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

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

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

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

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

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

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

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

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

Background For persons entering congregate settings, optimal severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) arrival surveillance screening method, nucleic acid amplification test (NAAT) versus rapid antigen detection test (RADT), is debated. To aid this, we sought to determine the risk of secondary symptomatic coronavirus disease 19 (COVID-19) among military trainees with negative arrival NAAT or RADT screening. Methods Individuals who arrived for US Air Force basic military training from 1 January–31 August 2021 were placed into training groups and screened for SARS-CoV-2 via NAAT or RADT. Secondary symptomatic COVID-19 cases within 2 weeks of training were then measured. A case cluster was defined as ≥5 individual symptomatic COVID-19 cases. Results 406 (1.6%) of 24 601 trainees screened positive upon arrival. The rate of positive screen was greater for those tested with NAAT versus RADT (2.5% vs 0.4%; RR: 5.4; 95% CI: 4.0–7.3; P <.001). The proportion of training groups with ≥1 positive individual screen was greater in groups screened via NAAT (57.5% vs 10.8%; RR: 5.31; 95% CI: 3.65–7.72; P <.001). However, NAAT versus RADT screening was not associated with a difference in number of training groups to develop a secondary symptomatic case (20.3% vs 22.5%; RR:.9; 95% CI:.66–1.23; P =.53) or case cluster of COVID-19 (4% vs 6.6%; RR:.61; 95% CI:.3–1.22; P =.16). Conclusions NAAT versus RADT arrival surveillance screening method impacted individual transmission of COVID-19 but had no effect on number of training groups developing a secondary symptomatic case or case cluster. This study provides consideration for RADT arrival screening in congregate settings. [ABSTRACT FROM AUTHOR]

Numerous traditional assessments have been developed to determine suitability of US military recruits for cyber careers. Cyber career field managers expressed a concern there may be well-qualified candidates that lack cyber knowledge, and therefore are not identified with knowledge-based tests. Technological advances such as serious gaming may provide opportunities to assess constructs traditional methods do not effectively measure. The purpose of this effort was to identify potential gains in validity that could be achieved beyond traditional methods through the use of serious games for several cyber jobs (both for enlisted and officer positions). Throughout this phase of research, an extensive literature review of military and civilian assessments targeted cyber occupations. Then, military subject matter experts in these career fields provided input and guidance (e.g., focus on aptitudes and traits as knowledge and skill are rapidly outdated). A gap analysis between all measures of such constructs identified a short list of candidates for measurement in a serious game. A survey of 800 airmen in the 1N4X1A, 3D1X2 and 17DEX/SX career fields was conducted; 290 respondents identified six constructs to be the focus for serious game assessment. The game was developed, and constructs validated on a sample chosen to model Air Force enlisted recruits. Additional psychometric data from enlistees and cyber trainees will be gathered once COVID-19 restrictions are lifted. [ABSTRACT FROM AUTHOR]

Aptitude requirements for US Air Force officer commissioning include completion of a college degree and minimum scores on the Air Force Officer Qualifying Test (AFOQT) Verbal and Quantitative composites. Although the AFOQT has demonstrated predictive validity for officer training, the Air Force has striven to improve predictive validity and diversity. To this end, a Situational judgment Test (SJT) was added to the AFOQT in 2015. SJT development was consistent with recommendations to broaden the competencies assessed by the AFOQT with the goal of providing incremental validity, while reducing adverse impact for historically underrepresented groups. To ensure content validity and realism, SJT development was based on competencies identified in a large-scale analysis of officership and input from junior officers in scenario and response generation and scoring. Psychometric evaluations have affirmed its potential benefits for inclusion on the AFOQT. An initial study showed the SJT to be perceived as highly face valid regardless of whether it was presented as a paper-and-pencil test (with narrative or scripted scenarios) or in a video-based format. Preliminary studies demonstrated criterion-related validity within small USAF samples, and a larger Army cadet sample. Additionally, operational administration of the SJT since 2015 has demonstrated its potential for improving diversity (i.e., reduced adverse impact relative to the AFOQT Verbal and Quantitative composites). Predictive validation studies with larger Air Force officer accession samples are ongoing to assess the incremental validity of the SJT beyond current AFOQT composites for predicting important outcomes across accession sources. [ABSTRACT FROM AUTHOR]

Introduction: The effectiveness of the Stress Management and Resilience Training (SMART) with U.S. military personnel has not been reported in the literature. The purpose of this study was to examine the effectiveness of SMART in increasing resilience in Air Force healthcare personnel. Materials and Methods: We conducted a pilot, randomized preventive trial with active component Air Force healthcare personnel. SMART was offered via an in-person, 2-h training session delivered through face-to-face or synchronous video teleconference training, or via a self-paced, computer-based training. A baseline survey included demographics questions and the Connor–Davidson-10 Resilience Scale (CD-10), Perceived Stress Scale (PSS), Generalized Anxiety Disorder Scale (GAD-7), and overall quality of life (QOL) measure. Follow-up surveys with the CD-10, PSS, GAD-7, and quality of life were sent to participants at 12, 18, and 24 weeks after completing SMART. Results: Fifty-six service members completed the baseline assessment and were randomized to either the in-person modality (comprised of video teleconference or face-to-face training) or the computer-based training modality, and 49 participants completed SMART. Significant increases in median CD-10 scores were observed among all participants, showing a 4-point (14%), 6-point (21%), and 5-point (17%) increase at week-12, -18, and -24, respectively, from the baseline. A significant overall decrease in median PSS scores from baseline were observed, with 5.5-points (22%), 7.81-points (32%), and 8.5-points (35%) decrease at 12, 18, and 24 weeks post-SMART, respectively. Conclusions: In this pilot study, SMART demonstrated significant and meaningful improvements in self-reported CD-10 and PSS-14 scores at 12, 18, and 24 weeks post-training completion. A future replication of the study is necessary to evaluate the effectiveness of SMART on a larger scale. [ABSTRACT FROM AUTHOR]

Introduction: Polycystic ovary syndrome (PCOS) is the most prevalent reproductive endocrinopathy in women, ranging from 5% to 26% depending on diagnostic criteria applied. Common manifestations of PCOS include overweight and obesity, abnormal menstrual cycles, pelvic pain, increased facial and body hair, acne, and infertility. These abnormalities and associated complications have significant military operational and readiness implications. There is a large gap in research regarding active duty servicewomen (ADW) with PCOS. Therefore, the purpose of this study is to describe ADW's experience of living with PCOS and to describe the service-branch-specific differences among these women. Materials and Methods: Moderator's guide, audiotapes, transcripts, and field notes. This was a qualitative descriptive study using focus groups and individual interviews. The David Grant Medical Center Institutional Review Board at Travis AFB, CA, USA, approved the study protocol. Women with PCOS were recruited from U.S. Air Force, Army, and Navy locations. Data were analyzed using constant comparative content analysis. Results: Twenty-three servicewomen from 19 occupations across the Army, Navy, Air Force, and Marine Corps participated. Three overarching categories emerged: (1) challenges managing PCOS symptoms, (2) navigating the military health care system, and (3) navigating PCOS as a service member. Conclusions: Servicewomen may have significant career consequences related to PCOS sequelae, such as overweight, obesity, uncontrolled menstrual cycle, and pain. Managing the myriad of symptoms can distract women while deployed, in austere conditions, or at their home stations. As one of the most common cardiometabolic, reproductive endocrinologic conditions in women, PCOS has not received the attention, awareness, education, or research necessary to sufficiently support ADW with this condition. It is imperative that evidence-based strategies are developed to inform relevant and high-quality care for these warfighters. Future qualitative studies are needed to further describe specific stressors and needs of ADW with PCOS. Future intervention studies are also needed to evaluate effective management options for ADW with PCOS. [ABSTRACT FROM AUTHOR]

The number of women in the military has more than tripled over the past 50 years, increasing from 5% in the 1970s to 17% in 2023, making them essential for global health engagement and military operations. Provider competence and confidence are barriers to the consistent availability of preventive, gynecologic, and reproductive services for women across service locations and duty platforms. The Defense Health Board recommends standardizing services and improving the availability and scope of services for women at every point of care. In direct conflict with these recommendations, however, is a congressional call for a drawdown of medical forces, which creates a need for operationally trained clinicians with a broad skill set including comprehensive care for women. Advanced practice registered nurses, such as family and women's health nurse practitioners, are key assets to fill this gap on military medical health-care teams. At the request of the U.S. Air Force, the Graduate School of Nursing at the Uniformed Services University began offering a Women's Health Nurse Practitioner (WHNP) program in 2014. The WHNP curriculum was layered onto the existing Family Nurse Practitioner program so that Family Nurse Practitioner students receive enhanced education in women's health and WHNP students are prepared to meet the holistic, primary care needs of patients across the lifespan in addition to caring for women with obstetric and urogenital health concerns. This article highlights the value of dual-certified Family Nurse Practitioners and WHNPs in the military health-care system. These Uniformed Services University alumni are uniquely prepared to provide comprehensive primary and specialty care for female warfighters across the lifecycle from stable, well-resourced duty stations to austere, operational settings or deployment platforms. [ABSTRACT FROM AUTHOR]

In this study, we aimed to investigate the impact of acute fatigue on pistol shooting performance among Air Force marksmen. We compared the accuracy, precision, speed-accuracy trade-off, shooting cycle time, and hits on a silhouette target among 12 Brazilian Air Force servicemen (M age = 21.5, SD – 1.6 years) under both fatigue and non-fatigue conditions in a crossover design. In the fatigued condition, the participants performed a fatigue protocol composed of side runs, vertical jumps, push-ups, running, and burpees exercises before shooting. Participants performed the countermovement jump and the plyometric push-ups tests on a contact mat before and immediately after the fatigue protocol to compare the heights achieved pre- and post-fatigue. Paired t- tests showed a significant performance reduction of 34.36% and 40.02% for the countermovement jump and plyometric push-ups, respectively, indicating that participants were fatigued in their lower and upper limbs. In the non-fatigued condition, no exercise was performed before shooting. Results indicated no significant differences between conditions on shooting precision (p =.125; ES:.54), speed-accuracy trade-off (p =.261; ES =.33), hits within the silhouette (p =.167; ES =.41), or shooting cycle times (p =.868; ES =.05); but accuracy was greater (p =.025; ES:.54) when fatigued. We concluded that overall shooting performance was not impaired by physical fatigue, and shooting accuracy appeared to be improved. Perhaps physical fatigue was not enough to impair shooting accuracy in this young adult group, as accuracy decline is expected instead when shooters are in an exhausted state. Further research is needed to confirm these findings and test this presumption. [ABSTRACT FROM AUTHOR]

To protect civilian global positioning system (GPS) users from spoofing attacks, the U.S. Air Force Research Lab has proposed the chips-message robust authentication (Chimera) enhancement for the L1C signal. In particular, the Chimera fast channel allows users to authenticate the received GPS signal once every 1.5 or 6 s, depending on the out-of-band source utilized for receiving the fast channel marker keys. However, for many moving receiver applications, receivers often use much higher GPS measurement rates, at 5-20 Hz. In this work, we derive a stochastic reachability (SR)-based detector to perform continuous GPS signal verification and state estimation between Chimera authentications. Our SR detector validates the received GPS measurement against any self-contained sensor, such as an inertial measurement unit, in the presence of bounded biases in the sensor error distributions. We demonstrate via Monte Carlo simulations that our detector satisfies a user-defined false alarm requirement during nominal conditions, while successfully detecting a simulated spoofing attack. We further demonstrate that our SR state estimation filter successfully bounds the true state during both authentic and spoofed conditions. [ABSTRACT FROM AUTHOR]

This study conducts the first large-sample comparison of the impact of dropsondes in the tropical cyclone (TC) inner core, vortex, and environment on NWP-model TC forecasts. We analyze six observing-system experiments, focusing on four sensitivity experiments that denied dropsonde observations within annuli corresponding with natural breakpoints in reconnaissance sampling. These are evaluated against two other experiments detailed in a recent parallel study: one that assimilated and another that denied dropsonde observations. Experiments used a basin-scale, multistorm configuration of the Hurricane Weather Research and Forecasting (HWRF) Model and covered active periods of the 2017–20 North Atlantic hurricane seasons. Analysis focused on forecasts initialized with dropsondes that used mesoscale error covariance derived from a cycled HWRF ensemble, as these forecasts were where dropsondes had the greatest benefits in the parallel study. Some results generally support findings of previous research, while others are novel. Most notable was that removing dropsondes anywhere, particularly from the vortex, substantially degraded forecasts of maximum sustained winds. Removing in-vortex dropsondes also degraded outer-wind-radii forecasts in many instances. As such, in-vortex dropsondes contribute to a majority of the overall impacts of the dropsonde observing system. Additionally, track forecasts of weak TCs benefited more from environmental sampling, while track forecasts of strong TCs benefited more from in-vortex sampling. Finally, inner-core-only sampling strategies should be avoided, supporting a change made to the U.S. Air Force Reserve's sampling strategy in 2018 that added dropsondes outside of the inner core. Significance Statement: This study uses a regional hurricane model to conduct the most comprehensive assessment to date of the impact of dropsondes at different distances away from the center of a tropical cyclone (TC) on TC forecasts. The main finding is that in-vortex dropsondes are most important for intensity and outer-wind-radii forecasts. Particularly notable is the impact of dropsondes on TC maximum wind speed forecasts, as reducing sampling anywhere would degrade those forecasts. [ABSTRACT FROM AUTHOR]

Introduction Every year, approximately 35,000 recruits enter the United States Air Force Basic Military Training (BMT). Musculoskeletal problems are particularly vexing for BMT because a broad array of differentials render definitive diagnosis burdensome and while most sufferers will fully recover, healing often requires protracted training delays resulting in increased unrecoverable training costs to the program. The purpose of this study is to conduct a case-control study of basic military trainees entering service from 2012 to 2015 to assess detectable differences in demographics, retention, and health care utilization. Materials and Methods This is a retrospective case-control study of existing data and records obtained from existing and active information record systems for individuals who attended BMT between the years 2012 and 2015. Cohort assignment was based on incidence of first stress fracture diagnosis (i.e. having a select diagnosis code in one's medical record) relative to arrival at BMT. Health care utilization is operationalized as medical encounter frequencies and associated international classification of disease (ICD) codes occurring for all patients from BMT recruit date of arrival to 6 months post-graduation (i.e. 180 days). Results The primary dataset includes 132,359 distinct individuals, of which 129,637 (98%) had no history of stress fracture diagnosis and 1,487 (1%) of which have a diagnosis of stress fracture more than 60 days after arrival at BMT; these are assigned to the CONTROL group. There are 1,235 (0.9%) assigned to the CASE group. CASE members presented with 30.1 unique ICD-10 codes post-graduation compared to 6.3 in the CONTROL group. Six of the top thirteen ICD-10 codes were musculoskeletal in nature and all presented significantly higher rates for the CASE group. Conclusions Trainees who suffered a bone stress injury (BSI) during the United States Air Force BMT advanced in rank on par with trainees who did not, but BSI sufferers exhibited greater health care utilization than those who did not suffer BSI. The cost to replace a trainee unable to complete BMT is considerable; however, it is also important to consider the reduction in resiliency and readiness to the Department of Defense and the financial burdens from increased health care utilization. The 2-fold increase in BSI presentation in the graduated control group reflects that more needs to be done for all populations to identify better proactive efforts to foundationally support wellness and prevention rather than accept injury as the status quo. [ABSTRACT FROM AUTHOR]

Introduction The COVID-19 pandemic has had a significant impact on the psychological health of individuals. The pandemic has contributed to increased anxiety, elevated rates of depression, and worsening suicidal ideation among civilians. Reported rates of burnout are also elevated as employees and employers adapted to ever-changing work environments, finding it increasingly difficult to maintain a work-life balance. The objective of this study is to determine how the COVID-19 pandemic impacted the psychological health and rates of suicidal ideation of active duty military personnel in the USA. Materials and Methods A total of 2055 military personnel and military-adjacent employees stationed at a U.S. Air Force base completed a self-report survey that was administered six times from January 2020 to December 2021. Validated scales assessed measures of psychological health and suicidal ideation. General Estimating Equations were used to examine how indicators of time and psychological health predicted suicidal ideation in a military population. Results Life satisfaction, happiness, feeling life is worthwhile, depression severity, and suicidal ideation did not statistically change across the six time points. Worry (P  < .01) and depression (P  < .001) did decrease significantly, while burnout (P  = .01) significantly increased across these time points. Feeling life is worthwhile significantly predicted reduced suicidal ideation (B  = -.19; SE = 0.05), while depression (B  = 0.11; SE = 0.03), depression severity (B  = 0.24; SE = 0.05), worry (B  = 0.06; SE = 0.02), and burnout (B  = 0.15; SE = 0.07) predicted increased suicidal ideation. Conclusions The rates of depression and worry decreased throughout the pandemic for those in the study while rates of suicidal ideation remained constant, demonstrating the potential resilience of military personnel and military-adjacent employees in response to the COVID-19 pandemic. However, burnout increased and significantly predicted elevated rates of suicidal ideation, highlighting the importance of focusing on reducing workplace stressors for military personnel. [ABSTRACT FROM AUTHOR]

Introduction The U.S. Air Force implemented the Integrated Operational Support model, which involves embedding health care professionals within operational units to meet the health needs of the airmen. This study assessed the extent to which airmen sought out both traditional and embedded mental health services, as well as perceptions of factors that hinder or encourage health care–seeking behaviors. Materials and Methods A mixed-methods approach including a web-based occupational psychological health assessment and semi-structured interviews was used to assess airmen's experiences with seeking mental health care services. Results A total of 447 Remotely Piloted Aircraft operators participated in an occupational psychological health assessment (42% response rate) in 2018, and 15 airmen across five high operational tempo, restricted-access installations completed a semi-structured interview (60% participation rate) in 2021. From the occupational assessment, females (33%) sought care from the traditional mental health clinic significantly more than males (21%; χ2 = 5.10, P  = .02). However, there were no significant gender differences in seeking embedded mental health services. Respondents who had not sought out help from either the traditional clinic or embedded services were significantly more likely to seek assistance from embedded mental health services (M  = 4.29, SD = 2.09) over the traditional clinic (M  = 3.92, SD = 1.90), t (205) = 4.94, P  < .001. A resounding interview theme was the deep appreciation that airmen expressed for the availability of embedded mental health professionals. Airmen also discussed factors that hinder health care–seeking behaviors with the top-reported factor being the stigma associated with seeking mental health. The top three reported factors that encourage health care–seeking behaviors included leadership and mental health professionals normalizing care, trust in embedded mental health professionals, and ease of access to care. Conclusions Findings suggest that having mental health professionals integrated within the unit brings the care straight to the airmen and may reduce the stigma associated with airmen asking for help. [ABSTRACT FROM AUTHOR]

Introduction Clinical documentation is an essential component of the provision of medical care, enabling continuity of information across provider and site handoffs. This is particularly important in the combat casualty care setting when a single casualty may be treated by four or more or five completely disparate teams across the roles of care. The Battlefield Assisted Trauma Distributed Observation Kit (BATDOK) is a digital battlefield clinical documentation system developed by the Air Force Research Laboratory to address this need. To support the deployment of this tool, we integrated BATDOK into a commercially available virtual reality (VR) medical simulation platform used by the U.S. Air Force and Defense Health Agency personnel in order to provide an immersive simulation training experience which included battlefield documentation. Methods A multidisciplinary team consisting of medical educators, VR simulation engineers, emergency physicians and pararescuemen, and BATDOK developers first developed a specification for a virtual BATDOK capability, including a detailed listing of learning objectives, critical interfaces and task plans, and sensor integrations. These specifications were then implemented into the commercially available Virtual Advancement of Learning for Operational Readiness VR Medical Simulation System and underwent developmental testing and evaluation during pararescueman training exercises at the Air Force Special Operations Command Special Operations Center for Medical Integration and Development. Results and Conclusions The BATDOK capability was successfully implemented within the VR Medical Simulation System. The capability consisted of a virtual tablet with replicated interfaces and capabilities based on the developed specifications. These capabilities included integrated point-of-care ultrasound capability, multi-patient management, vitals sign monitoring with sensor pairing and continuous monitoring, mechanism of injury documentation (including injury pattern documentation), intervention logging (including tourniquets, dressing, airways, lines, tubes and drains, splints, fluids, and medications), and event logging. The capability was found to be operational and in alignment with learning objectives and user acceptance goals. [ABSTRACT FROM AUTHOR]

Dr. Marilyn A. Ray, nurse scholar and retired United States Air Force (USAF) veteran and former flight nurse, began her nursing scholarship in Canada. She was influenced by the experiences and interprofessional scholarly ideas that she encountered along her career trajectory. Her early love of the air and space led her to the United States Air Force Nurse Corps, where she served as a flight nurse during the Vietnam war era, followed by leadership positions in nursing education, administration, practice, and research. Dr. Ray's contributions to nursing knowledge includes two nursing theories and a caring inquiry methodology. Dr. Ray is helping to create a new caring science certificate program at Florida Atlantic University, Christine E. Lynn College of Nursing. In this column, Dr. Ray shares the story of her scholarly influences and how they helped her care for her husband and gain insight into her contributions to nursing knowledge development. [ABSTRACT FROM AUTHOR]

After the end of World War II, many military air bases in Greenland were abandoned with all the material left in place. One of these sites was the Bluie East Two military air base. A specific feature of this area is that it contained thousands of old barrels formerly used for fuel storage. In 2019, a rehabilitation of this area began. A few months prior to the rehabilitation, our expedition visited the area and mapped it using an unmanned aerial vehicle (UAV). This made it probably the latest documentation before the start of the sanitation. The aim of such mapping was to estimate the number of barrels in a given location. The second objective was to monitor the progress of the rehabilitation over the years. For this purpose, satellite data were acquired for the years 2019 through 2022. A supervised classification was performed to automatically detect sites with barrel occurrences, which enabled subsequent change detection. We conclude that a total of 33,786 old barrels were located in the investigated area in 2019. However, we suggest this number is a lower estimate of the actual number of barrels due to the factors we mention in our paper. The results further indicate that between the years 2019 and 2022 the barrels were removed from more than half of the area. [ABSTRACT FROM AUTHOR]

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

The given text is a collection of book reviews from the Air & Space Operations Review. The first review discusses the book "Networked Nonproliferation" by Onderco, which focuses on the negotiations and diplomatic maneuvering surrounding the 1995 NPT Review and Extension Conference. The review highlights the complexity of the negotiations and their importance in international politics. The second review is about the book "Eagles Overhead" by Dietz, which explores the history of the US Air Force Forward Air Controllers. The review praises the book for its comprehensive and approachable approach to the topic. The third review discusses "Britain's Secret Defences" by Chatterton, which reveals the secret plans of the British government to recruit and train civilians to counter a potential German invasion during World War II. The review commends the book for shedding light on this lesser-known aspect of British history. [Extracted from the article]

For over seventy years, the continued belief in the efficacy of strategic bombing has dominated United States Air Force thinking in times of war and peace. In addition, the core principles of air power articulated by the Air Corps Tactical School continue to reside in USAF doctrine. Despite the outcomes of the Korean, Vietnam, Iraq, and Afghanistan wars, which have all demonstrated the effectiveness of joint operations and the limitations of strategic bombing, the ACTS tenets remain embedded in the very DNA of airmen and continue to influence how the United States Air Force views the modern air, space, and cyber domains. [ABSTRACT FROM AUTHOR]

Differentiating performance components across military occupations is critical to developing assessments and other applications for matching people to occupations in the military. However, identifying occupation-specific performance components is challenging and resource intensive. The current paper summarizes different methods the services use to define and identify occupation-specific performance components. The paper concludes with recommendations and future directions for advancing the military's needs for information and data on occupation-specific performance components. [ABSTRACT FROM AUTHOR]

The article discusses the need for the U.S. Air Force to change its policies regarding marijuana in response to the legalization of medical marijuana in some states and a shift in public sentiment. It describes the toxicology and effects of marijuana, as well as the Air Force's drug testing program and disciplinary measures for illegal drug use. It explains a recommended proactive approach for leading the Department of Defense and federal government in a new direction regarding marijuana.

Introduction: The U.S. Air Force (USAF) Basic Military Training (BMT), a rigorous training program for all enlisted members of the USAF, trains roughly 36,000 recruits annually. Transforming civilians into ready warrior airmen has inherent risks to trainee health, which has infrequently included death. While the average death rate at USAF BMT has decreased between 1956 and 2007 due to process improvement and preventive medicine efforts, further review is warranted to examine the deaths that have occurred since the last published period (1997-2007) and to determine the impact policy changes and updates have had on death rates since that time. Therefore, the purpose of this paper is to identify death rates and types from 2008 to 2020, explore policy implementation, and identify areas needing further improvement or modifications to the overall safety, fitness, and health of USAF BMT trainees. Materials and Methods: All deaths were examined and reviewed from 2008 through 2020 for trainees attending the USAF BMT using medical records and autopsy reports. Death rates were calculated using the total population of trainees in a given year as well as over the entire 13-year study period. Results: From 2008 to 2020, five deaths occurred among USAF BMT trainees (one cardiac, two exertional sickling due to sickle cell trait, one infection, and one suicide). This resulted in an overall average death rate of 1.08 per 100,000 trainees, as compared to 1.46 per 100,000 from 1997 to 2007. The last death in the study period occurred in 2016. Conclusion: A modest downward trend of average death rate has continued since 2007, and no deaths from 2016 through 2020 represents the longest time frame without any deaths at USAF BMT over all times reported (dating back to 1956) which suggest that emergency best practice policies are/have improved. However, cardiac death rate and suicide rate have not changed since the last report. Policies and practices should be continuously reviewed and refined to reduce the risk of death at USAF BMT. [ABSTRACT FROM AUTHOR]

Background: Alcohol misuse poses significant public health concerns in the U.S. Military. An Alcohol Misconduct Prevention Program (AMPP), which includes a brief alcohol intervention (BAI) session, plus random breathalyzer program, has been shown to reduce alcohol-related incidents (ARIs) among Airmen undergoing training. Purpose: The current study sought to examine whether a booster BAI administered at the end of Airmen's training reduced ARIs out to a 1-year follow-up. Methods: Participants were 26,231 U.S. Air Force Technical Trainees recruited between March 2016 and July 2018. Participants were cluster randomized by cohort to two conditions: AMPP + BAI Booster or AMPP + Bystander Intervention. The primary analysis was a comparison of the interventions' efficacies in preventing Article 15 ARIs at a 1-year follow-up, conducted using a generalized estimating equations logistic regression model controlling for covariates. Results: There was no significant difference by condition in Article 15 ARIs at the 1-year follow-up (P = .912). Conclusions: Findings suggest that a booster may not be necessary to produce maximum effects beyond the initial AMPP intervention. It is also possible that alcohol behaviors changed as a result of the intervention but were not captured by our outcome measures. Future research should consider alternative outcomes or participant-tracking measures to determine whether a different or more intensive BAI booster is effective. The majority of Article 15 ARIs were for underage drinking; therefore, developing an intervention focused on this problem behavior could lead to large reductions in training costs in the military. [ABSTRACT FROM AUTHOR]

BACKGROUND: Per- and polyfluoroalkyl substances (PFAS) are a component of firefighting foams used at military installations. Although high PFAS exposures have been related to cancer risks among civilian populations, the effects for military personnel are unclear. OBJECTIVES: We investigated associations between serum PFAS concentrations and testicular germ cell tumors (TGCT) among U.S. Air Force servicemen. METHODS: This nested case–control study involved active-duty Air Force servicemen with sera from the Department of Defense Serum Repository. We selected 530 cases and 530 controls individually matched on birth date, race and ethnicity, year entered the service, and year of sample collection, with prediagnostic serum samples collected between 1988 and 2017. A second prediagnostic sample, collected a median of 4 y after the first, was selected for 187 case–control pairs. Seven PFAS were quantified using isotope-dilution tandem mass spectrometry. Odds ratios (ORs) and 95% confidence intervals (CIs) from conditional logistic regression adjusting for military grade, number of deployments, and, in some models, other PFAS, estimated associations between PFAS concentrations (categorized using quartiles among controls) and TGCT. RESULTS: Elevated concentrations of some PFAS were observed for military employment in firefighting [perfluorooctanesulfonic acid (PFOS), perfluorohexanesulfonic acid (PFHxS), perfluorooctanoic acid] and service at a base with high PFAS concentrations in drinking water (PFHxS). Elevated PFOS concentrations in the second sample were positively associated with TGCT [OR for fourth vs. first quartile (ORQ4)=2.6, 95% CI: 1.1, 6.4; 푝trend =0.02], including after adjustment for other PFAS (ORQ4 =4.6, 95% CI: 1.4, 15.1; 푝trend =0.009). Associations with PFOS in the first/only samples were weak and not statistically significant. Elevated concentrations of perfluorononanoic acid were inversely associated with TGCT, whereas results were null for other PFAS. DISCUSSION: We identified service-related predictors of PFAS concentrations and increased TGCT relative risks with elevated PFOS concentrations among Air Force servicemen. These findings warrant further investigation in other populations and military service branches. [ABSTRACT FROM AUTHOR]

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

Prioritizing artificial intelligence readiness in the US Air Force is vital. To confront this challenge, squadron commanders must spark (1) data-centric innovation and (2) artificial intelligence ideation at the warfighter level. Fusing Department of Defense policy with current management theory on digital transformation and strategy, this article explores crafting a data strategy, managing data infrastructure, cultivating technical talent, and redesigning organizational processes, all in support of fostering innovative culture at the squadron level. This unique action plan allows leaders to catalyze data-centric innovation into the artificial intelligence ideation process, posturing squadrons and parallel organizations in other services for digital warfare. [ABSTRACT FROM AUTHOR]

Recent congressionally directed changes gave the Defense Health Agency authority, direction, and control of military treatment facilities. But limited authorities resulted in the agency's pursuit of capacity, typically measured via medical productivity standards. The Air Force maintains command authorities to organize, train, equip, and provide capabilities, including medical, to the combatant commander. These dual authorities converge at the military treatment facility, producing a conflict between capacity and capability. Tension, already present due to the dual nature of the mission to provide support and healthcare delivery to beneficiaries, has increased and threatens the Air Force's ability to medically support combat operations, generating risk to the operational mission. With the increasing likelihood and stakes of armed conflict, senior leaders can mitigate the risk to the operational mission by decreasing the tension and risk at Air Force MTFs. [ABSTRACT FROM AUTHOR]

The purpose was to examine five types of adversity and their associations with separating from military service among a nationally representative sample of U.S. National Guard and Reserve (NGR) service members. Multivariate logistic regression analyses were conducted to examine the association between separating from the service and adversities, and demographic differences in adversities experienced among those who had separated from the service and those who stayed in the service. Those who left the military were more likely to report financial (OR = 1.65, 95% CI = 1.01–2.70) and healthcare access problems (OR = 2.21, 95% CI = 1.10–4.46). Among those who left the military, female service members were more likely to experience interpersonal adversity (OR = 4.28, 95% CI = 1.15–15.87), and Army and Marine service members were more likely to experience job-employment adversity (OR = 4.92, 95% CI = 1.50–16.12) and financial adversity (OR = 6.46, 95% CI = 1.22–34.33). Separating service members experience financial adversity and challenges with healthcare access. Interpersonal difficulties are particularly experienced by female service members, and job/employment difficulties experienced by Army and Marine veterans. Continued efforts are needed to facilitate service delivery for NGR separating service members who need them. [ABSTRACT FROM AUTHOR]

Upper-ocean temperatures from 72 airborne expendable bathythermographs (AXBTs) collected during U.S. Air Force Hurricane Hunter flights into Hurricane Dorian (2019) over a 72-h period are examined. Three transects collected behind the storm reveal increased cross-track sea surface temperature gradient magnitudes as Dorian intensified to a category-5 hurricane and slowed while approaching the Bahamas. The cold wake, evident in vertical and horizontal cross sections from in situ and satellite sensors, appears as an expected response to tropical cyclone passage. Atypical, however, is the 2°C surface cooling observed over 36 h in a pair of transects ahead of hurricane force winds in Dorian, likely due to changes in the tropical cyclone's translation speed and direction and/or proximity to the Gulf Stream and continental shelf. Collocated AXBT pairs document a dynamical regime shift from mixing to upwelling as Dorian slows and turns. Relationships between time-integrated wind stress and sea surface temperature indicate track-relative differences varying with storm translation speed and heading changes, paralleling the shift in cooling dynamics. Significance Statement: We studied in situ and satellite ocean temperature observations beneath Hurricane Dorian (2019) as the storm moved slowly, turned north, and weakened near Grand Bahama Island. We found a distinct change in the spatial distribution of cool upper-ocean temperatures beneath the storm, which indicated a shift in the primary cooling mechanism from ocean mixing to upwelling. This mechanism shift is important because hurricanes depend on warm ocean temperatures for energy, and upwelling roughly doubles the area of cooling beneath the storm. Our results highlight the effects of large heading changes on the upper-ocean response beneath tropical cyclones, especially in tandem with slow translation speeds. [ABSTRACT FROM AUTHOR]

Decomposition techniques are an important component of modern heuristics for large instances of vehicle routing problems. The current literature lacks a characterization of decomposition strategies and a systematic investigation of their impact when integrated into state-of-the-art heuristics. This paper fills this gap: We discuss the main characteristics of decomposition techniques in vehicle routing heuristics, highlight their strengths and weaknesses, and derive a set of desirable properties. Through an extensive numerical campaign, we investigate the impact of decompositions within two algorithms for the capacitated vehicle routing problem: the Adaptive Large Neighborhood Search of Pisinger and Ropke (2007) and the Hybrid Genetic Search of Vidal et al. (2012). We evaluate the quality of popular decomposition techniques from the literature and propose new strategies. We find that route-based decomposition methods, which define subproblems by means of the customers contained in selected subsets of the routes of a given solution, generally appear superior to path-based methods, which merge groups of customers to obtain smaller subproblems. The newly proposed decomposition barycenter clustering achieves the overall best performance and leads to significant gains compared with using the algorithms without decomposition. History: Erwin Pesch, Area Editor for Heuristic Search and Approximation Algorithms. Funding: This work was supported by the U.S. Air Force [Grant FA9550-17-1-0234], the Ministerio de Ciencia e Innovación (Juan de la Cierva Formación), H2020 Marie Skłodowska-Curie Actions [Grant 945380], the Ministero dell'Università e della Ricerca [Grant 2015JJLC3E_002], the Conselho Nacional de Desenvolvimento Científico e Tecnológico [Grant 308528/2018-2], and the Fundação Carlos Chagas Filho de Amparo à Pesquisa do Estado do Rio de Janeiro [Grant E-26/202.790/2019]. Supplemental Material: The software that supports the findings of this study is available within the paper and its Supplemental Information (https://pubsonline.informs.org/doi/suppl/10.1287/ijoc.2023.1288) as well as from the IJOC GitHub software repository (https://github.com/INFORMSJoC/2022.0048) at (http://dx.doi.org/10.5281/zenodo.7613129). [ABSTRACT FROM AUTHOR]

Introduction Diabetes and obesity pose a significant burden for the U.S. military beneficiary population, creating a great need to provide evidence-based diabetes and obesity prevention services for military personnel, retirees, and their dependents. Despite increasing dissemination of the Diabetes Prevention Program (DPP) lifestyle intervention nationwide, formal evaluation of implementation of this highly successful program is limited in the military setting. The purpose of this study is to prospectively evaluate delivery of a direct adaptation of a 1-year DPP lifestyle intervention at a U.S. Air Force medical facility, Wright-Patterson Medical Center (WPMC), to determine the feasibility of delivery of the program in a group of at-risk active duty military, retirees, and family members, as well as assess effectiveness in improving weight and other risk factors for type 2 diabetes. Materials and Methods A pre/post study design was utilized to evaluate feasibility and effectiveness of the DPP Group Lifestyle Balance (GLB), an up-to-date, 22-session direct adaptation of the DPP curriculum, at WPMC. Participants chose to complete the 1-year program either in coach-led face-to-face groups or via DVD with weekly telephonic coach contact. The study was approved by the University of Pittsburgh and WPMC Institutional Review Boards. Results A total of 99 individuals enrolled in the study, with 83 (84%) and 77 (78%) completing 6- and 12-month follow-up assessments, respectively. The mean age of participants at baseline was 57 (range 20-85 years), with 63% being female. The group was comprised of individuals who were non-Hispanic White (73.7%), non-Hispanic Black (18.2%), and other race or Hispanic ethnicity (8.1%). Within this group, there were 10 active duty military, 37 retirees, and 52 family members. The DPP-GLB program was shown to be feasible to implement in this military healthcare setting as demonstrated by the high engagement over the course of the year-long program. Significant improvements were shown in the two main behavioral goals: mean weight (−12.8 lbs, −6.3%, P  < .001) and mean physical activity (PA) (+18.9 Met-hrs/wk, P  < .001). In addition, significant improvements in other diabetes and cardiovascular risk factors including low-density lipoprotein cholesterol, fasting insulin, diastolic blood pressure, and waist circumference were noted, as well as improvement in health-related quality of life. Conclusions These results demonstrate that the DPP-GLB program delivered via face-to-face groups or DVD was feasible and effective in improving weight, PA levels, and diabetes and cardiovascular risk factors in this group of active and retired military personnel and their family members. The program was well received by the program participants as well as the WPMC team. These findings offer a model for provision of the DPP-GLB program throughout the Military Health System. [ABSTRACT FROM AUTHOR]

Introduction There is a gap in the nursing literature about the significant contributions of executive military nurse leaders to the advancement of nursing as a profession and into interprofessional leadership roles. Many executive military nurse leaders have demonstrated the value of nursing leadership in non-traditional roles and paved the way to expand the leadership opportunities for nurses who would follow. The purpose of this study is to explore the personal stories, experiences, leadership strategies, and lessons learned through the eyes of the first nurse to achieve the rank of Major General in the U.S. Air Force. Materials and Methods The oral history method guided the exploration of participant memories and experiences. In compliance with the Oral History Association guidelines, the investigator obtained Institution Review Board permission, informed consent, and audiotaped interviews. An expert panel provided feedback on the appropriate language use in semi-structured interview questions with Air Force nurse executives. The oral history method provided a framework for the semi-structured interview and analysis. Active listening techniques such as exploration, clarifying, and paraphrasing helped foster deep listening. A graduate research assistant transcribed the 4-hour interview verbatim. The primary investigator emailed a copy of the transcript to the participant to verify accuracy and clarify content. Analysis involved examination and interpretation of the professional, military, nursing, and participant's personal perspective to enhance historical understanding. Three independent coders extracted prevalent themes and subthemes during analysis. Results Repetitive major themes of courage, figuring it out, and winning others over emerged during data analysis. The major theme of courage has corresponding subthemes of tenacity, risk-taking, and re-writing the narrative. The major theme of figuring it out has subthemes of optimism, creativity, connectedness, learning, and managing change. Lastly, the winning others over theme has subthemes of emotional intelligence, teamwork, role-model/mentor, and moving from outsider to insider. The leadership strategies of taking calculated risks while remaining calm, being open to opportunities that she had never considered, and spending time learning new skills contributed to repeated advancement into higher leadership positions not previously held by a nurse within the U.S. Air Force. Conclusion The interview is packed full of leadership lessons that are just as relative today as 20 years ago. This presentation will conclude with a discussion of the most effective leadership strategies, the lasting impact of the leadership accomplishments, and current implications for nurse leaders today. [ABSTRACT FROM AUTHOR]

Aims The purpose of this study was to evaluate the effects of altered environmental conditions, specifically elevated temperature at various levels of expected relative humidity (RH), on the inactivation of SARS-CoV-2 when applied to U.S. Air Force aircraft materials. Methods and results SARS CoV-2 (USA-WA1/2020) was spiked (∼1 × 105 TCID50) in either synthetic saliva or lung fluid, dried onto porous (e.g. Nylon strap) and nonporous materials (e.g. bare aluminum, silicone, and ABS plastic), placed in a test chamber and exposed to environmental conditions ranging from 40 to 51.7 °C and RH ranging from 0% to 50%. The amount of infectious SARS-CoV-2 was then assessed at various timepoints from 0 to 2 days. Warmer test temperatures, higher RH, and longer exposure duration resulted in higher inactivation rates per material type. Synthetic saliva inoculation vehicle was more readily decontaminated compared to materials inoculated with synthetic lung fluid. Conclusions SARS-CoV-2 was readily inactivated below limit of quantitation (LOQ) for all materials inoculated using synthetic saliva vehicle within 6 hours when exposed to environmental conditions of 51.7 °C and RH ≥ 25%. Synthetic lung fluid vehicle did not follow the general trend of an increase in RH resulting in increased efficacy. The lung fluid performed best at the 20%–25% RH range to achieve complete inactivation below LOQ. [ABSTRACT FROM AUTHOR]

Military families are exposed to a unique constellation of risk factors, which may impact maltreatment outcomes. The present study examined prospective relationships between demographic, health, birth-related, and military-specific risk factors identified prior to a child's birth on their risk for maltreatment in the first two years of life. Data from the Millennium Cohort Study, Department of Defense (DoD) operational records and Family Advocacy Program data on met-criteria maltreatment, and Birth and Infant Health Research program data on suspected maltreatment were linked for 9076 service member parents. Discrete time survival analysis showed that preterm birth increased risk of maltreatment while parents' older age, physical health, and service in the Navy or Air Force decreased risk. Building on DoD's New Parent Support Program, findings suggest the need for universal and targeted prevention efforts, beginning during pregnancy, which limit or eliminate risk factors for maltreatment in military families. [ABSTRACT FROM AUTHOR]

The Air Force Officer Qualifying Test (AFOQT) is the primary selection tool for officer applicants in the U.S. Air Force (USAF) for nearly seven decades. The AFOQT is revised and modified periodically, with rigorous equating and linking effort to ensure comparability and connectivity across forms. The most recent version of AFOQT is Form T that includes 10 cognitive ability and knowledge subtests. Despite the continuing validation effort of the AFOQT across forms, it was mostly directed to the general population of officer applicants, but not to any specific subpopulation. The current investigation reported three studies in an attempt to provide evidence for factor structure and criterion-related validity of AFOQT Form T for pilot applicants via four analytical approaches: meta-analysis, exploratory factor analysis (EFA), confirmatory factor analysis (CFA), and structural equation modeling (SEM). The results suggested that AFOQT Form T data are best represented by a bifactor model with a general ability and four specific abilities, and that each latent construct has a distinct predictive utility for pilot performance criteria. [ABSTRACT FROM AUTHOR]

Utilizing the Job Demands-Resources (JD-R) theory as a guiding framework, the current study examined the relationships between job demands (work role strain) and occupational outcomes (burnout and job satisfaction) and assessed how job resources (team member social support and leader social support) mitigated the impact of high job demands for U.S. Air Force remotely piloted aircraft (RPA) operators. A total of 905 active duty U.S. Air Force RPA operators participated in a web-based occupational health assessment. Study findings confirmed that work role strain proved to be strongly related to negative occupational outcomes – increased burnout and reduced job satisfaction. Compelling evidence emerged suggesting that boosting job resources (i.e., team member and leader social support) may be a promising point of intervention to mitigate negative occupational outcomes. By investigating ongoing job demands that result in a higher incidence of burnout and job dissatisfaction, as well as job resources that protect against burnout and job dissatisfaction, researchers and practitioners can continue to introduce supportive resources at crucial points to alleviate the adverse consequences of occupational stress and burnout. Applying the JD-R theory to these findings highlights the importance of job resources for RPA operators and other employees working in high-risk, high-demand career fields. Implications and future directions are discussed. [ABSTRACT FROM AUTHOR]

Mixed-gender couples presenting for couple therapy are at 2–3 times higher risk for physical intimate partner violence (IPV) than community couples. However, it is unclear if this elevation of relative risk is the same in the general population because relationship distress and treatment-seeking are often confounded. We used archival data from three representative U.S. civilian samples and one representative U.S. Air Force sample to test the hypothesis that clinically significant relationship distress is associated with increased risk of various forms of IPV. In these community samples, those in mixed-gender distressed relationships were at 2–3 times higher risk than those in nondistressed relationships for any physical IPV during the past year and at 3–6 times higher risk for clinically significant psychological and physical IPV during the past year. Given that the increase in IPV risk is similar for individuals in distressed community relationships and therapy-seeking relationships, the prior findings of the elevated rates of IPV in clinical samples are unlikely to be due to therapy-seeking. Although epidemiological risk involves statistical, not causal, associations, the increased co-occurrence of IPV in distressed mixed-gender couples fits with numerous theories of IPV and has implications for both screening and future research. [ABSTRACT FROM AUTHOR]