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In 1948, the United States military government (OMGUS) played a crucial but invisible role in helping Germans in the western zones of occupation celebrate the centennial of the German Revolution of 1848. American officials viewed these celebrations as an important component in the democratization of Germany and as a means of demonstrating German-American cultural reconciliation in a highly public manner. Caught in an ambiguous, transitional period between punitive occupation and full civilian control, OMGUS pursued cultural diplomacy in the hopes that concretizing an ideological and cultural relationship based on history and shared values would help reorient German democracy and create a stable partner in central Europe, thereby serving long-term strategic goals in the Cold War. [ABSTRACT FROM AUTHOR]

In response to GIs' demands during World War II, the U.S. Army permitted widespread souvenir hunting and even looting, although these practices contravened both the Articles of War and, in some cases, international law. This article argues that although the War Department tried to reduce the number of captured guns that entered the United States, it declined to ban them because soldiers and officers disregarded regulations that deprived them of war trophies. This article proves the centrality of material rewards to soldier morale in World War II and establishes the difficulty of regulating the conduct of citizens drafted and sent to fight in foreign countries. [ABSTRACT FROM AUTHOR]

A common occupational task for the military is carrying heavy loads for long periods of time. The US Army has set a time standard of 3 hours to complete a 19.31-km march with a 15.9-kg ruck sack for combat arms training and specialty schools. The purpose of this study was to identify characteristics associated with 19.31-km foot march completion rates in Reserve Officers' Training Corps (ROTC) Cadets. Demographics, anthropometrics/body composition, Army Combat Fitness Test (ACFT) scores, and vertical countermovement jump (CMJ) data were collected on 65 ROTC cadets who conducted a 19.31-km foot march. Independent t tests and Mann-Whitney U tests compared variables between those who did and did not finish the foot march in less than 3 hours. Logistic regressions were used to calculate the odds of completing the foot march using military experience, fat-free mass, ACFT, and CMJ outcomes. Cadets who met the 3 hours standard had lower body fat percent, greater fat-free mass, higher ACFT scores, and higher CMJs than those who did not. In addition, for every one point increase in ACFT score and 1-kg increase in fat-free mass, a cadet's chances of finishing the foot march increased by 6.1 and 24%, respectively. When analyzing ACFT events separately, 2-mile run was the only significant variable, and for every 1 point increase in 2-mile run score, a cadet's chances of finishing the foot march increased by 9%. Thus, aspiring and current soldiers should train to improve aerobic fitness and build muscle mass in preparation for load carriage requirements. [ABSTRACT FROM AUTHOR]

Objective: To describe sex differences in concussion characteristics in US Service Academy cadets. Design: Descriptive epidemiology study. Setting: Four US service academies. Participants: 2209 cadets (n = 867 females, n = 1342 males). Independent Variable: Sex. Outcome Measures: Injury proportion ratios (IPR) compared the proportion of injuries by sex (females referent) for injury situation, certainty of diagnosis, prolonged recovery, recurrent injuries, mental status alterations, loss of consciousness (LOC), posttraumatic amnesia (PTA), retrograde amnesia (RGA), motor impairments, delayed symptom presentation, and immediate reporting. Main Results: Concussions from varsity/intercollegiate sports [IPR of 1.73, 95% confidence interval (CI) 1.43–2.10] and intramurals (IPR of 1.53, 95% CI 1.02–2.32) accounted for a larger proportion in males, whereas concussions outside of sport and military activities accounted for a smaller proportion among males (IPR of 0.70, 95% CI 0.58–0.85). The proportion of concussions with prolonged recovery was lower among males (IPR of 0.69, 95% CI 0.60–0.78), while concussions with altered mental status (IPR of 1.23, 95% CI 1.09–1.38), LOC (IPR of 1.67, 95% CI 1.17–2.37), PTA (IPR of 1.94, 95% CI 1.43–2.62), and RGA (IPR of 2.14, 95% CI 1.38–3.31) accounted for a larger proportion among males. A larger proportion of concussions that were immediately reported was observed in males (IPR of 1.15, 95% CI 1.00–2.31). Proportions of other characteristics (e.g., recurrent injuries) were not different between sexes. Conclusions: A higher proportion of concussions occurred outside of sport and military training for female cadets, who also displayed proportionally longer recovery times than males, despite males demonstrating a higher proportion of LOC, PTA, and RGA. Possible factors may include different mechanisms of injury outside of sport and military training, different biopsychosocial states associated with sex or injury context, and delayed injury reporting when outside of an observed environment, possibly secondary to perceived stigma about reporting injuries. [ABSTRACT FROM AUTHOR]

Introduction: Overuse musculoskeletal injuries (MSKI) remain a significant medical challenge in military personnel undergoing military training courses; further understanding of the biological process leading to overuse MSKI development and biological signatures for injury risk are warranted. The purpose of this study was to determine the association between overuse MSKI occurrence and physiological characteristics of allostatic load characterized as maladaptive biological responses to chronic stress measured by wearable devices in US Marine Corps officer candidates during a 10-wk training course. Methods: Devices recorded energy expenditure (EE), daytime heart rate (HR), sleeping HR, and sleep architecture (time and percentage of deep, light, rapid eye movement sleep, awake time, total sleep). Flux was calculated as the raw or absolute difference in the average value for that day or night and the day or night beforehand. Linear mixed-effect model analysis accounting for cardiorespiratory fitness assessed the association between overuse MSKI occurrence and device metrics (α = 0.05). Results: Sixty-nine participants (23 females) were included. Twenty-one participants (eight females) sustained overuse MSKI. Overuse MSKI occurrence in male participants was positively associated with daytime HR (β = 5.316, P = 0.008), sleeping HR (β = 2.708, P = 0.032), relative EE (β = 8.968, P = 0.001), absolute flux in relative EE (β = 2.994, P = 0.002), absolute EE (β = 626.830, P = 0.001), and absolute flux in absolute EE (β = 204.062, P = 0.004). Overuse MSKI occurrence in female participants was positively associated with relative EE (β = 5.955, P = 0.026), deep sleep time (β = 0.664, P < 0.001), and percent deep sleep (β = 12.564, P < 0.001) and negatively associated with absolute flux in sleeping HR (β = -0.660, P = 0.009). Conclusions: Overuse MSKI occurrences were associated with physiological characteristics of allostatic load, including chronically elevated HR and EE and greater time in restorative sleep stages, which may serve as biological signatures for overuse MSKI risk. [ABSTRACT FROM AUTHOR]

Context: Early identification of incoming military personnel at elevated odds for bone stress injury (BSI) is important for the health and readiness of the US military. Design: Prospective cohort study. Methods: Knee kinematic data of the incoming US Military Academy cadets were collected while performing a jump-landing task (The Landing Error Scoring System) using a markerless motion capture system and depth camera. Data on incidence of lower-extremity injury, including BSI, were collected throughout the study period. Results: A total of 1905 participants (452 females, 23.7%) were examined for knee valgus and BSI status. A total of 50 BSI occurred during the study period (incidence proportion = 2.6%). The unadjusted odds ratio for BSI at initial contact was 1.03 (95% confidence interval [CI], 0.94–1.14; P =.49). Adjusted for sex, the odds ratio for BSI at initial contact was 0.97 (95% CI, 0.87–1.06; P =.47). At the instant of maximum knee-flexion angle, the unadjusted odds ratio was 1.06 (95% CI, 1.02–1.10; P =.01), and the odds ratio was 1.02 (95% CI, 0.98–1.07; P =.29) after adjusting for sex. This suggests that there was not a significant enough association for an increase in the odds of BSI based on either degree of knee valgus. Conclusions: Our results did not demonstrate an association between knee valgus angle data during a jump-landing task and future increased odds of BSI in a military training population. Further analysis is warranted, but the results suggests the association between kinematics and BSI cannot be effectively screened by knee valgus angle data in isolation. [ABSTRACT FROM AUTHOR]

In spring and early summer 1945, U.S. forces in Germany were responsible for a wave of violent rapes of local women and girls. Investigating and prosecuting these crimes proved a major challenge for the U.S. Army's military justice system. This article examines ninety-five documented cases of rape and sexual assault from the period, involving more than two hundred uniformed culprits. Within the constraints imposed by wartime, investigators and members of courts-martial brought a surprising degree of professionalism to bear upon their task. Their efforts were, however, often frustrated by the army's system of post-trial review which, in response to public pressure, displayed a marked preferential option for perpetrators. The record thus indicates that in contrast to a pervasive "rape culture" at all levels of command, the failure to deliver justice to victims is attributable in these cases to more specific and identifiable causes. [ABSTRACT FROM AUTHOR]

Background: Previous studies have found that unintended pregnancy rates are higher among racial minorities and active duty servicewomen (ADSW), correlating with lower rates of effective contraceptive use. The Military Health System (MHS) provides universal health care benefit coverage for all ADSW, including access to all highly effective contraceptive (HEC) methods. This study investigated the association between race and HEC use among ADSW. Materials and Methods: We conducted a cross-sectional study using fiscal year 2016–2019 data from the MHS Data Repository for all ADSW ages 18–45 years. Statistical analyses included descriptive statistics and logistic regression models, adjusted and unadjusted, determining the odds of HEC use, overall and by method. Results: Of the 729,722 ADSW included in the study, 59.7% used at least one HEC during the study period. The highest proportions of users were aged 20–24 years, White, single, Junior Enlisted, and serving in the Army. Lower odds of HEC use were demonstrated in Black (odds ratio [OR] = 0.94, 95% confidence interval [CI] = 0.92–0.95), American Indian/Alaska Native (OR = 0.85, 95% CI = 0.82–0.89), Asian/Pacific Islander (OR = 0.81, 95% CI = 0.80–0.83), and Other (OR = 0.97, 95% CI = 0.94–0.99) ADSW compared with White ADSW. Conclusions: Universal coverage of this optional preventive service did not guarantee its use. The MHS can serve as a model for monitoring racial disparities in HEC use. [ABSTRACT FROM AUTHOR]

In occupations with high physical demands, strength relative to bodymass is an important measure as it signifies an individual's ability to control and move their body mass through space. The purpose of this investigation was to examine physical characteristics, training, and performance based on different magnitudes of relative strength. Subjects were 1,806 male and 319 female US Army soldiers. Sex, age, height, body mass, and physical training data were obtained by an electronic survey. Physical performance was measured by the Army Combat Fitness Test (ACFT), which includes a three-repetition maximum deadlift, standing power throw, hand release push-up, sprint-drag-carry, leg tuck, and two-mile run. The relative body mass deadlifted was calculated and categorized into 4 groups for men and 3 groups for women. An analysis of variance and post hoc least significant difference test were used to evaluate the differences in relative strength and physical performance. Overall, 33% of men deadlifted ≥1.5 times their body mass, while 30% of women deadlifted ≥1.25 times their body mass. Men and women deadlifting the highest percentage of their body mass (≥1.5 times for men and ≥1.25 times for women) outperformed those with lower relative strength within their own sex in all 6 ACFT events. In 4 of the 6 ACFT events, women who deadlifted ≥1.25 times their body mass had similar performance compared with men deadlifting 1 to 1.24 times their body mass and outperformed men deadlifting <1 times their body mass. Greater strength relative to body mass was associated with higher physical performance. [ABSTRACT FROM AUTHOR]

Purpose: A corpus of English matrix sentences produced by 60 native and nonnative speakers of English was developed as part of a multinational coalition task group. This corpus was tested on a large cohort of U.S. Service members in order to examine the effects of talker nativeness, listener nativeness, masker type, and hearing sensitivity on speech recognition performance in this population. Method: A total of 1,939 U.S. Service members (ages 18–68 years) completed this closed-set listening task, including 430 women and 110 nonnative English speakers. Stimuli were produced by native and nonnative speakers of English and were presented in speech-shaped noise and multitalker babble. Keyword recognition accuracy and response times were analyzed. Results: General(ized) linear mixed-effects regression models found that, on the whole, speech recognition performance was lower for listeners who identified as nonnative speakers of English and when listening to speech produced by nonnative speakers of English. Talker and listener effects were more pronounced when listening in a babble masker than in a speech-shaped noise masker. Response times varied as a function of recognition score, with longest response times found for intermediate levels of performance. Conclusions: This study found additive effects of talker and listener nonnativeness when listening to speech in background noise. These effects were present in both accuracy and response time measures. No multiplicative effects of talker and listener language background were found. There was little evidence of a negative interaction between talker nonnativeness and hearing impairment, suggesting that these factors may have redundant effects on speech recognition. [ABSTRACT FROM AUTHOR]

The COVID‐19 pandemic has led to economic turndowns, social restrictions, and family life alterations. The stress induced by the public health crisis and its consequences are beginning to be explored. This study examined stress experiences since the pandemic'sonset in work, financial, social, and health domainsamong a large sample of post‐9/11, United States military veterans. The sample, who separated from active‐duty service or deactivated from active status in a reserve component in 2016, completed an online survey (n = 3180) in 2020. Participants were 70% White non‐Hispanic, 81% male, and had an average age of 38 years. Frequencies and descriptive statistics were calculated. Female veterans and veterans of colour reported significantly higher levels of stress across most life domains. The results suggest White, male, post‐9/11 veterans may be somewhat protected from COVID‐19 stress, but that the pandemic is exacerbatinghealth and social disparities experienced by post‐9/11 veterans of colour and female veterans. Supports and comprehensive care, particularly targeted towardsat‐risk populations, are likely needed to provide sufficient resources for resiliency during and after the pandemic. [ABSTRACT FROM AUTHOR]

Public stigma is a significant deterrent to mental health service use for U.S. veterans. Media campaigns are often used to dispel stigmatizing beliefs and actions. Segmentation is an evidence-based practice for their effective use; however, little data has been published on veteran segments to target with anti-stigma messages. This article aims to identify and describe initial typologies of stigmatizing attitudes within a group of U.S. military veterans. Telephone-based cross-sectional surveys were conducted with a national random sample of veterans from 2014 to 2016 (N = 2142). Stigma outcomes were measured using a brief, validated instrument used in population-based surveys of public perceptions toward people with mental illness. Cluster analysis was conducted to identify specific groupings along multiple dimensions. A final four-cluster solution was identified among veterans with distinct patterns of attitudes toward mental illness and include: 1) the undecided, 2) the influencer, 3) the ambivalent, and 4) the potential ally. Several strategies were also identified for designing anti-stigma messaging toward these segments. This research demonstrates veterans can be segmented by attitudes to target with anti-stigma campaign messages. [ABSTRACT FROM AUTHOR]

Lower extremity injuries are prevalent in military trainees, especially in female and older trainees. Modifiable factors that lead to higher injury risk in these subgroups are not clear. The purpose of this study was to identify whether external loading variables during military‐relevant tasks differ by age and sex in U.S. Army trainees. Data was collected on 915 trainees in the first week of Basic Combat Training. Participants performed running and ruck marching (walking with 18.1 kg pack) on a treadmill, as well as double‐/single‐leg drop landings. Variables included: vertical force loading rates, vertical stiffness, first peak vertical forces, peak vertical and resultant tibial accelerations. Comparisons were made between sexes and age groups (young, ≤19 years; middle, 20–24 years; older, ≥25 years). Significant main effects of sex were found, with females showing higher vertical loading rates during ruck marching, and peak tibial accelerations during running and ruck marching (p ≤ 0.03). Males showed higher vertical stiffness during running and peak vertical tibial accelerations during drop landings (p < 0.01). A main effect of age was found for vertical loading rates during running (p = 0.03), however no significant pairwise differences were found between age groups. These findings suggest that higher external loading may contribute to higher overall injury rates in female trainees. Further, higher stiffness during running may contribute to specific injuries, such as Achilles Tendinopathy, that are more prevalent in males. The lack of differences between age groups suggests that other factors contribute more to higher injury rates in older trainees. Highlights: Female trainees showed higher lower extremity loading during running and ruck marching that may predispose them to higher rates of musculoskeletal injury during initial‐entry training.Male trainees showed higher stiffness during running, which may relate to an increased risk of specific musculoskeletal injuries that are more prevalent in males, such as Achilles tendinopathy.Overall, older trainees did not show different lower extremity loading patterns compared to younger, suggesting that these factors are not related to the increased risk for musculoskeletal injury in older trainees. [ABSTRACT FROM AUTHOR]

This submission is a piece of creative nonfiction that is partly memoir and partly a story about war memories in the context of the ongoing war in Ukraine. [ABSTRACT FROM AUTHOR]

The Department of Defense has mandated combat and operational stress control (COSC) efforts for the Services since 1999. Although several COSC-related programs have been implemented, few have undergone evaluation, and no standardized metrics have been established to assess their effectiveness and utility. The purpose of this review was to characterize the content and psychometrics of measures that have been utilized as outcome metrics in evaluations of COSC-related programs and interventions. Systematic literature searches were conducted for publications that: a) evaluated at least one measure from U.S. service members who participated in a program or intervention to prevent or reduce the adverse effects of combat and operational stress; and b) reported U.S. data on the internal consistency, test-retest reliability, convergent validity, and sensitivity/specificity of the identified measures. This process identified 15 measures for which psychometric properties were reviewed for acceptability based on recommended criteria. Identified measures varied from well-validated measures to newer instruments for which more data is needed on one or more of the target psychometric properties. Aside from internal consistency, psychometric data from U.S. military samples were sparse. Results further suggested that some measures might have reduced sensitivity in service members under certain conditions, such as large-scale screening. Additional studies are needed to validate COSC-relevant measures in service members. Future evaluations of programs and interventions for combat and operational stress should select measures that will increase the consistency of the literature, allow comparisons across studies, and ensure alignment with the objectives of identified programs. [ABSTRACT FROM AUTHOR]

This study examined racial and ethnic differences in the association between mild traumatic brain injury (mTBI) and work duty limitations in active-duty service members (ADSMs). This study used retrospective and cross-sectional data from the 2019–2021 Military Health System Data Repository on 910,700 ADSMs who were 18–64 years old and were grouped into racial and ethnic categories of White, non-Hispanic; Black, non-Hispanic; Hispanic/Latino; and Asian or Pacific Islander, non-Hispanic. Descriptive statistics showed that Black, Hispanic/Latino, and Asian or Pacific Islander patients had a lower proportion of having a diagnosis of mTBI compared to White patients (ps < 0.001). Further, the proportion of history of deployment varied by racial and ethnic group and deployment location. Multivariate logistic regression results showed odds of 1.52 (p < 0.001) for White patients with mTBI, odds of 1.61 (p < 0.001) for Black patients with mTBI, odds of 1.57 (p < 0.001) for Hispanic/Latino patients with mTBI, and odds of 1.99 (p < 0.001) for Asian or Pacific Islander patients with mTBI for being placed on work duty limitations. These results advance our understanding of the work duty limitations for racial/ethnic minority patients with mTBI in the Military Health System. [ABSTRACT FROM AUTHOR]

Purpose: The objectives of this study were to (a) describe normative ranges-- expressed as reference intervals (RIs)--for vestibular and balance function tests in a cohort of Service Members and Veterans (SMVs) and (b) to describe the interrater reliability of these tests. Method: As part of the Defense and Veterans Brain Injury Center (DVBIC)/Traumatic Brain Injury Center of Excellence 15-year Longitudinal Traumatic Brain Injury (TBI) Study, participants completed the following: vestibulo-ocular reflex suppression, visual-vestibular enhancement, subjective visual vertical, subjective visual horizontal, sinusoidal harmonic acceleration, the computerized rotational head impulse test (crHIT), and the sensory organization test. RIs were calculated using nonparametric methods and interrater reliability was assessed using intraclass correlation coefficients between three audiologists who independently reviewed and cleaned the data. Results: Reference populations for each outcome measure comprised 40 to 72 individuals, 19 to 61 years of age, who served either as noninjured controls (NIC) or injured controls (IC) in the 15-year study; none had a history of TBI or blast exposure. A subset of 15 SMVs from the NIC, IC, and TBI groups were included in the interrater reliability calculations. RIs are reported for 27 outcome measures from the seven rotational vestibular and balance tests. Interrater reliability was considered excellent for all tests except the crHIT, which was found to have good interrater reliability. Conclusion: This study provides clinicians and scientists with important information regarding normative ranges and interrater reliability for rotational vestibular and balance tests in SMVs. [ABSTRACT FROM AUTHOR]

Hearing difficulties are frequently reported by patients in audiology clinics, including patients with normal audiometric thresholds. However, because all individuals experience some difficulty understanding speech in noisy environments, it can be difficult to assess hearing complaints objectively across patients. Normative values help address this issue by providing an objective cutoff score for determining what is or is not clinically significant. The goal of this study was to establish normative values for the four-item hearing subscale of the Tinnitus and Hearing Survey (THS-H). Respondents completing the THS-H rate the level of difficulty understanding speech in the situations most commonly reported as being difficult: in the presence of noise, on TV or in movies, soft voices and group conversations. In this study, 22,583 US Service Members (SMs) completed the THS-H using an 11-point scale ranging from 0 (not a problem) to 10 (a very big problem). Responses to the four items were summed to produce values between 0 and 40. The distribution of the final scores was analyzed based on severity of hearing loss, age, and sex. Only 5% of SMs with clinically normal hearing scored above 27, so this score was selected as a cutoff for "clinically significant hearing problems." Due to its ease of administration and interpretation, the THS-H could be a useful tool for identifying patients with subjective hearing difficulty warranting audiological evaluation and management. [ABSTRACT FROM AUTHOR]

Objective: The offspring of US military service members may be at increased risk for eating disorders. However, no epidemiological studies to date have evaluated eating disorder incidence rates and prevalence estimates among military‐dependent youth. Method: This retrospective cohort study examined eating disorder diagnoses in the military healthcare system (MHS) from 2016 through 2021. Active duty and national guard military‐dependent youth, aged 10–17 years, who received care in the MHS via TRICARE Prime insurance, were identified by one or more ICD‐10 codes indicative of an eating disorder diagnosis (anorexia nervosa, bulimia nervosa, binge‐eating disorder, and other‐specified eating disorders). Results: During the 6‐year surveillance period, 2534 dependents received incident diagnoses of eating disorders, with a crude overall incidence rate of 1.75 cases per 10,000 person‐years. The most common diagnosis was other‐specified eating disorder, followed by anorexia nervosa, bulimia nervosa, and binge‐eating disorder. The crude annual incidence rate of all eating disorder diagnoses increased by nearly 65% from 2016 to 2021. Rates for all diagnoses were highest in 2020 and 2021. Period prevalence estimates were.08% for any eating disorder diagnosis,.01% for anorexia nervosa,.004% for bulimia nervosa,.004% for binge‐eating disorder, and.06% for other‐specified eating disorders. Discussion: The observed increase in eating disorder diagnoses during the surveillance period appeared to be driven by female dependents. More military dependents experienced a new‐onset diagnosis during the COVID‐19 pandemic compared to previous years. These findings highlight the need for eating disorder screening, identification, and treatment for dependents within the MHS. Public Significance Statement: Children of US military service members may be at increased risk for eating disorders. Results indicate new‐onset eating disorder cases increased 65% from 2016 to 2021, primarily among girls compared to boys. The most diagnosed and fastest growing diagnosis was other‐specified eating disorder. Rates of anorexia nervosa increased following the COVID‐19 pandemic. Findings highlight the need for eating disorder screening, identification, and treatment within the military healthcare system. [ABSTRACT FROM AUTHOR]

The article discusses dreams of U.S. Civil War soldiers and veterans of the war. The author argues that the various experiences of soldiers during the war could lead to emotional and psychological stress and damage, which were best illustrated by the recorded dreams of soldiers and veterans. The article also discusses the psychological impact of combat, trauma, and post traumatic stress disorder (PTSD).

This essay considers several recent publications on the history of sexual violence and World War II with a view to working through some of the issues currently shaping the field, including difficulties in using fragmentary sources, quantitative approaches to understanding sexual violence in war, and the inclusion of marginalized voices. Blending analysis of secondary works with insights from research conducted in national and regional archives across Britain, France, Germany, and the United States, it reflects on themes of race, gender, and nation, and concludes by offering some thoughts on the direction future scholarship on this subject may take. [ABSTRACT FROM AUTHOR]

An excerpt from a monthly progress report dated October 31, 1943, written by the U.S. Army Services Forces during the World War II campaign in Sicily in the North African Theater is presented, which discusses medical problems faced by military personnel resulting more from disease instead of injury in battle.

Background: The endorsement of symptoms upon initiation of a graduated return-to-activity (GRTA) protocol has been associated with prolonged protocols. It is unclear whether there are specific symptom clusters affecting protocol durations. Purpose: To describe the endorsement of specific concussion symptom clusters at GRTA protocol initiation and examine the association between symptom cluster endorsement and GRTA protocol duration. Study Design: Cohort study; Level of evidence, 2. Methods: This study was conducted among cadets enrolled at 3 US service academies. Participants completed an evaluation upon GRTA protocol initiation. Participants endorsing symptoms were binarized based on 6 symptom clusters (cognitive, emotional, insomnia, physical, sensitivity, and ungrouped). The primary outcome of interest was GRTA protocol duration based on symptom cluster endorsement severity. Prevalence rates were calculated to describe symptom cluster endorsement. Kaplan-Meier survival estimates and univariate and multivariable Cox proportional hazards regression models were calculated for all 6 symptom clusters to estimate GRTA protocol duration while controlling for significant covariates. Results: Data from 961 concussed participants were analyzed. Of these, 636 participants were asymptomatic upon GRTA protocol initiation. Among the 325 symptomatic participants, the physical symptom cluster (80%) was most endorsed, followed by the cognitive (29%), insomnia (23%), ungrouped (19%), sensitivity (15%), and emotional (9%) clusters. Univariate results revealed a significant association between endorsing cognitive (hazard ratio [HR], 0.79; p =.001), physical (HR, 0.84; p <.001), insomnia (HR, 0.83; p =.013), sensitivity (HR, 0.70; p <.001), and ungrouped (HR, 0.75; p =.005) symptom clusters and GRTA protocol duration. Endorsing physical (HR, 0.84; p <.001) and sensitivity (HR, 0.81; p =.036) clusters maintained a significant association with GRTA protocol duration in the multivariable models. Conclusion: Participants endorsing physical or sensitivity symptom clusters displayed GRTA protocols prolonged by 16% to 19% compared with participants not endorsing that respective cluster after controlling for significant covariates. [ABSTRACT FROM AUTHOR]

Aims: To test separatel the efficacy of a web‐based and a peer‐based brief intervention (BI), compared with an expanded usual care control (EUC) group, among military reserve component members using alcohoI in a hazardous and harmful manner. Design: In the randomized controlled trial, participants were assigned to: [1] web‐based BI with web‐based boosters (BI + web), [2] web‐based BI with peer‐based boosters (BI + peer) or [3] enhanced usual care (EUC). Setting: Michigan, USA. Participants: A total of 739 Michigan Army National Guard members who reported recent hazardous alcohol use; 84% were male, the mean age was 28 years. Intervention: The BI consisted of an interactive program guided by a personally selected avatar. Boosters were delivered either on the web or personally by a trained veteran peer. A pamphlet, given to all participants, included information on hazardous alcohol use and military‐specific community resources and served as the EUC condition. Measurements The primary outcome measure was binge drinking episodes in the past 30 days, measured at 12 months after the BI. Findings All randomized participants were included in the outcome analyses. In adjusted analyses, BI + peer [beta = −0.43, 95% confidence interval (CI) = −0.56 to −0.31, P < 0.001] and BI + web (beta = −0.34, 95% CI = −0.46 to −0.23, P < 0.001) reduced binge drinking compared with EUC. Conclusion: This satudy was a web‐based brief intervention for hazardous alcohol use, with either web‐ or peer‐based boosters, reduced binge alcohol use among Army National Guard members. [ABSTRACT FROM AUTHOR]

Background: Satisfaction with social roles and activities is an important outcome for postsurgical rehabilitation and quality of life but not commonly assessed. Purpose: To evaluate longitudinal patterns of the Patient-Reported Outcomes Measurement Information System (PROMIS) Satisfaction with Social Roles and Activities measure, including how it relates to other biopsychosocial factors, before and up to 6 months after sports-related orthopaedic surgery. Study Design: Cohort study (diagnosis); Level of evidence, 3. Methods: Participants (N = 223) who underwent knee and shoulder sports orthopaedic surgeries between August 2016 and October 2020 completed PROMIS computer-adaptive testing item banks and pain-related measures before surgery and at 6-week, 3-month, and 6-month follow-ups. In a generalized additive mixed model, covariates included time point; peripheral nerve block; the PROMIS Anxiety, Sleep Disturbance, and Pain Behavior measures; and previous 24-hour pain intensity. Patient-reported outcomes were modeled as nonlinear (smoothed) effects. Results: The linear (estimate, 2.06; 95% CI, 0.77-3.35; P =.002) and quadratic (estimate, 2.93; 95% CI, 1.78-4.08; P <.001) effects of time, as well the nonlinear effects of PROMIS Anxiety (P <.001), PROMIS Sleep Disturbance (P <.001), PROMIS Pain Behavior (P <.001), and pain intensity (P =.02), were significantly associated with PROMIS Satisfaction with Social Roles and Activities. The cubic effect of time (P =.06) and peripheral nerve block (P =.28) were not. The proportion of patients with a 0.5-SD improvement in the primary outcome increased from 23% at 6 weeks to 52% by 6 months postsurgery, whereas those reporting worsening PROMIS Satisfaction with Social Roles and Activities decreased from 30% at 6 weeks to 13% at 6 months. Conclusion: The PROMIS Satisfaction with Social Roles and Activities measure was found to be related to additional domains of function (eg, mental health, behavioral, pain) associated with postsurgical rehabilitation. [ABSTRACT FROM AUTHOR]

Background: US military servicemembers experience higher rates of posterior and combined-type instability as compared with their nonmilitary peers. Purpose: (1) To determine the prevalence of glenoid bone loss (GBL) in young, active-duty military patients with combined-type shoulder instability who underwent operative shoulder stabilization; (2) to evaluate whether GBL is associated with differences in postoperative outcomes; and (3) to identify factors associated with larger defects. Study Design: Case series; Level of evidence, 4. Methods: This study included active-duty military patients who underwent primary surgical shoulder stabilization for combined anterior and posterior capsulolabral tears between January 2012 and December 2018. Preoperative magnetic resonance arthrograms were used to calculate anterior, posterior, and total GBL using the "perfect circle" technique. We recorded patient characteristics, revisions, complications, return to duty, range of motion, and scores on multiple outcome measures (visual analog scale for pain, Single Assessment Numeric Evaluation, American Shoulder and Elbow Surgeons, and Rowe). GBL prevalence was compared by time to surgery, glenoid version, history of trauma, and number of anchors used for labral repair. Outcome scores, return to active duty, and revision procedures were compared by degree of anterior or posterior GBL: <13.5% (mild) versus ≥13.5% (subcritical). Results: GBL was noted in 28 (77.8%) of the 36 patients. Nineteen (52.8%) patients had anterior GBL, 18 (50.0%) had posterior, and 9 (25.0%) had combined. Four (11.1%) patients had subcritical anterior or posterior GBL. Increased posterior GBL was associated with history of trauma (P =.041), time to surgery >12 months (P =.024), and glenoid retroversion ≥9° (P =.010); increased total GBL was associated with longer time to surgery (P =.023) and labral repair requiring >4 anchors (P =.012); and increased anterior GBL was associated with labral repair requiring >4 anchors (P =.011). There were statistically significant improvements on all outcome measures, with no changes in range of motion postoperatively. No significant difference on any outcome score was observed between patients with mild and subcritical GBL. Conclusion: In our analysis, 78% of patients had appreciable GBL, suggesting that GBL is highly prevalent in this patient population. Longer time to surgery, traumatic cause, significant glenoid retroversion, and large labral tears were identified as risk factors for increased GBL. [ABSTRACT FROM AUTHOR]

The article discusses the international incident that ensued following the decision by U.S. consul to Morocco James DeLong arrested two Confederate sailors who had disembarked a French ship in Tangier, Morocco, in February 1862, particularly focusing upon French condemnation of DeLong's act, the impact of the arrests on Moroccan-U.S. relations, and the significance of the U.S. Civil War in the Middle East and North Africa.

The article discusses the significance of portrait photography to Northern soldiers and citizens during the U.S. Civil War. It examines the role of portrait photography in the management of death and the attempt to close the space between home and the battlefield, how portrait photographs enhanced correspondence, and how soldiers utilized portraiture during their service.

The article offers information on the prevalence of food insecurity among active-duty members of the U.S. military. Topics discussed include the comparison of food insecurity rates between military personnel and civilians; the demographics most affected by food insecurity within the military; and the challenges in accurately measuring this issue.

To a) demonstrate that adopting 'at risk' waist-to-height ratio (WHTR) cut-off points, recently approved by National Institute for Health and Care Excellence (NICE) and the United States Department of Defense (USDoD), will unfairly penalize shorter individuals and will be too lenient for taller individuals, b) to confirm that waist circumference (WC) of a sample of US service personnel, scales to approximately height0.5, supporting the notion that WC, to be independent of height (HT), should be normalized using WC.HT−0.5 (WHT•5R), and c) to identify the WHT•5R cut-off points that will reduce or eliminate this unwanted bias. We employed a three independent cross-sectional sample design. All n = 58,742 participants underwent anthropometric assessment of body mass, stature and waist circumference. The allometric power-law model WC=a.HT^b for US service personnel identified the height exponent to be b= 0.418 (95 % CI 0.251–0.585), confirming that the simple body-shape index for WC to be independent of HT, should be WC.HT−0.5. Chi-square tests of independence and for linear trend confirmed that by adopting WHTR cut-off point, shorter individuals (both service personnel and non-service participants) will be over penalized (classified as being 'at risk'). New WC independent-of-height ratio cut-off points were found to resolve this problem. Adopting WHTR cut-off thresholds (either 0.5 or 0.55) will lead to shorter adults being unfairly classified as being 'at risk' in terms of their central adiposity and general health status. Adopting new WHT•5R cut-off point thresholds were found to greatly reduce or eliminate this bias. [ABSTRACT FROM AUTHOR]

The article discusses the significance of the relationship between Union soldiers during the U.S. Civil War with unionist women in private residents in southern states, particularly focusing on the concept of intimate space as related to loyalty, the nation and U.S. government, and political sympathies.

US military physique and body composition standards have been formally used for more than 100 years. These metrics promote appropriate physical fitness, trim appearance, and long-term health habits in soldiers, although many specific aspects of these standards have evolved as evidence-based changes have emerged. Body composition variables have been shown to be related to many physical performance outcomes including aerobic capacity, muscular endurance, strength and power production, and specialized occupational tasks involving heavy lifting and load carriage. Although all these attributes are relevant, individuals seeking to improve military performance should consider emphasizing strength, hypertrophy, and power production as primary training goals, as these traits appear vital to success in the new Army Combat Fitness Test introduced in 2020. This fundamental change in physical training may require an adjustment in body composition standards and methods of measurement as physique changes in modern male and female soldiers. Current research in the field of digital anthropometry (i.e., 3-D body scanning) has the potential to dramatically improve performance prediction algorithms and potentially could be used to inform training interventions. Similarly, height-adjusted body composition metrics such as fat-free mass index might serve to identify normal weight personnel with inadequate muscle mass, allowing for effective targeted nutritional and training interventions. This review provides an overview of the origin and evolution of current US military body composition standards in relation to military physical readiness, summarizes current evidence relating body composition parameters to aspects of physical performance, and discusses issues relevant to the emerging modern male and female warrior. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

Background: Active-duty servicemembers are a population at risk for the development of posterior shoulder instability. While short-term outcomes after arthroscopic posterior labral repair for posterior shoulder instability are promising, there is a paucity of longer term follow-up data for this procedure. Purposes: The primary purpose was to report midterm outcomes after arthroscopic posterior labral repair in active-duty military patients for posterior shoulder instability without bone loss. The secondary purpose was to determine if outcomes varied between anchor types used. Study Design: Cohort study; Level of evidence, 3. Methods: Preoperative and postoperative outcomes, with a minimum 3-year follow-up, for a visual analog scale for pain, the Single Assessment Numeric Evaluation (SANE), the American Shoulder and Elbow Surgeons (ASES) score, and the Rowe score were collected and analyzed. A separate subgroup analysis was performed comparing the outcomes of patients who underwent repair with biocomposite anchors versus those who underwent repair with all-suture anchors. Results: A total of 73 patients with a mean follow-up of 82.55 ± 24.20 months met the inclusion criteria and were available for analysis. As a whole, the cohort demonstrated statistically and clinically significant improvements in outcome scores at final follow-up. Preoperative and postoperative range of motion did not vary significantly. While the difference in final outcome scores between the 2 anchor types did not reach statistical significance, a statistically significantly larger proportion of patients who underwent repair with all-suture anchors versus those who underwent repair with biocomposite anchors met the Patient Acceptable Symptom State for the SANE (97.14% vs 78.95%, respectively; P =.0180) and the ASES score (88.57% vs 68.42%, respectively; P =.0171). The proportion of patients who achieved the substantial clinical benefit or surpassed the minimal clinically important difference, however, did not vary by anchor type. Overall, 70 patients (95.89%) remained on active duty and were able to return to preinjury work and recreational activity levels. There were 3 patients (4.11%) who had recurrent posterior instability. Conclusion: This population of active-duty servicemembers undergoing posterior labral repair for posterior labral instability without bone loss demonstrated a statistically and clinically significant improvement in midterm outcomes, a low recurrence rate, and a rate of return to active duty of 95.89%, regardless of the anchor type used. [ABSTRACT FROM AUTHOR]

Background: Although research has shown that exposure to potentially traumatic and morally injurious events is associated with psychological symptoms among veterans, knowledge regarding functioning impacts remains limited. Methods: A population-based sample of post-9/11 veterans completed measures of intimate relationship, health, and work functioning at approximately 9, 15, 21, and 27 months after leaving service. Moral injury, posttraumatic stress, and depression were assessed at ~9 months post-separation. We used Latent Growth Mixture Models to identify discrete classes characterized by unique trajectories of change in functioning over time and to examine predictors of class membership. Results: Veterans were assigned to one of four functioning trajectories: high and stable, high and decreasing, moderate and increasing, and moderate and stable. Whereas posttraumatic stress, depression, and moral injury associated with perpetration and betrayal predicted worse outcomes at baseline across multiple functioning domains, moral injury associated with perpetration and depression most reliably predicted assignment to trajectories characterized by relatively poor or declining functioning. Conclusions: Moral injury contributes to functional problems beyond what is explained by posttraumatic stress and depression, and moral injury due to perpetration and depression most reliably predicted assignment to trajectories characterized by functional impairment over time. [ABSTRACT FROM AUTHOR]

Objective This study examines Patient-Reported Outcome Measurement Information System (PROMIS ®)-29 v1.0 outcomes of chiropractic care in a multi-site, pragmatic clinical trial and compares the PROMIS measures to: 1) worst pain intensity from a numerical pain rating 0–10 scale, 2) 24-item Roland-Morris Disability Questionnaire (RMDQ); and 3) global improvement (modified visual analog scale). Design A pragmatic, prospective, multisite, parallel-group comparative effectiveness clinical trial comparing usual medical care (UMC) with UMC plus chiropractic care (UMC+CC). Setting Three military treatment facilities Subjects 750 active-duty military personnel with low back pain Methods Linear mixed effects regression models estimated the treatment group differences. Coefficient of repeatability to estimate significant individual change. Results We found statistically significant mean group differences favoring UMC+CC for all PROMIS®-29 scales and the RMDQ score. Area under the curve estimates for global improvement for the PROMIS®-29 scales and the RMDQ, ranged from 0.79 to 0.83. Conclusions Findings from this pre-planned secondary analysis demonstrate that chiropractic care impacts health-related quality of life beyond pain and pain-related disability. Further, comparable findings were found between the 24-item RMDQ and the PROMIS®-29 v1.0 briefer scales. [ABSTRACT FROM AUTHOR]

The article reports that Weight cycling is prevalent in sports/professions with body composition standards, and has been associated with weight management behaviours that may contribute to suboptimal diet quality and weight gain. US Army Soldiers may be at increased risk of weight cycling relative to civilians due to mandated body composition standards.

Maladaptive anger and aggression are common in US military veterans and increase risk for impaired social relationships and functioning, justice‐involvement and violence. Early life (before age 18) adversity predisposes veterans to later life psychopathology, though the link to increased later life anger is unclear. We analysed cross‐sectional data of 158 post‐9/11 veterans from the Translational Research Center for Traumatic Brain Injury and Stress Disorders study with and without a history of early life adversity (ns = 109 and 49, respectively). We explored the relationship among major clinical variables and current veteran anger (Dimensions of Anger Reactions) and whether the associations with these variables differed among participants with and without a history of retrospective self‐reported early life adversity (Childhood Trauma Questionnaire). In the overall sample, posttraumatic stress disorder (PTSD) and depression severities had the strongest associations with current veteran anger (βs = 0.261 and 0.263; p‐values = 0.0022 and 0.0103, respectively). In the subsample without early life adversity, only PTSD severity was significantly associated with anger (β = 0.577, p = 0.0004). In the early life adversity subsample, this strong association weakened and was no longer significant (β = 0.168, p = 0.1007); instead, anxiety and depression severities showed moderate associations with anger (βs = 0.243 and 0.287, p‐values = 0.0274 and 0.0130, respectively). Findings suggest that clinicians should screen veterans with history of early life adversity for depression and anxiety when anger is present. [ABSTRACT FROM AUTHOR]

Novel sampling methods have been utilized to reach "hidden" and "hard-to-reach" populations. These communities are referred to in this way because they are also stigmatized and may not wish to disclose their identities to researchers. Men who have sex with men, people who inject drugs, and female sex workers, for example, have been sampled using respondent driven sampling (RDS) worldwide. RDS leverages the social ties between members of a group to build rapport and acceptance of a research endeavor, which results in high levels of participation through peer-to-peer recruitment. Despite the success of "state of the art" RDS in reaching "hidden" populations, researchers have encountered challenges in implementing "state of the art" RDS studies in multiple contexts and have addressed these challenges through novel adaptations to the methodology including situations where populations have weak ties to each other, difficulty reaching seed participants, and small personal networks which limit length of recruitment chains and increases number of seeds. In the context of a study of LGBT military personnel using RDS, we adapted seed recruitment methods, explored analytic approaches, and implemented a comprehensive fraud checking protocol to determine if these adaptations would successfully produce a diverse sample of LGBT active duty military personnel. The present paper describes the steps taken to overcome some of the common challenges encountered by other researchers in reaching hidden populations using RDS and offers methodological insights to other researchers who seek to work with this population of interest. [ABSTRACT FROM AUTHOR]

The article discusses the use of statistical analysis and data in the database known as the Early Indicators of Later Work Levels, Disease, and Death that was established by scholar Robert W. Fogel to better understand U.S. Civil War soldiers and veterans. It examines several facets of the project including its research on military leadership, desertion, and the experiences of prisoners of the war. It also discusses the experiences of African American soldiers.

The article discusses fraternization between Union and Confederate soldiers during the U.S. Civil War conflict known as the Siege of Petersburg in Petersburg, Virginia, in 1864 and 1865. It examines the concept of resistance to authority as a method by which soldiers expressed individualism, the concept of the third space, and the trading of goods among soldiers.

The article discusses beliefs among Americans during the U.S. Civil War concerning the potential health risks posed by clothing and the relationship between clothing, disease, and the significance of appropriate clothing to the well-being of armies and displaced citizens during the war. It also discusses the significance of the medical profession's study of how disease spread during the Civil War era.