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We conducted a cognitive task analysis to provide input on the curriculum and technology currently used to train parachute descent procedures in the Naval Aviation Survival Training Program. Subject matter experts provided insight into the correct decision-making thought processes used in parachute descent. Techniques for analysis included focus groups, interviews, and a think-aloud procedure involving a parachute descent simulator at a Naval Aviation Survival Training Center. Results and findings inform the instructional design process to improve the training pipeline's development, implementation, and evaluation. [ABSTRACT FROM AUTHOR]

Background: Evidence on return to sports/work after high tibial osteotomy (HTO) is limited, especially in a young, high-demand population. Purpose: To (1) identify whether preoperative knee pathology or intraoperative correction was associated with successful return to duty (RTD) and (2) assess whether postoperative complications and reoperation were associated with failure to RTD. Study Design: Case series; Level of Evidence, 4. Methods: We performed a retrospective cohort study of a consecutive series of patients in the Military Health System aged 18 to 55 years with medial compartment osteoarthritis who underwent HTO between 2003 and 2018. Concomitant meniscal and cartilage procedures were included, while cases with concomitant ligamentous procedures were excluded. The inclusion criteria were as follows: active-duty military status, minimum 2-year follow-up, preoperative knee radiographs, and pre- and postoperative long-leg alignment radiographs. Preoperative Kellgren-Lawrence grades and pre- and postoperative hip-knee-ankle angles were measured. The primary outcome was RTD. Failure was defined as knee-related medical separation from the military or conversion to total knee arthroplasty. The secondary outcome was reoperation. Results: A total of 55 HTOs were performed in 50 patients who met the inclusion criteria, with a mean age of 39 years old (range, 22.8-55 years). The mean follow-up was 5 years (range, 2.1-10.7 years). Ten knees (18.2%) failed HTO (1 conversion to total knee arthroplasty, 9 medical separations), 15 additional knees (27.3%) had permanent activity restrictions, and 30 knees (54.5%) returned to duty without restrictions. Reoperation occurred in 36.4% of knees and was associated with medical separation (P =.039). Younger age was associated with medical separation (P =.003) and permanent restrictions (P =.006). Patients with a postoperative varus deformity of >5° were more likely to undergo medical separation (P =.023). Conclusion: In a young, high-demand population, HTO succeeded in returning 54.5% of knees to full duty without restriction despite 36.4% of knees requiring reoperation. Residual varus deformity or reoperation was associated with lower RTD rates. No association was identified between RTD and preoperative osteoarthritis grading or deformity. [ABSTRACT FROM AUTHOR]

Background: Researchers have assessed postoperative injury or disability predictors in the military setting but typically focused on 1 type of surgical procedure at a time, used relatively small sample sizes, or investigated mixed cohorts with civilian populations. Purpose: To identify the relationship between baseline variables and injury incidence or military discharge status in US Army soldiers after knee surgery. Study Design: Case-control study; Level of evidence, 3. Methods: Data were obtained from a repository containing personnel, performance, and medical records for all active-duty US Army soldiers. Multivariate logistic regressions were used to estimate the effects of numerous variables on postoperative injury or on medical discharge. Variable selection and model validation were conducted using the k-fold method. Results: A total of 7567 soldiers underwent knee surgery between 2017 and 2019. Meniscal procedures were the most common type of surgery (39%), and approximately 71% of the cohort had a postoperative injury. Significant predictors for sustaining a postoperative injury included having a previous nonknee injury (odds ratio [OR], 1.5), female sex (OR, 1.3), and Black race (OR, 1.2). Within 4 years after surgery, 17% of soldiers were discharged from the military because of knee-related disability. Significant predictors for discharge from duty included enlisted rank (OR, 2.3), recent fitness test failure (OR, 1.9), number of previous knee surgeries (OR, 1.7), and having a previous nonknee injury (OR, 1.6). Conclusion: After knee surgery, nearly three-fourths of the soldiers in this cohort sustained a postoperative injury and almost one-fifth of soldiers were medically discharged from the military within 4 years. This study identified variables that indicate statistically increased risk for these postoperative outcomes and highlighted potentially modifiable factors. [ABSTRACT FROM AUTHOR]

By examining the Guomindang's (GMD's) on-the-ground implementation of its student military training program, this article addresses the ideological tensions and diplomatic predicaments underlying the party-state's youth mobilization strategies. While fetishizing a regimented society, the program incorporated a heterogeneous set of tactics to both inspire and control youth martial activism. The peculiar mix of military discipline, Confucian modes of education, and liberal ideals of voluntarism and competition gave rise to multifarious experiences and sentiments that muddied the main objective of the state—to convert military training into a form of personal cultivation. This study sheds light on the gap between Chiang Kai-shek's conception of militarization as the practice of everyday discipline and Chinese students' embrace of military training as patriotic resistance against Japanese invasion. Ultimately, the program's mobilizational potential was undercut by its obsession with managing the trivialities of everyday life and Nanjing's appeasement policy toward Japan. [ABSTRACT FROM AUTHOR]

Background: Large variations exist in the reported frequency and etiology of posterior and combined shoulder instability in the active-duty military population. Purpose: To compare imaging and clinical examination findings as well as reoperation rates between active-duty military patients who underwent surgery for anterior, posterior, and combined-type shoulder instability. Study Design: Cross-sectional study; Level of evidence, 3. Methods: A retrospective review was conducted on patients treated surgically for shoulder instability from a single military base from January 2010 to December 2019. Each case was characterized as isolated anterior, isolated posterior, or combined, according to arthroscopic findings. Information was collected on patient characteristics, history of trauma, time to surgery, associated pathological findings, and survivorship at a minimum 2-year follow-up. Results: Overall, 416 patients (n = 394 men; n = 22 women), with a mean age of 29.1 years, underwent primary shoulder stabilization surgery during the study period. There were 158 patients (38%) with isolated anterior instability, 139 (33%) with isolated posterior instability, and 119 (29%) with combined instability. A history of trauma was more prevalent with isolated anterior instability (129 [81.7%]) than with either isolated posterior (95 [68.4%]) or combined instability (73 [61.3%]) (P =.047 and P =.001, respectively). Patients with anterior instability were significantly more likely to be diagnosed on the preoperative physical examination when compared with patients with posterior instability (93% vs 79.1%; P <.001) or combined instability (93% vs 75.6%; P <.001) and were also more likely to have a discrete labral tear detected on a preoperative magnetic resonance arthrogram than patients with posterior instability (82.9% vs 63.3%; P <.001). There was no significant difference in the rate of medical discharge or recurrent instability requiring reoperation between groups. Conclusion: The study findings indicated that young, active-duty military patients are at increased risk for isolated posterior and combined-type shoulder instability, with posterior and combined instability collectively accounting for over 60% of instability cases in this cohort. Orthopaedic surgeons should be aware of instability when evaluating and treating young, active-duty military patients with shoulder pain, even in the absence of diagnostic physical examinations or imaging findings. [ABSTRACT FROM AUTHOR]

Background: The surgical management of type II superior labrum anterior and posterior (SLAP) tears in patients younger than 40 years is controversial, but growing evidence suggests comparable outcomes between primary SLAP repair and primary biceps tenodesis, with lower rates of reoperations after primary biceps tenodesis. Given the relatively similar patient-reported outcomes, cost-effectiveness analyses of direct and indirect costs associated with the two procedures propound a valuable comparative technique. Hypothesis: In this value-based comparison of SLAP repair versus biceps tenodesis, we hypothesized that biceps tenodesis would be more cost-effective than SLAP repair in patients younger than 40 years. Study Design: Economic and decision analysis; Level of evidence, 4. Methods: A 1-month Markov cycle was simulated to reflect 10 years of health outcomes. Health states were selected based on outcomes that are especially important in assessing indirect costs for a younger, active patient population: return-to-sport rates, which demonstrate a return to baseline function, and reoperation rates. Transition state probabilities were obtained through an index systematic review and meta-analysis comparing labral repair and biceps tenodesis for the treatment of type II SLAP lesions in patients younger than 40 years. Health state utility and cost values were obtained from accepted values denoted in existing literature. Results: Both primary SLAP repair and primary biceps tenodesis yielded an average expected 8.1 quality-adjusted life years over the 10-year period. The average cost (in 2021 US$) was $16,619 for biceps tenodesis and $19,388 for SLAP repair. Conclusion: In a younger patient population, SLAP repair and biceps tenodesis had comparable quality-adjusted life years and utility in the treatment of type II SLAP tears; however, SLAP repair cost $19,388, while biceps tenodesis cost $16,619, reflecting a 14% cost savings with biceps tenodesis. These findings can be extrapolated to further establish the role for these procedures in treating SLAP tears. [ABSTRACT FROM AUTHOR]

The Synthetic Environment (SE) takes the power of computing, digital processing, artificial intelligence, extended reality technology, and other advancements borrowed from the gaming industry to create a computer simulation with near-perfect levels of realism. Designed to enable connectivity across all domains and platforms, SE has the potential to dramatically improve military training, force development, situational awareness, and communications. Our article provides a technical overview of SE and offers a high-level analysis of its use in Canada, the US, UK, and Australia. Informed by dozens of interviews and a roundtable workshop held with experts from academia, industry, and government, this article relates SE to Canada's future defence policy. We argue that leveraging SE effectively will require that Canada commit to a long-term SE program, promote new government-industry partnerships, encourage top-down leadership from both civilian and military officials, and consolidate domestic skillsets and industry knowhow to maintain and retain Canadian sovereignty. [ABSTRACT FROM AUTHOR]

Background: Current consensus and position statements recommend that concussed patients be asymptomatic upon the initiation of the graduated return to activity (RTA) protocol. However, a significant number of concussed patients are beginning their RTA protocols while endorsing symptoms. Purpose: To characterize symptom endorsement at the beginning of the RTA protocol and examine the association between symptom endorsement and RTA protocol duration in service academy cadets. Study Design: Cohort study; Level of evidence, 2. Methods: A prospective cohort study was conducted with cadets at 3 US service academies. Postconcussion symptom inventories were recorded upon the initiation of an RTA protocol. The Sport Concussion Assessment Tool Symptom Inventory was used to classify participants into 3 groups (0 symptoms, 1 symptom, and ≥2 symptoms) upon the initiation of the RTA protocol. The primary outcome of interest was RTA protocol duration. Kaplan-Meier survival estimates were calculated to estimate RTA protocol duration by symptom endorsement, sex, varsity status, academic break, and time to graduated RTA initiation. Univariate and multivariable Cox proportional hazards models were used to estimate the association between symptom endorsement at the initiation of the RTA protocol and RTA protocol duration (α <.05). Results: Data were analyzed from 966 concussed cadets (36% women). Headache (42%) and faintness/dizziness (44%) were the most commonly endorsed symptoms on the Sport Concussion Assessment Tool-Third Edition and the Brief Symptom Inventory-18, respectively. Univariate results revealed a significant association between endorsing ≥2 symptoms and RTA protocol duration. In the multivariable model, endorsing ≥2 symptoms maintained a statistically significant association with RTA protocol duration. Significant associations were observed between RTA protocol duration and nonvarsity status (27% longer), women (15% longer), academic breaks (70% longer), and time to the initiation of the RTA protocol (1.1% longer daily incremental increase) after controlling for covariates. Conclusion: Symptom endorsement at the initiation of an RTA protocol was associated with RTA protocol duration. Cadets who had returned to preinjury baseline symptom burden or improved from baseline symptom burden and endorsed ≥2 symptoms at the initiation of the RTA protocol took longer to RTA. [ABSTRACT FROM AUTHOR]

Background: Untreated or residual developmental dysplasia of the hip may cause significant morbidity. Periacetabular osteotomy (PAO) allows for surgical reorientation of the acetabulum but requires a significant recovery period. Because of the physical demands of active military service, hip dysplasia or its treatment with PAO may cause a significant impact on the careers of affected personnel. Purpose: To measure the impact of symptomatic acetabular dysplasia and its treatment with PAO on the physical readiness of personnel in the United States Armed Forces. Study Design: Case series; Level of evidence, 4. Methods: Records from an interservice hip-preservation practice were reviewed for all patients who underwent PAO while on active duty from January 2014 through April 2017. Collected information included branch of service, military occupation, preoperative duty restrictions related to the hip, and concomitant surgical procedures. Patients were evaluated for a minimum of 24 months and assessed for their time to return to duty, continued duty restrictions, and referrals to the medical evaluation board. Results: Twenty patients (15 female, 5 male) underwent a PAO while on active duty during the period assessed. The mean patient age at surgery was 25.9 years, and the mean follow-up was 3.3 years (range, 2.3-5.4 years). In the 6 months preceding surgery, 94% of the 17 patients with available records were on duty restrictions specific to their hip (14 temporary, 2 permanent). After PAO, 35% of patients (n = 7) returned to full duty and 85% were able to remain on active duty (n = 12) or complete their military service commitments (n = 5) without noted medical disability. Three patients were medically discharged after PAO, with 1 patient referred due to hip pathology. Conclusion: Acetabular dysplasia significantly affects physical readiness in affected servicemembers, with 94% requiring duty restrictions. PAO allowed 85% of patients to return to military service, and 1 in 3 were able to return to full duty. [ABSTRACT FROM AUTHOR]

Background: Few studies have reported the long-term outcomes of patellar stabilization surgery in an active duty military cohort. Purpose: To evaluate the long-term results of a combined open and arthroscopic patellar stabilization technique for the treatment of recurrent lateral patellar instability in members of a military population. Study Design: Case series; Level of evidence, 4. Methods: We performed a retrospective review of a consecutive series of 63 patients who underwent operative management for patellar instability at a tertiary military medical center between 2003 and 2017. All cases were performed by a single sports medicine fellowship–trained orthopaedic surgeon. Patients with recurrent lateral patellar instability whose nonoperative management failed were included. All patients underwent arthroscopic imbrication of the medial patellar retinaculum, an open lateral retinacular release, and an Elmslie-Trillat tibial tubercle osteotomy. Outcome measures at final follow-up included recurrent instability, need for surgical revision, subjective assessments, and military-specific metrics. We also analyzed anatomic risk factors for failure: patella alta, coronal plane alignment, trochlear dysplasia, and tibial tubercle–trochlear groove distance. Results: A total of 51 patients were included (34 men, 17 women; mean ± SD age at surgery, 27.2 ± 5.8 years; mean follow-up, 5.3 years). The mean postoperative SANE score (Single Assessment Numeric Evaluation) was 75.0 ± 17.7, and the mean visual analog scale pain score was 2.5 ± 2.1. Four patients (7.8%) reported redislocation events, and 4 underwent revision surgery. Twenty-five patients (49.0%) reported a decrease in activity level as compared with preinjury, while 10 (19.6%) cited restrictions in activities of daily living. Of the 21 patients remaining on active duty, 6 (28.6%) required an activity-limiting medical profile. Of the 48 active duty patients, 12 (25.0%) underwent evaluation by a medical board for separation from the military. Differences in the Caton-Deschamps Index and tibial tubercle–trochlear groove distance between surgical success and failure were not statistically significant. Conclusion: Surgical management of patellar instability utilizing a multifaceted technique resulted in low recurrence rates and may be independent of predisposing anatomic risk factors for instability. At 5-year follow-up, most patients retained their active duty status, although nearly half experienced a decrease in activity level. [ABSTRACT FROM AUTHOR]

Background: The American Society for Surgery of the Hand advises patients that symptoms after wrist sprains resolve in 6 weeks and that recovery is usually excellent; however, there is scant supporting evidence for this reassurance. Purpose: To describe the epidemiology and report long-term outcomes of wrist sprains. Study Design: Descriptive epidemiology study. Methods: The US Department of Defense Military Health System Management Analysis and Reporting Tool was queried for wrist sprain International Classification of Diseases, Ninth Revision, codes between 2005 and 2008 among US Military Academy cadets. The electronic medical records were reviewed to obtain demographic information, mechanism of injury, and patient characteristics. A telephone survey was conducted to collect Single Assessment Numeric Evaluation (SANE) score, the shortened version of Disabilities of the Arm, Shoulder and Hand (QuickDASH) score, and ability to return to full military duty. Results: Of the 90 patients identified, 49 patients (50 wrists) met the final inclusion criteria. The mean patient age was 21 years, the majority were male (86%), and most sprains occurred during athletics (65%) and military activities (20%). Most patients (61%) had radiographs taken after index wrist sprain, and few (14%) underwent magnetic resonance imaging (MRI). After a mean follow-up of 10.4 years, most patients (78%) had no further wrist injury. The average SANE and QuickDASH scores were 88 and 7.5, respectively. Two patients (4%) ultimately were treated with surgical repair. Most patients (96%) were on an upper extremity profile, limiting military duty for a median of 14 days. All patients ultimately returned to full military duty. Conclusion: Patients with a wrist sprain diagnosis were followed for an average of 10 years. Although the majority (96%) of patients required a median of 14 days with limited upper extremity function, MRI is rarely indicated in the acute setting and most patients will never have another wrist injury and can expect excellent wrist recovery outcomes. [ABSTRACT FROM AUTHOR]

Background: Clinical recommendations for concussion management encourage reduced cognitive and physical activities immediately after injury, with graded increases in activity as symptoms resolve. Empirical support for the effectiveness of such recommendations is needed. Purpose: To examine whether training medical providers on the Defense and Veterans Brain Injury Center's Progressive Return to Activity Clinical Recommendation (PRA-CR) for acute concussion improves patient outcomes. Study Design: Cohort study; Level of evidence, 2. Methods: This study was conducted from 2016 to 2018 and compared patient outcomes before and after medical providers received an educational intervention (ie, provider training). Patients, recruited either before or after intervention, were assessed at ≤72 hours, 1 week, 1 month, 3 months, and 6 months after a concussion. The participant population included 38 military medical providers and 106 military servicemembers with a diagnosed concussion and treated by one of the military medical providers: 58 patient participants received care before the intervention (ie, provider training) and 48 received care after intervention. The primary outcome measure was the Neurobehavioral Symptom Inventory. Results: The patients seen before and after the intervention were predominantly male (89.7% and 93.8%, respectively) of military age (mean ± SD, 26.62 ± 6.29 years and 25.08 ± 6.85 years, respectively) and a mean ± SD of 1.92 ± 0.88 days from injury. Compared with patients receiving care before intervention, patients receiving care after intervention had smaller increases in physical activities (difference in mean change; 95% CI, 0.39 to 6.79) and vestibular/balance activities (95% CI, 0.79 to 7.5) during the first week of recovery. Although groups did not differ in symptoms at ≤72 hours of injury (d = 0.22; 95% CI, –2.21 to 8.07), the postintervention group reported fewer symptoms at 1 week (d = 0.61; 95% CI, 0.52 to 10.92). Postintervention patients who completed the 6-month study had improved recovery both at 1 month (d = 1.55; 95% CI, 5.33 to 15.39) and 3 months after injury (d = 1.10; 95% CI, 2.36 to 11.55), but not at 6 months (d = 0.35; 95% CI, 5.34 to 7.59). Conclusion: Training medical providers on the PRA-CR for management of concussion resulted in expedited recovery of patients. [ABSTRACT FROM AUTHOR]

Background and aim. Previous literature has discussed tensions between the field of game design and the field of education. It has been emphasized that it is important to address this tension when developing game based learning (GBL). In order to find potential ways of approaching this problem, we investigate the development of GBL when performed by those who have both pedagogical content knowledge (PCK) and experience in game development. Method. Two case studies about serious games production were conducted, a game section at a national defense college and a university course in educational game design. The cases, as well as individual development projects within the settings, were analyzed with a focus on the role of PCK during serious games development. Results. While the developers and instructors at the defence college, who designed games for their in-house needs, had both PCK and knowledge about game development, these competencies varied a lot among the participants at the university course. The results show that educational goals added complexity to the design process. By comparison, some studied game projects at the university course avoided this complexity. These projects legitimized their games as educational by suggesting unproven far transfer. In other cases, where the developers did have PCK, the instructional goals where taken as a starting point that guided the whole development process. This lead to games that were designed to match highly specific educational contexts. The developers, instructors and teachers in both of the settings who used their PCK tended to break a number of established game design heuristics that would have been counter productive in relation to the learning objectives of the games. Conclusions. The paper suggests that there is a need for people with pedagogical content knowledge AND knowledge about game development. Enhancing these dual competencies in game workers could forward the field of GBL. [ABSTRACT FROM AUTHOR]

Mind wandering is common during daily activities and is even more prevalent under stressful conditions, which could lead to lapses in attention and poor performance. Newly recruited military personnel who undergo demanding training often experience high levels of stress. It is therefore imperative to find ways to foster mental health and avoid performance deterioration related to mind wandering in times of intense military training. This feasibility study investigated the effectiveness of an established low-dose mindfulness-based intervention (MBI), called Mindfulness-based Attention Training (MBAT), on mind wandering, attentional performance, and well-being, delivered by a facilitator who was taught how to deliver MBAT. A sample of newly recruited Royal New Zealand Navy (RNZN) Junior Officers (n = 17) undergoing demanding training participated in the 8-week long MBI with one weekly contact session. Measures of well-being and the Sustained Attention to Response Task (SART) were completed 4 weeks prior to the MBAT, at the start of the MBAT, at the end of the MBAT and 4 weeks after completion of the MBAT. Results suggest that MBAT might protect from performance decline during intense training and enhance levels of well-being at follow-up. These findings highlight the valuable role of mindfulness as a component in military training. [ABSTRACT FROM AUTHOR]

Background: The Functional Movement Screen (FMS) is a series of 7 tests used to assess the injury risk in active populations. Purpose: To determine the association of the FMS with the injury risk, assess predictive values, and identify optimal cut points using 3 injury types. Study Design: Cohort study; Level of evidence, 2. Methods: Physically active male soldiers aged 18 to 57 years (N = 2476) completed the FMS. Demographic and fitness data were collected by survey. Medical record data for overuse injuries, traumatic injuries, and any injury 6 months after the FMS assessment were obtained. Sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were calculated along with the receiver operating characteristic (ROC) to determine the area under the curve (AUC) and identify optimal cut points for the risk assessment. Risks, risk ratios (RRs), odds ratios (ORs), and 95% CIs were calculated to assess injury risks. Results: Soldiers who scored ≤14 were at a greater risk for injuries compared with those who scored >14 using the composite score for overuse injuries (RR, 1.84; 95% CI, 1.63-2.09), traumatic injuries (RR, 1.26; 95% CI, 1.03-1.54), and any injury (RR, 1.60; 95% CI, 1.45-1.77). When controlling for other known injury risk factors, multivariate logistic regression analysis identified poor FMS performance (OR [score ≤14/19-21], 2.00; 95% CI, 1.42-2.81) as an independent risk factor for injuries. A cut point of ≤14 registered low measures of predictive value for all 3 injury types (sensitivity, 28%-37%; PPV, 19%-52%; AUC, 54%-61%). Shifting the injury risk cut point of ≤14 to the optimal cut points indicated by the ROC did not appreciably improve sensitivity or the PPV. Conclusion: Although poor FMS performance was associated with a higher risk of injuries, it displayed low sensitivity, PPV, and AUC. On the basis of these findings, the use of the FMS to screen for the injury risk is not recommended in this population because of the low predictive value and misclassification of the injury risk. [ABSTRACT FROM AUTHOR]

Background: Numerous studies document the health benefits of a physically active lifestyle, but relatively few document the hazards of physical activity. Because of the requirement for physical fitness to complete their mission, the United States military services have a vested interest in understanding the benefits and risks of physical activity including exercise and sports. One of these risks is injury. Rates and proportion of injuries caused by exercise- and sports-related (ESR) activities have not been reported previously across the services. Purpose: The purposes of this population survey were to (1) document the rates and proportion of all injuries caused by ESR activities among military personnel, (2) compare rates across the military services, and (3) describe the causes and types of ESR injuries as well as associated days of limited activity. Study Design: Descriptive epidemiology study. Methods: The Defense Manpower Data Center administered the web-based 2008 Status of Forces Survey of Active Duty Service Members to a random sample of active-duty personnel. In all, 10,692 servicemembers completed the survey, which included questions about injuries from any cause and from exercise and sports during the previous year. Responses were weighted to produce population estimates for injury rates (any injury and ESR injury). Percentage distributions were used to describe activities, injury types, days of limited activity, and contributing factors for ESR injuries. Results: There were 49% of servicemembers who sustained an injury from any cause in the previous year; 25% had an ESR injury. Thus, 52% of all injuries were ESR injuries. ESR injury rates ranged from 20% for the Navy to 33% for the Marine Corps. Running accounted for 45% of ESR injuries. Forty percent of ESR injuries were sprains and strains. As an indicator of injury severity, 35% of ESR injuries required more than 2 weeks of limited activity. Conclusion: This study quantified the overall incidence of injuries and the large proportion that are caused by exercise and sports among military personnel, a population of healthy, physically active adults. Prevention strategies should focus on running, weight training, basketball, and football. Recommendations include adherence to evidence-based practices to reduce the occurrence of ESR injuries. [ABSTRACT FROM AUTHOR]

For the development of serious gaming, it is necessary to articulate the specific features that lend themselves best to the creation of effective learning games. Given the limited resources of the typical serious games developer, time and money should be spent in a way such that features with the greatest return on investment take priority. Opening cinematics, a popular feature of games, was examined through the lens of three major theoretical perspectives that promote learning, specifically situated learning, emotional arousal, and goal orientation. A series of three experiments was conducted to determine if the inclusion of opening cinematics was able to change the goal orientation of players as well as improve the effectiveness of a serious game used to train U.S. Navy recruits shipboard damage control procedures. The data suggest that opening cinematics were not worth the immense development investment. Game design suggestions and potential topics for future research are provided. [ABSTRACT FROM PUBLISHER]

Trainers need to identify effective, low-cost training experiences for today’s military workforce to meet the increasing demands of today’s warfighting environment. Although low-fidelity simulations have been demonstrated to be effective in this regard, research has demonstrated that specially tailored pre-experiences can increase the effectiveness of these simulations. Unfortunately, the cost of these pre-experiences negates the cost benefits of the simulations that they improve. In this article, we describe a study to evaluate the effectiveness of a lower cost pre-experience. The results are discussed in the context of future directions for research. [ABSTRACT FROM AUTHOR]

In this article, I examine the bodily changes that soldiers undergo in an intensive counter-terrorism military training course. I argue that military draftees develop control and violent capabilities through Violent Reflexive Bodily Practices (VRBPs), a concept I introduce here. VRBPs, which form the core of training in this elite military unit, are simultaneously recursive, reflexive and reconstructive: they are expressed by the soldier’s body and inflicted upon his body, by using them more violence is created, and their aim is not breaking the body apart, but rebuilding it into a new entity. VRBPs are concrete body techniques that are not discussed through a broad theoretical or cultural approach but as a material and concrete experience that reconstructs individuals’ bodies. This article shows how ‘techniques of the body’ (Mauss, 1973) can be changed in a short period and reveals possible dynamics of habitually instilled capabilities. [ABSTRACT FROM PUBLISHER]

This article reviews the literature on deployment trauma and examines the limitations of conventional understandings of trauma as they relate to veterans' experiences. It suggests that the failure to take into account social influences and social relationships limits the usefulness of conventional approaches to trauma. The article considers the role that masculinity plays in male veterans' experience of and sense making about trauma. It is suggested that while formal recognition of posttraumatic stress disorder in the DSM has provided a helpful language for veterans, it is an incomplete response. A new model of masculinity that better enables the male veteran to speak about trauma and to reconnect with others has implications for counselling practice with veterans. [ABSTRACT FROM AUTHOR]

Decision-making is identified as a key element of elite sporting success. There are many challenges, however, in the design and implementation of a decision-training tool. These include difficulty in recreating a scenario in which the simulation allows the participant to feel like they are performing in the 'real game', and creating a training tool that can complement an existing physical training regime. The main aim of this paper is to present arguments for the use of above-real-time training, as popularly used in military and pilot training, as a viable simulation training method in the sporting arena. Above-real-time simulations are simulations that are played above normal speed. The potential benefits of using traditional video simulations are discussed, especially with respect to the promotion of key characteristics of elite performance, such as automaticity. Furthermore, the possible practical applications of using above-real-time video simulations will be explored in relation to fast-paced invasion sports. [ABSTRACT FROM AUTHOR]

Background: Anterior knee pain (AKP) is the most common activity-related injury of the knee. The authors investigated the effect of an exercise intervention on the incidence of AKP in UK army recruits undergoing a 14-week physically arduous training program.Hypothesis: Modifying military training to include targeted preventative exercises may reduce the incidence of AKP in a young recruit population.Study Design: Randomized controlled trial; Level of evidence, 1.Methods: A single-blind cluster randomized controlled trial was performed in 39 male and 11 female training groups (median age: 19.7 years; interquartile range, 17-25) undergoing phase 1 of army recruit training. Each group was randomly assigned to either an intervention (n = 759) or control (n = 743) protocol. The intervention consisted of 4 strengthening and 4 stretching exercises completed during supervised physical training lessons (7 per week). The control group followed the existing training syllabus warm-up exercises. The primary outcome was a diagnosis of AKP during the 14-week training program.Results: Forty-six participants (3.1%; 95% confidence interval [CI], 2.3-4.1) were diagnosed with AKP. There were 36 (4.8%; 95%CI, 3.5-6.7) new cases of AKP in the control group and 10 (1.3%; 0.7-2.4) in the intervention group. There was a 75% reduction in AKP risk in the intervention group (unadjusted hazard ratio = 0.25; 95% CI, 0.13-0.52; P < .001). Three participants (0.4%) from the intervention group were discharged from the military for medical reasons compared to 25 (3.4%) in the control group.Conclusion: A simple set of lower limb stretching and strengthening exercises resulted in a substantial and safe reduction in the incidence of AKP in a young military population undertaking a physical conditioning program. Such exercises could also be beneficial for preventing this common injury among nonmilitary participants in recreational physical activity. [ABSTRACT FROM AUTHOR]

Background: Overuse lower limb injury is common in incidence and morbidity. Many risk factors, gait related and biomechanical, have been identified, although little conclusive evidence has been found in terms of injury prevention to date.Hypothesis: Orthoses, as produced by proprietary software interpretation of plantar pressures, are able to reduce injury rates in an ‘‘at risk’’ military population.Study Design: Randomized controlled trial; Level of evidence, 1.Methods: Four hundred military officer trainees were assessed by means of pressure plate recording of their contact foot pressures during walking. Participants were risk assessed and randomized to receive or not receive customized orthoses using the D3D system. Both cohorts were followed up for injury through their basic training at the 7-week point.Results: The orthotic intervention group sustained 21 injuries in total (1 injury per 4666 hours of training), whereas the control group sustained 61 injuries in total (1 injury per 1600 hours of training) (P < .0001), thereby demonstrating an absolute risk reduction of 0.49 from use of the orthoses (P < .0001, chi square; confidence interval, 1.7, 2.4).Conclusion: In this military trainee population, orthoses were effective in the prevention of overuse lower limb injury. This is the first study to identify a positive preventive role of orthoses. [ABSTRACT FROM AUTHOR]

This article explores the role of training practices at the United States Air Force Academy (USAFA) in perpetuating power and control issues and the potential consequences of those practices. This article also includes an overview of the training practices at the USAFA, issues of power and control manifested in the training process, and gendered reactions to the loss of personal control experienced during the initial socialization training. The author argues that cadet responses to control deprivation may have resulted in the (alleged) sexual assaults by male cadets and the eating disorders manifested by female cadets, both of which ultimately represent violence against women. The article concludes with implications for research and practice, including a call for recognizing the strategic role of training in forming organizational culture. [ABSTRACT FROM AUTHOR]

Numerous studies have documented the prevalence of hazing rituals and other rites of initiation in predominantly male organizations, including the military. However, little is known about how gender is related to hazing, specifically in male-dominated institutions where women are a relatively new population. This case study draws on survey and interview data to examine both differences and similarities in men and women's experiences with hazing in an elite military institution: the U.S. Naval Academy, which is the U.S. Department of Defense's service academy for training Naval and Marine Corps officers. Although women have attended the Naval Academy since 1976, they comprise only 10% of the student population. Despite attempts to eradicate hazing, findings reveal that not only is hazing pervasive but that men and women are equally likely to experience it during their first year at the Academy. This suggests that one's status as a plebe (freshman) overrides one's gendered status. Men and women's attitudes about hazing, however, vary on some issues. Men are more likely than women to agree that certain types of hazing should be allowed at the Academy and are less likely to perceive negative consequences of reporting hazing. In contrast, men and women are equally likely to agree that the rigors of plebe year should be used to eliminate students who are not committed to the military. In addition to calling for an expansion of hazing research to include an examination of gender, a primary implication of the findings presented here is that future studies take into account the impact of men and women's shared experiences as initiates or new members of formal institutions. [ABSTRACT FROM AUTHOR]