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Dicks, ND, Ketterling, JJ, Wooldridge, JD, Shoemaker, ME, and Barry, AM. Evaluating Army Combat Fitness Test scores: The influence of sleep, nutrition, and body composition in army reserve officers' training corps cadets. J Strength Cond Res 40(2): 218-224, 2026-The U.S. Army's Holistic Health and Fitness (H2F) program highlights the importance of physical, mental, nutritional, spiritual, and sleep domains for optimizing soldier readiness. Reserve Officers' Training Corps (ROTC) cadets must meet physical fitness standards, including the Army Combat Fitness Test (ACFT), yet often lack access to H2F resources. This cross-sectional study investigated how lifestyle factors-physical activity (PA), sleep quality, nutritional habits, and fat-free mass (FFM)-influence ACFT performance among Army ROTC cadets. Forty-six cadets (21.6 &#xb1; 2.0 years; women = 7) completed validated questionnaires assessing PA (IPAQ), sleep (PSQI), and nutrition (REAP-S), and underwent anthropometric testing. ACFT scores were obtained from the cadre within 30 days of survey completion. Cadets scoring &#x2265;540 on the ACFT demonstrated significantly better sleep quality (PSQI; p < 0.01) and shorter sleep latency than those scoring <540. Backward linear regression identified PSQI as a significant negative predictor of ACFT scores ( &#x3b2; = -0.42, p = 0.007), with REAP-S and FFM showing marginal significance. Correlation analyses revealed small, significant associations between BF%, MVPA, and PSQI. The final regression model explained 22.4% of the variance in ACFT scores. These results emphasize the importance of sleep quality and body composition in cadet performance, suggesting that targeted education and training strategies could improve readiness in ROTC populations. Future programs should consider holistic approaches to cadet wellness, especially without formal H2F support.

Few studies have investigated body mass index (BMI) and physical fitness factors related to coronavirus disease (COVID)-19 hospitalizations among U.S. active duty service members. This investigation examined associations between measures of physical fitness, BMI, and Army physical fitness test (APFT) performance with COVID-19 hospitalizations of U.S. Army active duty soldiers. From May 2020 through November 2021, 13,074 male soldiers were diagnosed with COVID-19 (90 hospitalized, 12,984 non-hospitalized) who also had an APFT and BMI record no more than 9 months from the COVID-19 diagnosis date. Female soldiers were excluded due to insufficient numbers of COVID-19 hospitalizations. In adjusted logistic regression models controlling for race and ethnicity as well as comorbidities, and including age, BMI, and their interactions, both BMI (adjusted odds ratio [aOR] 1.07; 95% CI 1.01, 1.14; p=0.021), and the age and BMI interaction were statistically significant (aOR 1.01; 95% CI 1.00, 1.02; p=0.004). Each additional year of age amplified the odds of hospitalization by an additional 1% for every 1 unit increase in BMI. Development and maintenance of a healthy body weight may reduce likelihood of COVID-19 hospitalization and sustain individual and unit health and medical readiness. For male U.S. Army active duty soldiers, the association between having a higher BMI and COVID-19 hospitalization was amplified by age, indicating about a 1% increase in the odds of hospitalization per BMI unit for each additional year of age. Maintaining a healthy body weight may reduce the risk of COVID-19 related hospitalization for military personnel. The U.S. Army's Holistic Health and Fitness Program is one example of a comprehensive health program established to simultaneously enhance several facets of military health and fitness.

This survey study assesses public awareness of military medical research domains, perceptions of civilian benefit of military medical research, and regional variations.

On June 25, 2024, the first Kenyan contingent of the Multinational Security Support Mission (MSSM) deployed to Haiti amid escalating gang violence and civil unrest. To support medical operations, Aspen Medical USA established a Role II field hospital under contract with Amentum through the US Army&#x2019;s Logistics Civil Augmentation Program V (LOGCAP V), providing surgical and resuscitative care for MSSM forces, Haitian National Police, and American contractors. Central to this capability was the creation of a multinational walking blood bank (WBB) capable of delivering fresh whole blood in emergencies. Establishing this network posed significant challenges, including logistics, regulatory frameworks, donor pool limitations, cultural considerations, and infectious disease screening. Despite these obstacles, WBB drills consistently demonstrated the ability to provide fresh whole blood from a same nation cohort within 45&#x2013;55&#xa0;min of WBB activation. This review outlines the operational, regulatory, and cultural complexities of building a multinational WBB in Haiti and its implications for future austere medical operations.

The U.S. Army's Ask, Care, Escort (ACE) suicide gatekeeper training has been the annual requirement for all personnel since 2009; however, this training has never been formally evaluated. The present study evaluated three updated versions of ACE: a training for Army leaders (ACE-Suicide Intervention), a training for basic combat trainees (ACE for Basic Combat Training and One Station Unit Training), and a standard training for all personnel (ACE for the Force). Self-report surveys measured pre- to posttraining changes in objective and subjective knowledge and stigma, as well as preparedness, self-efficacy, and likelihood to engage in gatekeeper behaviors. Implementation outcomes, such as training acceptability, suitability, and usability were also assessed. Across these evaluations, participants reported that knowledge and gatekeeper behaviors significantly improved from pre- to posttraining. Implementation metrics revealed a high degree of acceptability and relevance for all three ACE trainings. Overall, the findings of these evaluations suggest important changes in key suicide prevention outcomes following the ACE suite of trainings. Further longitudinal assessment is needed to establish the full effectiveness of gatekeeper interventions in the Army. (PsycInfo Database Record (c) 2026 APA, all rights reserved).

This article explores the uses of historical cartography in the territorial dispute between the states of Piau&#xed; and Cear&#xe1; in a civil suit (1.831/2011) filed in Brazil's Supreme Court. We base our analysis on historical maps from the seventeenth to the nineteenth centuries in order to understand continuities and transformations in how this region is represented. This analysis is then contrasted with documentation from the Overseas Historical Archive and the Brazilian Army's Technical Report on the dispute in order to relate the active role played by the environment, political influences with representations of the zones involved in the dispute, showing how cartography still serves to "reflect the world." Este artigo explora os usos da cartografia hist&#xf3;rica na disputa territorial entre Piau&#xed; e Cear&#xe1;, ajuizada em a&#xe7;&#xe3;o c&#xed;vel origin&#xe1;ria n.1.831/2011 no Supremo Tribunal Federal. Propomos um exerc&#xed;cio anal&#xed;tico a partir de mapas hist&#xf3;ricos dos s&#xe9;culos XVII a XIX, no intento de perceber as continuidades e transforma&#xe7;&#xf5;es nos modos de representar a regi&#xe3;o. Contrastamos esse exerc&#xed;cio com documenta&#xe7;&#xe3;o do Arquivo Hist&#xf3;rico Ultramarino e com o Relat&#xf3;rio T&#xe9;cnico do Ex&#xe9;rcito Brasileiro sobre a disputa. Com isso, buscamos relacionar a ag&#xea;ncia do ambiente, influ&#xea;ncias pol&#xed;ticas e representa&#xe7;&#xf5;es das zonas litigantes, demonstrando como a cartografia permanece utilizada como &#x201c;espelho do mundo&#x201d;.

Tuberculosis (TB) remains a force health protection threat to the U.S. military, particularly in crucial populations at increased risk of exposure or re-activation. This analysis examined TB testing trends and the prevalence of latent tuberculosis infection (LTBI) among U.S. Army active component soldiers from 2014 through 2023, the first decade following a major policy shift to targeted testing. Defense Medical Surveillance System data indicate that a total of 339,465 TB tests were administered, primarily (81.0%) tuberculin skin tests. Of those tests, 22,762 (6.7%) were positive, leading to the identification of 18,018 (5.3%) LTBI diagnoses. Asian/Pacific Islander soldiers demonstrated the highest LTBI diagnosis proportion (10.2%), followed by non-Hispanic Black (8.6%), Hispanic (5.6%), and Non-Hispanic White (2.9%) soldiers; the data also include 'other' (6.8%) and 'unknown/missing' (3.6%) categories. Recruits exhibited a significantly higher LTBI diagnosis proportion (11.0%) than non-recruits (3.6%), highlighting a high prevalence of LTBI among incoming personnel at time of accession. A marked decline in testing volume-a 72% decrease from 2014 to 2023 in the annual numbers of tests administered-followed the 2013 U.S. Army Medical Command policy shift. The substantially higher average proportion (6.7%) of positive tests from 2014 to 2023 compared to the average from the pre-policy era (1.3%) of universal screening demonstrates the successful concentration of testing resources on those most at risk, thereby improving diagnostic yield within a low-prevalence military force. This analysis's findings describe the epidemiological outcomes of the Army's targeted testing policy and underscore the importance of ongoing, targeted surveillance to mitigate TB risks in military settings. The 2013 policy that successfully transitioned the U.S. Army from universal tuberculosis screening to a targeted, risk-based strategy reduced testing volume by 72% over the next decade. The decline in tuberculosis testing volume coincided with a substantial increase in diagnostic yield, with the overall positivity proportion rising from 1.3% in the pre-policy era to 6.7% in 2023. The 2013 policy revision to a targeted, risk-based tuberculosis testing strategy succeeded in focusing valuable public health resources on high-risk groups. The high prevalence (14.0%) of latent tuberculosis infection that has been identified in recruits confirms that accession is the most critical juncture for tuberculosis control within the Army. Slight but notable differences in testing type positivity suggests opportunity for further policy refinement.

Military medical evacuation education must adapt to meet rapid changes in the operational environment experienced during the Russia-Ukraine War and expected in the Indo-Pacific. The Medical Evacuation Doctrine Course is the U.S. Army's preeminent course on intra-theater medical evacuation and has been revamped to ensure the curriculum is relevant, useful, rigorous, and modern in preparation for large-scale combat operations in multiple theaters. Course changes include a renewed curriculum focus on air-ground medical evacuation integration and casualty evacuation, the development and deployment of a novel medical evacuation wargaming initiative, adding intelligence and operations staff roles to the final practical exercise, a return to analog planning products, and establishing theater-specific training days with targeted readings, discussions, guest speakers, and wargames. These revisions ensure that the next generation of military medical planners is adequately equipped to meet the demands of complex, multidomain operations in future conflicts. Additionally, this case study serves as a template for other military medical courses looking to realign their curricula accordingly.

The purpose of this study was to examine the clinical outcomes and efficacy of the U.S. Army's Holistic Health and Fitness (H2F) program compared to standard physical therapy practices across the U.S. Military Health System. The H2F initiative aims to improve access to care and rehabilitation outcomes through a multidisciplinary approach, offering a potential advantage over traditional methods used in military hospital settings. This study utilized a retrospective cohort design, analyzing archived medical records of active duty U.S. Military personnel treated for musculoskeletal injuries. The records spanned from physical therapy, outpatient hospital clinics, and H2F outpatient services at Fort Liberty, NC. A total of 24,143 records were screened (23,324 from hospital clinics and 819 from H2F clinics), with 4,555 records (4,279 from hospital clinics and 276 from H2F clinics) ultimately included for analysis. The study compared holistic rehabilitative care provided by H2F with standard physical therapy care. Key outcome measures included days from injury to initial evaluation and changes in clinical outcome scores using the Numeric Pain Rating Scale (NPRS), Global Rating of Change (GROC), Modified Oswestry Disability Index (MODI), Lower Extremity Functional Scale (LEFS), Neck Disability Index (NDI), and Shoulder Pain and Disability Index (SPADI). Institutional Review Board (IRB) approval was obtained for the study. Patients treated through the H2F program were evaluated an average of 33.8 days sooner than those treated in hospital clinics (P&#x2009;<&#x2009;.001). Holistic Health and Fitness patients also demonstrated significant improvements in clinical outcome measures, including reduced disability scores on the NDI (P&#x2009;=&#x2009;.037), ODI (P&#x2009;<&#x2009;.001), SPADI (P&#x2009;<&#x2009;.045), and increased functional scores on the LEFS (P&#x2009;<&#x2009;.001). Additionally, patients in the H2F group reported lower NPRS scores (P&#x2009;<&#x2009;.001) and higher GROC scores (P&#x2009;<&#x2009;.001), indicating less pain and greater perceived improvements compared to those receiving traditional care. Embedding physical therapists within H2F units is a safe and effective strategy for enhancing access to physical therapy services among soldiers, resulting in earlier intervention and improved rehabilitation outcomes. The study's findings suggest that the multidisciplinary care model offered by H2F can significantly reduce time to care and enhance recovery, providing a potential framework for optimizing soldier readiness. Limitations include differences in sample sizes between the groups, which may affect generalizability. Future research should explore the broader implementation of H2F and its impact on other military installations.

In 1918, the British Army, having just defeated the Turkish Army in Palestine, intimated that the future of Palestine was considered hopeless due to the severity of malaria in the country. The British Army's victory was partially attributable to its employment for six months of thousands of mainly Egyptian labourers to control the disease in the country through destruction of mosquito breeding sites. When the control ceased on 19th September 1918, the disease returned shortly thereafter. Due to the disease, the country was desolate and was either almost empty or uninhabitable in many rural areas. With the dream of a Jewish Homeland somewhere in Palestine, the Zionists were obliged to view malaria control as a priority. But the Zionists were unable to conduct malaria control in the same manner as that carried out by the British Army due to lack of finances and manpower that were available to the British Army. The Zionists were obliged, therefore, to think creatively and set about launching the first start of a sustainable malaria control programme for the whole country, of which it is only now realised that it was also the first step anywhere in the decolonisation of malaria control, an approach that was conducted by all the inhabitants for all the inhabitants.

During World War II, the Japanese Kwantung Army's Unit 731 secretly conducted large-scale, inhumane, and unethical human experimentation in China, culminating in one of the most heinous medical atrocities, crimes against humanity, and war crimes in the Asia-Pacific theatre of the war. Despite the gravity of the subject matter and its historical significance, research on Unit 731 has, for a long time, been rather limited, but has gradually increased in recent decades. In this article, we identify several important characteristics and trends in research activities related to Unit 731, with a view to providing a general overview of the existing scholarship and to providing recommendations for future research.From the 1950s to the 1970s, academic research started to accumulate. The second stage was one of rapid development from the 1980s to the 1990s. During this period, research efforts in Japan had a far-reaching influence and began to spread to China, Europe, and the U.S. Scholars from scientific, medical, and educational communities began participating in Unit 731 research successively. The third stage of multi-dimensional development began at the onset of the twenty-first century. Research expanded into comparative inquiries of Japanese medical atrocities and their Nazi counterpart; at the same time, research on many topics in diverse disciplines was also deepened and intensified. In addition to focusing on pragmatic issues such as reflections and actions of modern society and reconciliation, researchers have also been concerned with historical writing and collective memory.

An ergonomic assessment was conducted to quantify the activities and physical demands during the British Army's 8-week Platoon Sergeant and Section Commander Battle Courses (PSBC, SCBC). Twenty PSBC and 18 SCBC male infantry soldiers volunteered. Body Mass (BM) was measured pre- and post-course, with course physical activity levels (PAL), energy expenditure (EE) and sleep profiles quantified using tri-axial accelerometery. The courses were predominately field-based, involving slow and rapid load carriage tasks, digging and moving casualties. Average daily EE (SCBC&#x2009;=&#x2009;4020&#x2009;&#xb1;&#x2009;599 vs. PSBC&#x2009;=&#x2009;3876&#x2009;&#xb1;&#x2009;525&#x2009;kcal.day-1; p>0.05) and BM decreases were similar (SCBC&#x2009;=&#x2009;-3.9&#x2009;&#xb1;&#x2009;2.9 vs. PSBC&#x2009;=&#x2009;-2.0&#x2009;&#xb1;&#x2009;2.7&#x2009;kg; p>0.05). Daily PAL was higher for SCBC than PSBC (2.1&#x2009;&#xb1;&#x2009;0.3 vs. 2.0&#x2009;&#xb1;&#x2009;0.3, p=0.041), likely due to greater moderate-vigorous activity levels (p=0.003). Daily sleep durations were variable, but similar across courses (&#x2248;5.1&#x2009;hr.day-1; p>0.05). These data confirm these courses are arduous and can be used to inform course-specific physical screening tests and training to increase course success. Understanding the physical requirements of arduous military training courses is essential in ensuring personnel maintain role-related physical capability. An ergonomic analysis quantified training load, course activities, and sleep patterns. The high physical demands of PSBC and SCBC can inform evidence-based interventions (e.g. screening standards) to improve candidate preparation and success.

Large-scale combat operations (LSCO) are expected to produce prolonged care scenarios characterized by delayed evacuation, limited resources, and high patient acuity. In these environments, Army pharmacists are increasingly relied upon to provide advanced clinical support, particularly in critical care and prolonged field care settings. However, traditional pharmacy training may not fully prepare pharmacists for these expanded roles. The aim of this article is to describe the need for an Army Pharmacy Critical Care Short Course to develop the necessary knowledge, skills, and attributes for deploying Army pharmacists to effectively and confidently support the casualties expected in the setting of prolonged care in LSCO. An Army Pharmacy Critical Care Short Course represents an important step in preparing Army pharmacists for the evolving demands of future LSCO. As future conflicts are expected to challenge traditional medical support paradigms, this course will provide a scalable and relevant training model that enhances readiness and supports the Army's goal of delivering high-quality pharmaceutical care across the continuum of combat operations.

Diabetic retinopathy (DR) stands as a common microvascular issue associated with diabetes mellitus, a condition defined by progressive structural decline in the retina. Although studies have reported that vitexin exhibits positive pharmacological activity in inflammatory eye diseases and has been shown to protect against neuronal damage, its efficacy in treating DR and its underlying mechanism of action remain unreported. Cellular viability was determined via the Cell Counting Kit-8 (CCK-8) approach. Oxidative stress, apoptosis, and inflammatory response in cells were assessed via flow cytometry, the thiobarbituric acid (TBA) assay, commercial kits, and western blot analysis. Combined with bioinformatics analysis (online Swiss Target Prediction, Comparative Toxicogenomics Database (CTD), online Gene Cards, and molecular docking), it was confirmed that vitexin's cytoprotection in ARPE-19 cells against damage is mediated by caspase-3 (CASP3). In HG-challenged ARPE-19 cells, vitexin successfully mitigated oxidative stress. This was evidenced by downregulated levels of malondialdehyde (MDA) and reactive oxygen species (ROS), coupled with enhanced enzymatic performance of superoxide dismutase (SOD) and glutathione peroxidase (GSH-Px). It also attenuated the inflammatory response by suppressing tumor necrosis factor-&#x3b1; (TNF-&#x3b1;) and interleukin-6 (IL-6) while promoting interleukin-10 (IL-10), ultimately leading to reduced apoptosis. Differential gene screening and molecular docking analysis revealed an interaction between CASP3 and vitexin. Moreover, in HG challenged ARPE-19 cells, overexpressing CASP3 significantly compromised the protective benefits conferred by vitexin. Vitexin alleviates damage to ARPE-19 cells induced by HG via CASP3, exerting a protective effect in early DR.

The 2024&#x2009;U.S. Army Talent Assessment Strategy (ATAS) established a unified vision for leveraging assessments to transform and modernize how the Army makes personnel decisions across the Soldier lifecycle. Military organizations have a number of talent management tools at their disposal that can identify which talent attributes to capture, such as job analysis to better understand tasks and the attributes required to perform them effectively, competency modeling to identify strategically relevant attributes for organizational success, and taxonomic approaches to developing systems for classifying tasks and attributes. In this article, we suggest that systematic review approaches can build upon these tools to identify, evaluate, and recommend strategically relevant talent assessments to military organizations. We provide a demonstration of this practice to identify valid and reliable assessments capable of measuring talent attributes contained in the Army Talent Attribute Framework (ATAF), the Army's universal framework of knowledge, skills, abilities, and other characteristics (KSAOs) critical to successful performance across positions. For each assessment, we documented information on features that may influence decisions for use (e.g. practical considerations such as response format, number of items). We applied a systematic review approach to academic, commercial, governmental, and public sources, identifying 69 evidence-based assessments that could be used to assess the top 30 most highly rated officer KSAOs identified in a recently conducted Army-wide job analysis. We discuss several directions for future work and implications of this approach (e.g. facilitating automated battery assembly).

This study aims to analyse trends in PTSD over time among combat veterans who participated in war or major military operations. This retrospective cohort study included 4376 veterans (4027 males; 97.9%) of the Israel Defence Forces (IDF) who sought assistance from the army's Combat Stress Reactions Unit (CSRU) between January 1, 2000 and June 30, 2024. Background and service data were obtained from CSRU electronic records, along with PTSD self-report questionnaires (PTSD Checklist [PCL-5]). We found PTSD levels lowest during two specific periods of major warfare: 2014 (average score 38.9, SD&#x2009;=&#x2009;20.15) and 2024 (average score 36.8, SD&#x2009;=&#x2009;18.13). Conversely, between 2015 and October 2023, years with intermittent lower-intensity military operations, levels were higher, ranging from 43.0 (SD&#x2009;=&#x2009;18.59) to 50.1 (SD&#x2009;=&#x2009;17.72). Data analysis also highlights a significant increase in applications to the CSRU from 2014 onward. This continued in 2024, with 703 soldiers (16.1% of sample) applying to the unit-the highest number in a single year. PTSD levels were neither higher nor consistent in times of intense warfare. The relatively low levels of PTSD recorded during these times suggest complex factors influence PTSD development, beyond time since exposure to traumatic events.

To develop and validate a machine learning model predicting venous thromboembolism (VTE) risk in intensive care unit (ICU) patients with traumatic brain injury (TBI). Utilizing data from 1564 TBI patients in MIMIC-IV (2008-2021), models were trained (80%) and tested (20%). We used 304 TBI patients from the 904th Hospital of the Joint Support Force of the Chinese People's Liberation Army's ICU (2021-2024) as an external validation cohort. Feature selection employed Boruta and Least Absolute Shrinkage and Selection Operato&#x159; regression. Four machine learning algorithms, including support vector machine (SVM) and logistic regression (LR), were trained. Performance was evaluated using area under the curve and other metrics. The Shapley Additive explanations method interpreted feature importance. Independent risk factors for VTE were identified as length of hospital stay, systolic blood pressure, lower limb fracture, and lung infection. Six variables were selected: ICU stay duration, length of hospital stay, lung infection, heart rate, partial thromboplastin time, and lower limb fracture. Among the 4 ML models, the LR model demonstrated excellent performance, with area under the curve values of 0.723 for the test set, and 0.759 for the external validation set. The nomogram based on the LR model showed good performance in the calibration curve and the clinical decision curve. Furthermore, Shapley Additive explanations analysis highlights that the length of ICU stay and lung infection are the primary determinants influencing the prediction. The logistic regression model demonstrates strong predictive capability for early VTE following TBI, which may potentially contribute to reducing complications associated with VTE and improving patient outcomes.

The Department of the Army's 2021 strategy to "Regain Arctic Dominance" highlights the operational necessity of sustaining combat readiness in Arctic or extreme cold environments (AoECE). Presented are five scenarios inspired by casualties that illustrate capability gaps and best practices as the Army Health System applies tactical combat casualty care (TCCC) in austere, frigid climates: (1) adapting TCCC to the AoECE as a unique environment; (2) technological limitations in the prevention and treatment of hypothermia; (3) freezing cold injury (FCI) and non-freezing cold injury (NFCI) treatment and the institutional need for a cold injury center; (4) a proposal for a FCI rule-out pathway to preserve the fighting force; (5) carbon monoxide poisoning and logistical constraints. These scenarios emphasize the need for research, procurement, and doctrine tailored specifically to the AoECE, as environmental exposure and equipment capability will be a decisive factor in casualty survivability and force regeneration.

The Master Resilience Training (MRT) course is the U.S. Army's resilience program of record to develop soldiers as resilience trainers within their home units. The Walter Reed Army Institute of Research (WRAIR) recently conducted an MRT Quality Improvement Evaluation (QIE) to understand perceptions of the MRT course, determine the effectiveness of the course, and provide revision recommendations for the next iteration of the course. Soldiers who were completing the MRT course were invited to take surveys and participate in interviews. Results from quantitative and qualitative data suggest that most participants felt satisfied with the training and that it was relevant for soldiers. Most participants also agreed that the training would help them become better soldiers and leaders. Along with positive feedback about the course, participants also identified areas that could be improved. Soldier feedback along with program evaluators' observation informed recommendations for improving the overall MRT course and its implementation. Program evaluators recommend MRT participants learn fewer and less complex skills, focus on coach education throughout the course, and highlight leader development by promoting motivation and enhancing effective communication. Program evaluators recommendations for ways to improve buy-in from leaders and graduated MRTs are also discussed.