent law in Japan mandating intervention for older adults with WC exceeding 90 cm (women) and 85 cm (men). The U.S. military has also faced issues of generalizability of WC-based adiposity standards that are fair and achievable. Data from many studies indicate that WC is a reliable biomarker for T2DM risk, suggesting that, for adult men and women, action thresholds should be more stringent than current U.S. guidelines, and it would not be harmful to set worldwide targets somewhere below 90 cm for men and women, regardless of weight status. Medical technology has provided many great insights into disease, including modern imaging technologies that have differentiated fat depots that have the greatest influence on T2DM, but ultimately, an inexpensive measuring tape provides the most useful and cost-effective preventive measure for T2DM today. At some point in the future, a Star Trek-like abdominal body fat "tricorder" noninvasive assessment of tissue composition may provide an advantage over abdominal girth., (Copyright 2009 Diabetes Technology Society.)

Recent Institute of Medicine (IOM) reviews of the process for deriving Dietary Reference Intakes (DRIs) suggest that determining the need for a new nutrient review should be evaluated against criteria set a priori. After selecting the criterion of significant new and relevant research, a working group of US and Canadian government scientists used results from a systematic review and 2 conferences on vitamin D and health to evaluate whether significant new and relevant scientific evidence had become available since the 1997 IOM publication of the DRIs for vitamin D. This working group concluded that there appears to be new research meeting the criteria for 4 key DRI questions. The new research is of larger quantity and quality for the elderly than for other groups, but overall 1) adds to the bone-related and status evidence available to the 1997 DRI Committee for several of the life-stage groups, 2) identifies new outcomes with respect to risk of falls and performance measures in the elderly and potential adverse effects, and 3) provides additional information on dose-response relations between intakes and circulating 25-hydroxyvitamin D concentrations and between 25-hydroxyvitamin D concentrations and several health outcomes (ie, bone-related outcomes for all ages and risk of falls and performance measures in older adults). Members of the working group concluded that significant new and relevant research was available for reviewing the existing DRIs for vitamin D while leaving the decision of whether the new research will result in changes to the current DRIs to a future IOM-convened DRI committee.

Information on the mental status of soldiers operating at the limits of human tolerance will be vital to their management in future deployments; it may also allow earlier intervention for conditions such as undiagnosed Gulf War illnesses and Parkinson's Disease. The Army needs a parsimonious set of neuropsychological tests that reliably identify subtle changes for: (1) early detection of individual health and military performance impairments and (2) management of occupational and deployment health risks. Testing must characterize cognitive lapses in healthy individuals faced with relevant operational stressors (i.e., anxiety, information overload, thermal strain, hypoxia, fatigue, head impact, chemical or radiation exposures, metabolic challenges). This effort must also explore the neuropsychological methods in militarily relevant conditions to extend our understanding of relevant functional domains and how well they correspond to modes of testing. The ultimate objective is unobtrusive real-time mental status monitoring.

Background: A challenging 7-d ranger field exercise (FEX) by cadets in the Norwegian Military Academy provided a venue in which to study the effects of negative energy balance., Objective: We quantified total energy expenditure (TEE), food intake, and changes in body composition in male and female cadets., Design: TEE (measured by doubly labeled water), food intake, activity patterns (measured by accelerometry), and body composition (measured by dual-energy X-ray absorptiometry) were measured in 16 cadets (10 men and 6 women aged 21-27 y)., Results: The physically active (approximately 23 h/d) and semistarved (0.2-2.2 MJ/d) cadets lost weight (x +/- SD: men, -7.7 +/- 1.1 kg; women, -5.9 +/- 1.1 kg; P < 0.05). Absolute TEE differed by sex (men, 26.6 +/- 2.0 MJ/d; women, 21.9 +/- 2.0 MJ/d; P < 0.05) but body weight-specific TEE did not (men, 343 +/- 26 kJ . kg(-1) . d(-1); women, 354 +/- 18 kJ . kg(-1) . d(-1); NS). Fat-free mass (FFM) loss differed significantly by sex (men, -4.0 +/- 1.2 kg; women, -2.5 +/- 1.1 kg; P < 0.05), but percentage FFM loss did not (men, -6.3 +/- 1.9%; women, -5.6 +/- 2.4%). In contrast, absolute FM loss did not differ significantly by sex (men, -3.45 +/- 0.72 kg; women, -3.42 +/- 0.22 kg), but fat oxidation (men, 5.2 +/- 1.0 mg . min(-1) . kg FFM(-1); women, 7.3 +/- 0.5 mg . min(-1) . kg FFM(-1)) and the relative contribution of FM to TEE (men, 74 +/- 14%; women, 89 +/- 6%) were significantly greater in women than in men (P < 0.05)., Conclusion: Female cadets maintained a significantly more fat-predominant fuel metabolism than did male cadets in response to sustained exercise and semistarvation.

Objective: Prolonged physical exertion with inadequate time for recuperation may result in an overtraining phenomenon characterized by reduced physical strength and endurance capacity. We tested the hypothesis that highly motivated men pushed to the limits of their endurance capacity for 3 months would suffer physical breakdown characterized by loss of lean mass and reduced physical performance capacity., Methods: Two well-trained men (VO2max > 60 mL/kg/min), aged 25 years, completed an unsupported, 2928-km, south-to-north ski trek across Greenland in 86 days. The trek involved ski marching, typically for 9 h/d, pulling sleds initially containing 150 kg and a high-fat (60%) energy-dense diet of 25.1 MJ/d. Body composition and physical performance data were collected 14 days before and 4 days after the trek., Results: Energy expenditure based on doubly labeled water during three 2-week periods ranged from 28.3 and 34.6 MJ/d in rugged terrain to 14.6 and 16.1 MJ/d during travel on flat terrain for subjects 1 and 2, respectively. Both men lost weight, completing the trek with low-normal fat stores (approximately 13% body fat). The lighter man gained 0.6 kg lean mass, while the heavier man lost 1.4 kg lean mass and a larger amount of fat weight (7.0 kg). Most performance measures showed trivial changes within the errors of measurement and test reproducibility, indicating no loss of endurance capacity, but anaerobic tests (Wingate and vertical jump) were markedly reduced. Markers of metabolic status, including oral glucose tolerance tests, indicated no functional impairments., Conclusions: Although the number of subjects was limited, this observational study demonstrated that well-trained and experienced long-distance ski trekkers who eat an adequate high-calorie diet can perform endurance treks in severe cold, with little or no loss of lean mass and physical capability.

We tested the hypothesis that key endocrine responses to semistarvation would be attenuated by changing only the food intake in a multistressor environment that also included sustained workload, inadequate sleep, and thermal strain. Serum hormones were compared within and between two groups of healthy young male volunteers participating in the 8-wk US Army Ranger course, with four repeated cycles of restricted energy intakes and refeeding: group 1 (n = 49) and group 2 (n = 48); energy deficits averaged 1,200 and 1,000 kcal/day, respectively. After 8 wk, most of group 1 achieved a minimum body fat, serum 3,5,3'-triiodothyronine (T(3)) was below normal (78 +/- 20 ng/dl), testosterone (T) approached castrate levels (4.5 +/- 3.9 nmol/l), insulin-like growth factor I (IGF-I) declined by one-half (75 +/- 25 microg/l), and cholesterol rose from 158 +/- 31 to 217 +/- 39 mg/dl. Bioavailable T(3) and T were further reduced by increases in their specific binding proteins in response to declining insulin. Refeeding, even with continuation of the other stressors, produced prompt recovery of T(3), T, and IGF-I. Higher energy intakes in group 2 attenuated the subclinical hypothyroidism and hypercholesterolemia, whereas consistent luteinizing hormone suppression indicated centrally mediated threshold effects on gonadal hormone suppression. We conclude that low T, T(3), and IGF-I remained reliable markers of acute energy deficits in the presence of other stressors; elevated cholesterol and cortisol provided information about chronic status, corresponding to diminishing body fat stores.

Isometric maximal handgrip strength (GSmax) has been used as an expedient test of overall muscle strength and index of fat-free mass (FFM). We tested this relationship in 55 fit young men undergoing high rates of FFM loss in an 8.5-wk military training course involving multiple stressors including nutritionally uncomplicated energy deficit. GSmax was measured by a hand dynamometer interfaced with a computer providing visual feedback; another strength test, measuring dynamic strength of larger muscle groups (Cleansim), was also performed. GSmax did not change (530 +/- 57 vs 529 +/- 63 N) in the face of a 15.6% loss of body weight (12.1 +/- 3.4 (SD) kg), including 6.9% loss of FFM (4.6 +/- 2.6 kg), but Cleansim decremented significantly (77.4 +/- 9.6 to 58.7 +/- 8.9 kg) and changes were significantly correlated with delta FFM for GSmax (r = 0.31) and Cleansim (r = 0.49). We conclude that GSmax is not a good representation of changes in total FFM in healthy young men even though it appears to be useful in more severely catabolic patients with extreme losses of FFM and in pubertal boys making large gains in FFM. Other aspects of physical performance are clearly affected by high rates of weight loss, as demonstrated by decrements in the Cleansim and its stronger relationship to delta FFM.

This study evaluates effects on serum lipids of continuous or sequential progestogens for hormonal replacement in women. Subjects received either a cyclic regimen of replacement (0.625 mg/d of conjugated equine estrogens (Es) for 25 days/month and 10 mg medroxyprogesterone acetate [MPA] for the last 13 days of E) or 0.625 mg/d E along with either 5 or 10 mg MPA (Provera, Upjohn Company, Kalamazoo, MI). Study parameters were measured over a 24-week period. No differences in total cholesterol, high-density lipoprotein (HDL) cholesterol, triglycerides, apolipoproteins I and II, sex hormone-binding globulin, or serum MPA levels were noted between the sequential and 5 mg continuous group. The 10 mg MPA group did not have an increase in HDL or decrease in low-density lipoprotein as did the other groups.