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Concept: United States Department of Defense

176

On July 13, 2015, U.S. Defense Secretary Ashton Carter announced that the military anticipates lifting its ban on service by transgender persons, those whose gender identity does not match the sex that they were assigned at birth. Although an estimated 12,800 transgender personnel currently serve in the U.S. armed forces (see table for explanations of estimates), they must conceal their gender identity because military policy bans them from serving and prohibits military doctors from providing transition-related care. Although some transgender people do not change their bodies to match their gender identities, government agencies, courts, and scientists agree that for many, transition-related . . .

Concepts: Gender, Gender role, Gender identity, Transgender, Third gender, Armed forces, Homosexuality, United States Department of Defense

28

A recent large civilian randomized controlled trial on the use of tranexamic acid (TXA) for trauma reported important survival benefits. Subsequently, successful use of TXA for combat casualties in Afghanistan was also reported. As a result of these promising studies, there has been growing interest in the use of TXA for trauma. Potential adverse effects of TXA have also been reported. A US Department of Defense committee conducted a review and assessment of knowledge gaps and research requirements regarding the use of TXA for the treatment of casualties that have experienced traumatic hemorrhage. Here we present identified knowledge gaps and associated research priorities. We believe that important knowledge gaps exist and that a targeted, prioritized research effort will contribute to the refinement of practice guidelines over time.

Concepts: Present, Time, Pharmacology, Randomized controlled trial, Psychological trauma, Adverse drug reaction, Tranexamic acid, United States Department of Defense

24

Training of emergency procedures is challenging and application is not routine in all health care settings. The debate over simulation as an alternative to live tissue training continues with legislation before Congress to banish live tissue training in the Department of Defense. Little evidence exists to objectify best practice. We sought to evaluate live tissue and simulation-based training practices in 12 life-saving emergency procedures.

Concepts: Health care, Medicine, Health, Practice, Simulation, Best practice, United States Department of Defense, Live television

24

Rickettsia montanensis has long been considered a nonpathogenic member of the spotted fever group rickettsiae. However, the infection potential of R. montanensis is being revisited in light of its recent association with a case of human infection in the United States and the possibility that additional cases may have been misdiagnosed as Rocky Mountain spotted fever. To this end, DNA was extracted from American dog ticks (Dermacentor variabilis) removed from Department of Defense (DoD) personnel and their dependents at DoD medical treatment facilities (MTFs) during 2002-2012 (n = 4792). These 4792 samples were analyzed for the presence of R. montanensis (n = 136; 2.84%) and all vector DNA was confirmed to be of D. variabilis origin using a novel Dermacentor genus-specific quantitative real-time polymerase chain reaction procedure, Derm, and a novel Dermacentor species multilocus sequence typing assay. To assess the risk of R. montanensis infection, the positive and negative samples were geographically mapped utilizing MTF site locations. Tick localities were imported into a geographical information systems (GIS) program, ArcGIS, for mapping and analysis. The ecological niche modeling (ENM) program, Maxent, was used to estimate the probability of tick presence in eastern United States using locations of both R. montanensis-positive and -negative ticks, climate, and elevation data. The ENM for R. montanensis-positive D. variabilis estimated high probabilities of the positive ticks occurring in two main areas, including the northern Midwest and mid-Atlantic portions of the northeastern regions of United States, whereas the R. montanensis-negative D. variabilis tick model showed a wider estimated range. The results suggest that R. montanensis-positive and -negative D. variabilis have different ranges where humans may be at risk and are influenced by similar and different factors.

Concepts: DNA, Polymerase chain reaction, United States, Geographic information system, Rocky Mountain spotted fever, Tick, Dermacentor variabilis, United States Department of Defense

24

The purpose of this study was to describe changes in hearing, using the permanent threshold shift metric, among United States Air Force servicemembers, including active duty, Reserve and Air National Guard components, for demographics, job categories, and career fields. In the United States Air Force, only servicemembers who are occupationally exposed routinely to hazardous noise are monitored. Audiogram records and demographic variables were analyzed for servicemembers from 2005 to 2011 using data from the Department of Defense system that captures occupational hearing tests worldwide. Results suggest that occupational hearing loss was larger in males than females, in officers than enlisted populations, and in Reserve and Air National Guard than in active duty. Compared to similar civilian career fields, active duty has lower prevalence rates for occupational hearing loss overall, although Reserve and Air National Guard prevalence rates were more similar to the civilian reported rates. The proportion of personnel with permanent threshold shifts varied between 4.6 - 16.7% within active duty career fields, which includes 76% of the population for study timeframe. Permanent threshold shift was larger in small job categories, and in jobs that are not considered exposed to hazardous noise routinely which is comparative with results from civilian data analysis of occupational hearing loss. Further investigation into testing practices for Air Force specific groups, use of the system for non-occupational hearing testing, and challenges to follow-up compliance is warranted. Increased surveillance procedures for occupational hearing loss are needed to address concerns on the prevalence of servicemember hearing loss, the role of recreational and lifestyle factors to contribute the high reported hearing loss prevalence of veterans compared to non-veterans.

Concepts: United States, Demographics, Audiogram, Hearing, United States Army, United States Air Force, United States Department of Defense, National Guard of the United States

20

The burden of alcohol misuse is unknown among shipboard U.S. Navy and Marine Corps military personnel immediately prior to deployment and may be elevated.

Concepts: Gulf War, United States Marine Corps, Royal Marines, United States Navy, Navy, United States Department of Defense, Uniformed services of the United States, Joint Chiefs of Staff

18

The natural history of mild traumatic brain injury (TBI) or concussion remains poorly defined and no objective biomarker of physiological recovery exists for clinical use. The National Collegiate Athletic Association (NCAA) and the US Department of Defense (DoD) established the Concussion Assessment, Research and Education (CARE) Consortium to study the natural history of clinical and neurobiological recovery after concussion in the service of improved injury prevention, safety and medical care for student-athletes and military personnel.

Concepts: Health care, Psychology, Medicine, Traumatic brain injury, Avicenna, Concussion, United States Department of Defense, United States Service academies

5

The Department of Defense uses a universal prevention framework for sexual assault prevention, with each branch implementing its own branch-wide programs. Intensive interventions exist, but would be cost effective only if targeted at high-risk personnel. This study developed actuarial models to identify male U.S. Army soldiers at high risk of administratively recorded sexual assault perpetration.

Concepts: United States, Actuarial science, Vietnam War, United States Army, Iraq War, United States Department of Defense, Joint Chiefs of Staff, Continental Army

4

Traumatic brain injury (TBI) is one of the most frequent causes of combat casualties in Operations Iraqi Freedom (OIF), Enduring Freedom (OEF), and New Dawn (OND). Although less common than combat-related blast exposure, there have been significant numbers of blast injuries in civilian populations in the United States. Current United States Department of Defense (DoD) ICD-9 derived diagnoses of TBI in the DoD Health Care System show that, for 2016, severe and moderate TBIs accounted for just 0.7% and 12.9%, respectively, of the total of 13,634 brain injuries, while mild TBIs (mTBIs) accounted for 86% of the total. Although there is a report that there are differences in the frequency of long-term complications in mTBI between blast and non-blast TBIs, clinical presentation is classified by severity score rather than mechanism because severity scoring is associated with prognosis in clinical practice. Blast TBI (bTBI) is unique in its pathology and mechanism, but there is no treatment specific for bTBIs-these patients are treated similarly to TBIs in general and therapy is tailored on an individual basis. Currently there is no neuroprotective drug recommended by the clinical guidelines based on evidence.

Concepts: Medicine, United States, Traumatic brain injury, Injury, Concussion, Operation Enduring Freedom, Iraq War, United States Department of Defense

4

In April 2017, the U.S. Department of Veterans Affairs (VA) and the U.S. Department of Defense (DoD) approved a joint clinical practice guideline for the management of type 2 diabetes mellitus.

Concepts: Diabetes mellitus type 2, Diabetes mellitus, United States Department of Defense