OBJECTIVE: The purpose of this study was to compare the physical performance of elite New Zealand and other nations olympic class sailors and to undertake an initial examination of the relation between physical and sailing performance. EXPERIMENTAL DESIGN: A comparative study. SETTING: Healthy elite national level olympic class sailors were examined. PARTICIPANTS: Thirty-one elite New Zealand Olympic sailing squad team members and 108 Olympic team sailors from ten other nations. INTERVENTIONS: The data for the two groups of subjects was compared using unpaired "t"-tests. A qualitative analysis was used to examine the relation between physical and sailing performance. MEASURES: Measurements included age, body mass, muscular strength endurance (as assessed by the maximum number of push-ups, pull-ups and sit-ups that could be performed) and serobic power (as assessed by the time taken to cover 2500 m and the distance completed in 12 minutes in a maximal effort rowing ergometer test). Sailing performance was assessed by national coach ranking of each New Zealand sailor. RESULTS: On average the New Zealanders were younger and lighter than the sailors from the other nations. They tended to have greater shoulder/arm strength endurance as reflected in their performance for push-ups and pull-ups, but a lesser ability in their sit-up performance. They also tended to be aerobically fitter. There were clear and logical differences between body mass and both class of vessel and the position of the sailor i.c. crew or helmsman. Lighter sailors sailed lighter craft whilst heavier sailors sailed the heavier craft. Crew members were generally heavier than helmsmen. Age appeared to be related to sailing performance. CONCLUSIONS: Elite New Zealand Olympic class sailors tend to be younger, lighter, stronger and aerobically fitter than elite sailors from other nations. Age appeared to be related to on-water sailing performance.
The U.S. Army perioperative nurse (66E) plays a pivotal role in delivering surgical care that directly influences battlefield survivability, operational readiness, and overall force health. Rooted in a legacy dating back to the American Revolutionary War, Army perioperative nurses embody a unique blend of clinical precision, operational agility, and leadership excellence. These nurses serve as circulating or scrub personnel in operating rooms, managing sterile technique, surgical equipment, implants, and intraoperative imaging, while coordinating preoperative and postoperative care in both domestic and deployed settings. Their responsibilities extend beyond the surgical suite, encompassing trauma response, setting up field hospitals, managing mass casualties, and providing surgical logistics in austere environments. Specialization in perioperative nursing offers distinct career advancement opportunities and aligns with the Military Health System's goals of maintaining a medically ready force. Through training, mentorship, research dissemination, and advanced academic programs such as the Doctor of Nursing Practice Adult-Gerontology Clinical Nurse Specialist with a perioperative focus at USUHS, 66Es contribute to surgical innovation and quality improvement across the continuum of care. In 2024, 66Es demonstrated significant impact through leadership roles, global deployments, scholarly achievements, and clinical education initiatives. Looking forward, strategic efforts to reintegrate 66Es into forward surgical units and expand CNS authorizations will further strengthen the specialty's influence. Army perioperative nurses remain essential to military surgical capability, shaping the future of combat care and enhancing patient outcomes across operational and humanitarian missions.
Military personnel are exposed to bouts of acute stress during their careers, in which cognitive processes associated with decision-making might simultaneously suffer. Currently, it is still unclear how hormones and neurotransmitters involved in the acute stress response specifically affect these decision-making subprocesses, particularly in the military. We aimed to expose military personnel to pharmacological stress, in which noradrenaline and/or cortisol activity was stimulated. Next, decision-making subprocesses (i.e. working memory, impulse control and risk-taking) were assessed. A sample of 100 Dutch military personnel were recruited. Noradrenaline and/or cortisol activity was stimulated through oral administration of yohimbine and hydrocortisone, respectively. Decision-making subprocesses were assessed through computerised tasks. Induction of stress was confirmed through psychophysiological measures. Working memory seemed subtly affected by stress, as heightened noradrenaline slowed recall while cortisol accelerated it. Inhibition was unaffected by acute stress. Risk-taking was enhanced solely by noradrenaline, contrasting earlier research positing cortisol as a predictor of amplified risk-taking in civilians. Our findings contribute to the existing literature of the effects of acute stress on cognitive processes associated with decision-making, emphasising intricacies of the effects of specific stress hormones and neurotransmitters. Future research is needed to further identify these differential intricacies on cognitive processes, keeping potential differences between demographic subgroups in mind.
There are bidirectional associations between COVID-19 and thyroid disease; little is known about these risks among active-duty service members (ADSM). This study seeks to understand the associations between COVID-19 and thyroid disease in this population and in non-active-duty adults within the military health system. The researchers conducted a retrospective propensity score-matched cohort study using the Military Health System Database including individuals 18-64 years of age. International Classification of Diseases, 10th revision codes and laboratory results identified COVID-19 infections from July 2020 to June 2021. Patients with COVID-19 were matched 1:2 to controls based on age, sex, beneficiary type, month, and a propensity score. Thyroid disease was identified by ICD-10 codes and those with a thyroid diagnosis in the year prior were excluded. Hazard ratios (HR) and Bonferroni-adjusted 95% confidence intervals (95BoCI) were calculated. There were 103,778 exposures and 207,556 controls among ADSM and 125,399 exposures and 250,798 controls among non-ADSM. Among ADSM there was a significant association with having any thyroid disease diagnoses (HR = 1.48, 95%CI [1.15-1.89]). However, no significant relationship was found between COVID-19 infection and hypothyroidism (HR = 1.11, 95BoCI [0.93-1.31]), Hashimoto's thyroiditis (HR = 1.07, 95BoCI [0.77-1.48]), Grave's disease (HR = 1.20, 95BoCI [0.85-1.70]), or other thyroiditis (HR = 1.11, 95BoCI [0.83-1.47]). Non-ADSM adults from ages 18-64 showed significantly increased rates of hypothyroidism (HR = 1.11, 95BoCI [1.03-1.19]), Hashimoto's thyroiditis (HR = 1.15, 95BoCI [1.01-1.31]), Grave's disease (HR = 1.26, 95BoCI [1.09-1.46]), and other thyroiditis (HR = 1.31, 95BoCI [1.18-1.45]). ADSMs with COVID-19 infection demonstrate an increased risk for combined thyroid disease, although non-ADSM adults had significantly increased rates of Grave's disease, Hashimoto's disease, hypothyroidism, and other thyroiditis. These results highlight that even in young, healthy populations like the ADSMs, COVID-19 can lead to long-term thyroid dysfunction.
The Army nurse in the 66G obstetric/gynecological nursing area of concentration (AOC) plays a critical role in sustaining the health of female soldiers and military families. While often associated with childbirth, the 66G's capabilities extend beyond the delivery room. Their expertise enhances combat readiness, humanitarian response, and population health efforts worldwide.
Military aviators experience earlier spine degeneration and neck pain than civilians. Concerns exist about the performance of cervical total disc replacement (CTDR) in tactical military flight, including during aircrew ejection. Aviators in ejection-seat aircraft may obtain a medial waiver and return to flight after anterior cervical discectomy and fusion (ACDF); however, ACDF limits index/surgical level motion, increases motion at adjacent segments, accelerates adjacent spinal degeneration, and increases the risk for future cervical spine surgery. CTDR reduces the adverse effects of ACDF, yet CTDR biomechanics are understood based only on quasi-static loading. This study evaluated responses of ACDF and CTDR under simulated hyperdynamic (military aircrew ejection) vertical loading. Ejection-type vertical (Gz) loading was applied to the human body finite element model. ACDF and CTDR procedures were simulated at the C5-C6 level. The CTDR was modeled using a Mobi-C (ZimVie) design, while the ACDF represented the conventional plating construct used commonly in the United States. Segmental motion and facet force at the index and adjacent segments, and intradiscal pressure at the adjacent segments were obtained and normalized with respect to the intact/native spine. Range-of-motion and load parameters were compared with known failure criteria. Compared to the native spine, the index level segmental motion decreased by 30% for CTDR and 81% for ACDF. Superior level segmental motions decreased for CTDR (6%) and increased for ACDF (23%), while the motions at the inferior adjacent level increased for both CTDR and ACDF (+11% and +18%). Intradiscal pressure at the superior level increased by <5% for both interventions, as well as at the inferior level (17% for CTDR and 35% for ACDF). Facet forces at the index level increased by 33% and 3% (CTDR vs. ACDF) yet were minimally changed at adjacent levels (<10%, ACDF and CTDR). No condition (native, ACDF, CTDR) resulted in spine failure when referenced to known failure criteria. This preliminary study investigated the biomechanical responses of post-ACDF and CTDR spines under dynamic vertical loading, applicable to military aviators in ejection-seat aircraft. CTDR preserved motion at the index level and decreased motion transmission to adjacent spinal levels, while increasing the index-level posterior column load sharing. Spine failure criteria were not exceeded in any simulated condition. These findings are important components for the continued evaluation of CTDR safety and performance in the tactical aviator domain.
Concern has grown over the potential neurological effects following repetitive exposure to blast waves generated by explosives and weapons during training and operations. Military personnel may be repeatedly exposed to low-level blast although using explosives to gain entry and during routine heavy weapons training. Repeated blast exposure, even within allowable limits, has been associated with cognitive deficits. The Blast Overpressure (BOP) Tool was developed to support BOP exposure mitigation guidance by informing training cadre, unit commanders, and range managers of predicted exposures to facilitate mitigation of BOP risk during training. Section 734 of the National Defense Authorization Act for Fiscal Year 2018 (Public Law 115-91) required the Secretary of Defense to conduct a longitudinal medical study of blast pressure exposure of members of the armed forces. The BOP Tool was developed as a part of this initiative to improve awareness and mitigation of BOP in training environments. The team received feedback from the operational community. The BOP Tool predicts BOP exposures based on weapon type, ammunition, individual posture, and proximity to the weapon system. Three versions of the tool address specific end-user requirements. A mobile application offers real-time feedback and increased feasibility for field use. A desktop version includes a Site Module for planning weapon placement and personnel positions to minimize exposure, and a Scene Module for three-dimensional visualization of blast effects on the human body, allowing users to test mitigation strategies and assess cumulative exposure to different body regions. Additionally, an ArcGIS-integrated version supports range safety management by providing enhanced BOP risk assessment capabilities. Preliminary end user feedback suggests that the tool is already informing best practices to protect Service Members from BOP in the garrison environment by simulating comparatively more protective postures and positioning around weapon systems during live fire training. The BOP Tool advances understanding of blast exposure and supports the development of safer training protocols for military personnel. By enabling real-time prediction and visualization of BOP effects, the tool augments leader risk assessment and decision-making, ultimately contributing to optimized health and safety of Service Members during heavy weapon training.
Limited healthcare access can adversely affect military readiness and the health of active duty service members (ADSM) and their families, particularly following serious injury. Approximately half of U.S. military installations are overseas, or in federally designated primary care (PC) Health Professional Shortage Areas, or "PC deserts," characterized by limited provider availability and longer distances to care, which may impact post-injury care. The study objective was to assess the impact of living in a U.S. PC desert or overseas compared to a U.S. non-desert on the rate of general medical (GM) non-surgical, non-mental health care encounters during the year following a serious injury among ADSM, spouses, and children. A retrospective cohort study of Military Health System (MHS) data from FY 2005-2016 identified seriously injured ADSM, spouses, and children using ICD-9 codes for concussion, fractures, post-traumatic stress disorder, blindness, burns, shrapnel, and other traumatic injuries. Negative binomial regression estimated post-injury GM encounter rates comparing beneficiaries assigned to installations in PC deserts or overseas with those in U.S. non-desert areas, adjusting for age, sex, ADSM race, and rank. Among 545,611 injured beneficiaries (301,846 ADSM, 77,813 spouses, 75,952 children), residence in PC deserts was associated with increased outpatient civilian care and decreased outpatient military treatment facility (MTF) care. In PC deserts, inpatient care was decreased for spouses and children but increased for ADSM compared to U.S. non-deserts. Overseas outpatient care was decreased for all beneficiary categories, as was inpatient care for dependents, although inpatient care for ADSM was increased overseas. In PC deserts, civilian care was generally increased, whereas overseas, care at military facilities was increased. These findings highlight geographic disparities in healthcare utilization among MHS beneficiaries and underscore the importance of considering location-based access challenges in military medical resource planning and policy.
Advancing technology offers opportunities to incorporate tools from sport and performance psychology to enhance Soldiers' mental performance. User acceptance is important for successful technology adoption; thus, technology should be accepted and usable to those leading mental performance training (MPT) (e.g., Performance Experts [PEs]). This study sought to assess the use, interest, and preferences for technology among PEs. Performance Experts assigned to Ready and Resilient Performance Centers (R2PCs) at 34 Army installations were surveyed electronically about PEs' use, interest, and preferences for technology, with 119 complete responses. Technology was defined as supplementing/enhancing MPT for mental skills development. Spearman's rank-order correlations analyzed associations between PE technology perceptions and use questions. Descriptive statistics were utilized to present dimension-specific and mean total scores from the Technology Readiness Index (TRI) 2.0. Open-ended responses were summarized using descriptive coding and thematic analysis regarding PE responses to technology use and suggestions. Performance Experts indicated low technology use with individuals (2.45 ± 0.90) and groups (2.33 ± 0.93). Performance Experts belief in using technology in MPT positively correlated with knowledge, confidence, and belief that technology enhances MPT for individuals and groups (P's < .001). Performance Experts perceived that technology enhances MPT for individuals which correlated with the frequency of technology with individuals (P < .01), with no relationship observed for groups (P > .05). Technology readiness index 2.0 (TRI 2.0) scores showed PEs tend to be optimistic (3.98 ± 0.71) and have lower discomfort (2.15 ± 0.70) around technology, while neutral on innovativeness (3.09 ± 0.95) and somewhat insecure (3.17 ± 0.93) towards technology. Performance Experts raised issues with technology access and maintenance, and the importance of technology applicability. Although PEs show strong interest, confidence, and understanding of technology's potential to improve MPT, barriers such as access and opportunities to apply technology hinder its effective use.
Healthcare professional recruiting within the Army Medical Department (AMEDD) requires specialized knowledge and strategic outreach. This article describes the outcomes of Army Nurse Corps (ANC) officers in medical recruiting roles. Data from Fiscal Year 2024 (FY24) and Quarters 1 and 2 (Q1/2) of FY25 demonstrate that ANC officers may enhance healthcare professional recruiting efficiency, reduce applicant processing timelines, and improve overall mission achievement. ANC officer's clinical expertise, ability to conduct skills-based outreach events, and familiarity with medical commissioning processes contribute to stronger applicant engagement and throughput. This data although limited, may suggest that expanding the role of ANC officers in recruiting could strengthen the military healthcare workforce pipeline.
[This corrects the article DOI: 10.3389/fpubh.2026.1787493.].
Cervical spine musculature contributes to stability and load carrying capacity of the human head-neck. As muscle morphologies influence segmental neck biomechanics and physiological responses to operational activities, their accurate description in computational musculoskeletal models is needed to better estimate osteoligamentous column loads, and determine the mechanisms of internal load transfer, and segmental and local component load sharing. Cervical muscle morphologies specific to fighter jet pilot populations have not been included in the current musculoskeletal injury models. The objective of the current preliminary descriptive study was to obtain muscle morphological data from a group of pilots from the US Air Force. Supine magnetic resonance images (MRIs) were taken from nine experienced pilot subjects. Cross-sectional areas of the flexor (longus capitis, longus colli, and sternocleidomastoid) and extensor (semispinalis and spinalis cervicis, semispinalis capitis, and multifidus) muscles of the sub-axial spine were obtained. Muscles were segmented on the axial view images at the inferior vertebral endplate (the inferior axial section of the vertebral body) for each spinal segment. The mean age, stature, total body mass, and body mass index of two female and seven male pilots were 39 ± 5 years, 1.8 ± 0.1 m, 83 ± 8 kg, and 27 ± 2 kg/m2, respectively. These data for the females were 3 ± 5 years, 1.7 ± 0.01 m, 75 ± 4 kg, and 27 ± 1 kg/m2, and for the males were 41 ± 5 years, 1.8 ± 0.1 m, 85 ± 8 kg, and 26 ± 2 kg/m2, respectively. In the flexor group, the area of the sternocleidomastoid muscle decreased cranially from the lower cervical spine (C5 and C6 levels), although the longus colli muscle did not demonstrate such tendency. The longus capitis muscle increased from the lower (C5-C7) to the upper cervical levels, with a peak at the C3. In the extensor group, the area of the semispinalis capitis increased from the inferior to the superior direction although the spinalis cervicis muscles areas showed an inverse pattern. In contrast, the areas of the semispinalis cervicis and multifidus muscles did not show a pattern from the upper to lower or from the lower to upper cervical levels. Level specific data are given in the body of the main paper. The areas obtained from MRIs at different levels of the cervical column from a group of military pilots showed that their variations depend on muscle type and action. As fighter pilots were the subjects, the primary finding about the patterns in the muscle cross-sectional areas is related to the use of head supported mass, cockpit ergonomics, posture, head accelerations from high-g forces that the pilot experiences, and other factors. From this perspective, the present results are unique. Although the study had more males, an evenly matched group is necessary to elicit male-female differences. It would be a future study to enroll more female fighter pilots to delineate males-to-female differences. The current data can be used in musculoskeletal models to predict realistic neck loads, internal stresses and strains, and anterior and posterior column load sharing under military loading scenarios.
Sufficient sleep is critical to optimal physical, cognitive, and mental health, yet two-thirds of U.S. Army Soldiers chronically obtain less than the daily recommended 7 or more hours of sleep. Early morning physical training (PT) could impede the amount and quality of sleep soldiers obtain, thereby impairing overall health and operational readiness. This study examined the effects of a behavioral intervention, in which PT was shifted from morning to afternoon (at 2:00 PM), on measures of sleep health, mental health, and morale. Thirty-seven active-duty soldiers completed surveys along with cognitive and physical testing at 2 timepoints: after ∼30 days following a morning PT schedule (6:30 AM) and again after ∼30 days of an afternoon PT schedule. Although total sleep duration per 24 hours was not found to differ between PT schedules (t28 = -0.31, P = .38), measures related to general sleep health were significantly improved. Specifically, sleep quality (Pittsburg Sleep Quality Index; t33 = 2.60, P < .01), daytime sleepiness (Epworth Sleepiness Scale; t33 = 2.88, P < .01), and insomnia symptomology (Insomnia Severity Scale; t33 = 2.14, P = .02) were all significantly improved after shifting to afternoon PT. Furthermore, although subjective mental health metrics of stress and anxiety remained similar (low to moderate) between PT schedules, morale was significantly improved following an afternoon PT schedule (t34 = -2.04, P = .03). These findings indicate that a simple intervention of shifting PT timing from early morning to afternoon to allow for more opportunity to sleep, supported by leadership, can lead to improved sleep health and morale, which can improve overall operational readiness for active-duty service members.
Harmful behavior such as suicide, sexual assault, intimate partner violence, and substance abuse significantly impacts the mission of the Department of Defense (DoD) by degrading unit cohesion, straining resources, and diminishing military readiness. Recent independent reviews-such as the Independent Review Commission on Sexual Assault in the Military-emphasize the need for institutional reform to prioritize proactive prevention over reactive responses. In promoting the adoption of integrated primary prevention activities, the Department must utilize a comprehensive, evidence-based approach targeting shared risk and protective factors to address harmful behavior before it occurs. In contrast to past efforts, which often focus on awareness, outreach, clinical practice, or response, integrated primary prevention emphasizes data-driven, culturally competent, and systems-based strategies tailored to military populations. Key principles include fostering resilience, promoting positive command climates, and leveraging community partnerships. The establishment of an integrated primary prevention workforce to support the Department further amplifies these efforts by conducting needs assessments, developing tailored prevention plans, and translating research into actionable interventions. Despite its long-term benefits, a focus on primary prevention continues to face challenges in an environment that prioritizes immediate, tangible results over proactive measures with delayed outcomes. By addressing these challenges and investing in sustainable prevention infrastructure, the DoD can enhance the well-being and readiness of its service members, ultimately reducing harmful behavior throughout the Armed Forces.
Military service members face unique occupational stressors (e.g., combat deployment) that are compounded by additional life stressors (e.g., adverse childhood experiences [ACEs], financial problems). As stress has been shown to be associated with the increased risk of cardiovascular disease (CVD) in civilian populations, the present study examined the associations between stress exposure and cardiovascular health (CVH) among a contemporary military population. Using a cross-sectional design, survey data from 40,525 service members (71% men, 58% non-Hispanic White, 94% <35 years old) enrolled in the Millennium Cohort Study from 2020 to 2021 were analyzed to estimate associations between stress exposure and CVH. Individual stressors, including self-reported combat severity, bullying, hazing, discrimination, sexual harassment, ACEs, and stressful life events (SLEs) (e.g., divorce, financial problems), were z-score transformed and combined to form a cumulative stress measure. An index CVH score was adapted from the American Heart Association's Life's Essential 8 measure (i.e., self-reported sedentary time <8 hours/day, sleeping 7-9 hours/day, no daily fast-food intake, not currently smoking, healthy body mass index [18.5-24.9 kg/m2], no diabetes, no high cholesterol, and no hypertension). Linear regression models examining the relationship between individual stressors and cumulative stress with CVH were adjusted for sociodemographic, military, and behavioral factors. Higher cumulative stress scores were associated with lower CVH scores among service members in our sample. When examining individual stressors, SLEs were most strongly related with poorer CVH, followed by ACEs, bullying, and combat severity. Cumulative stress may have a significant impact on the CVH of service members. Moreover, SLEs (e.g., divorce, financial problems, moving) that occur outside of their military duties may have a substantial impact on force readiness and retention. A consideration of specific stressors and screening for multiple stressors during routine health care visits can provide an opportunity for early CVD prevention among military populations.
Sleep disturbance is highly prevalent in military populations, associated with adverse mental health, physiological, and operational outcomes. However, the epidemiology and longitudinal course of sleep disturbances among UK Armed Forces personnel remain unknown. Emerging evidence suggests that sleep disturbance may act as an upstream vulnerability factor for mental health disorders, with additional links to broader outcomes such as menstrual dysfunction in women. Prospective data in UK military populations are scant. This study aims to quantify the prevalence, incidence, and longitudinal associations between sleep disorder symptoms, mental health, and menstrual health outcomes in UK service personnel. The study aims to further investigate demographic and service-related moderators and explore potential mediating pathways underlying these relationships. This prospective, survey-based cohort study will aim to recruit ~n 1316 Regular and n 1387 Reserve UK Armed Forces personnel, stratified by military service branch (Army, Royal Navy, Royal Air Force) and sex (male and female). Participants will complete validated self-report measures of sleep, mental health (e.g. PTSD, depression, anxiety, nightmares, suicidal ideation) combat exposure, and menstrual health (women only) at baseline, 6, 12, and 24 months. Participants will also undertake a 14-day sleep monitoring protocol using wrist-worn actigraphy and consensus sleep diaries to derive objective and subjective sleep-wake indices. Analyses will aim to assess prevalence, incidence and chronicity of sleep disturbances, along with multivariable regression and longitudinal mixed-effects models to examine associations with mental health outcomes and potential moderating factors. Longitudinal mediation analyses (four models) will determine potential mechanisms linking sleep disturbance with adverse health outcomes. This protocol describes the study design and planned analyses. This study will provide the first comprehensive longitudinal assessment of sleep disturbance and its associations with mental and menstrual health in UK Armed Forces personnel. Findings will inform targeted interventions, including behavioural sleep strategies, and support evidence-based policy and practice within UK Defence.
Irving Roy Rathgeb, Jr., MD was a young physician and surgeon who was born in Highland (Ulster County), New York on 7 March 1913. His father, Irving Roy Rathgeb, Sr. was a co-owner of the Rathgeb Knitting Mills which specialized in the production of sweaters. Rathgeb was an excellent student in primary and high school and later attended Colgate and Cornell universities. In 1934 he entered the Long Island College of Medicine from where he received his MD degree in 1938. Graduating in the upper third of his class, he obtained an internship at the Norwegian Hospital in Brooklyn, New York. Because of his desire to become a surgeon, he was then accepted into the Department of Surgery at the St Louis Railway Company Hospital in Texarkana, Texas. Soon thereafter he joined the Texas National Guard while still continuing his training in surgery at the hospital and was commissioned as a First Lieutenant. He was assigned to the 111th Medical Regiment, 36th Infantry Division. Completing his residency in surgery at the hospital he was transferred to the US Army Medical Corps as a Captain. Once the US entered World War II, the 36th Infantry Division was transferred overseas and Rathgeb promoted to the rank of Major. The functions of the 111th Medical Regiment, of which Rathgeb was an essential part, was to serve as an evacuation hospital. This entailed the collecting and evacuating of the wounded soldiers from the front lines and taking them to medical facilities well behind the battle lines. This was a very high-risk responsibility since it regularly placed Rathgeb and his fellow medical personnel in the line of fire. In 1942 the 111th Regiment was temporarily posted to Eritrea in Eastern Africa. In early 1943 they were ordered to Cairo, Egypt in preparation for the allied invasion of Italy. On 23 March Rathgeb and seven of his medical team boarded a military plane for a flight to Cairo. About 50 miles south of Cairo, the plane encountered a severe sandstorm, and eventually crashed into a mountain peak and fell into a canyon. Initial search parties were unable to find the crash site and thus it was provisionally concluded that the plane might have crashed into the Red Sea. Rathgeb's family and the families of others on the flight were told that they were missing in action. After many months the crash site was found and the deceased victims of the accident removed and buried in a common grave in Suez, Egypt. Five years later in 1948, Rathgeb's remains and those of seven of his military companions were transferred to a common burial plot in the Zachary Taylor National Cemetery in Louisville, Kentucky. In 2026 a slide rule bearing Rathgeb's name neatly printed and black ink both inside and outside of the rule's leather case was found in a desk drawer whose content had once belong to Duncan W. Clark, MD. Clark had graduated from the Long Island College of Medicine in 1936, two years before Rathgeb. Following his graduation, he had a close relationship with the medical school and its successor, SUNY Downstate Health Sciences University. He served as Assistant Dean, Dean, Professor and Chair of the Department of Preventive Medicine and Community Health and later as Professor Emeritus. Clark passed away in 2007 at the age of 96. How Rathgeb's slide rule came into his possession is not known. However, its discovery enabled others many decades later to come to know Rathgeb as a remarkable and brilliant physician and surgeon whose great leadership abilities and surgical care contributions were never fully realized because he had given his life while serving others.
Normal blood oxygenation (SpO2) is important in the readiness of warfighters at high terrestrial altitudes and high-altitude parachuting operations. A hands-free SpO2 wearable with real-time alerting capability could allow for preventive actions before health or performance is compromised while not interfering with task performance. Prototype headbands were constructed with an embedded sensor that assesses SpO2 and heart rate from the forehead by photoplethysmography. Volunteers (n = 13) wore 12 similarly constructed prototype headbands while completing five minutes of sitting and self-paced treadmill walking and running. Volunteers also completed free living activities for two hours. A survey (Likert-type and open-ended questions) was administered that assessed fit, comfort, impact on activities, impact on the head/body, durability, and overall acceptability. Overall comfort was rated moderately comfortable: 5.8 ± 1.0; 7-point scale (1 = Very Uncomfortable, 7 = Extremely Comfortable). Open-ended responses revealed initial comfort was very comfortable, but after two hours the headband became slightly uncomfortable. When examining the impact on daily activities, a score of 5 = No Negative Impact and 4 = Slight Negative Impact, a rating of 4.7 ± 0.9 was seen. Headband was acceptable to wear for two hours or less, by 69% of volunteers. Regarding operations at high terrestrial altitude, a USARIEM-patented algorithm that uses continuous SpO2 measures provides risk guidance on acute mountain sickness (AMS). Early treatment or actions will help prevent AMS. For the high-altitude jumpers, verification of a healthy SpO2 level before exiting the aircraft is necessary. For both cases the use of the SpO2 headband should lead to safer operations. However, for the wearable to be effective, it needs to be acceptable. These results illustrate that for short-term operations of 2 hours or less, it is acceptable.
Non-combat musculoskeletal injuries (MSKIs) are the leading cause of medical disability across the military, with poor exercise form-including misalignment and mistiming-being key contributors. Rehabilitation and conditioning can build resilience and reduce risk. Our recent work resulted in a prototype Optical Screening and Conditioning for Injury Resilience (OSCIR) system offering real-time, non-contact, biofeedback through field-deployable motion capture equipped with three-dimensional (3D) camera-based technology and an augmented reality (AR) viewer for tracking exercise form while detecting and alerting the users of high injury risk movement patterns. Developments were shaped by military end-users across the U.S. This study assessed the usability of our field-deployed system and validated real-time biomechanical metrics against those computed from a marker-based system. OSCIR includes a laptop computer, two red-green-blue-depth (RGB-D) camera arrays, and a software package including nine exercise modules that display in real-time, the user's point cloud, a skeleton with graphical biofeedback, and range of motion tracking with exercise-specific MSKI risk indicators. Biomechanical accuracy validation was conducted among n = 13 nonmilitary controls in compliance with Western-Copernicus Group. Usability was assessed among n = 33 healthy active duty servicemembers at Marine Corps Base Camp Pendleton and Explosive Ordinance Disposal Group One training facilities using the system usability survey (SUS) and structured interviews in compliance with Naval Medical Center San Diego Institutional Review Board protocol. Compared to the marker-based system, OSCIR's metrics resulted in Intraclass Correlation Coefficient estimates between 0.80 and 0.98 ("good" to "excellent" agreement) for each metric. End-user feedback was notably positive, earning "excellent" SUS scores (Mean ± SD = 80.77 ± 12.93). OSCIR achieves high agreement with the gold-standard system for biomechanical metrics, and its user-friendly features score highly among military stakeholders. OSCIR will help military stakeholders manage MSKIs in warfighters by automating training and rehabilitation batteries, making quantitative form-correction readily accessible and accurate for operational training environments.
Concerns regarding cancer incidence, particularly non-Hodgkin lymphoma, among U.S. Air Force missile community members prompted the initiation of the Missile Community Cancer Study. This phased, retrospective process study was designed around the unique needs of the Missile Community and adapted to these requirements. A cohort of all active duty Department of the Air Force (DAF) service members from 1976 to 2010 (N∼1.82 million), including approximately 65,000 personnel in missile-related career fields, was created via multiple data sources through a phased approach. Phase 1A examined Department of Defense (DoD) electronic health records (EHR) (2001-2020); Phase 1B added DoD and Department of Veterans Affairs (VA) cancer registry data (1976-2020) and VA EHR (1991-2020); and Phase 1C analyzed cancer mortality using National Death Index data (1979-2020). Armed Forces Health Surveillance Division and Surveillance, Epidemiology, and End Results cancer incidence and mortality case definitions were applied. In Phase 1A, 4,865 incident cancers were identified from the DoD EHR across the cohort, including 198 cases in the missile community. After adding DoD and VA registry data and VA EHR data in Phase 1B, an additional 50,359 cases were identified, including 1,641 missile community cases. Mortality analysis (Phase 1C) identified 37,100 cancer deaths across the cohort, including 1,145 in the missile community. Across Phases 1A, 1B, and 1C, no statistically significant excess incidence or mortality of non-Hodgkin lymphoma or the 13 other study cancers was observed in the missile community compared to other DAF members or the U.S. population. The overlap between EHRs and cancer registries within both the VA and DoD systems found over half of EHR-identified cases were also included in their respective cancer registries and 76.1% of all Phase 1 cancer cases were captured in a registry. This study's multi-phase approach with both internal and external comparison groups enhanced the comprehensiveness and accuracy of cancer case identification. The phased data linkage and validation approach provided a replicable framework for epidemiological cancer studies in military populations, illustrating methods for integrating and prioritizing data sources to address health concerns. The findings may ultimately guide future epidemiologic studies of cancer in the military to select optimal datasets, optimizing resource utilization and streamlining study timelines.