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Objectives: Noise is one of the most common exposures, and occupational noise-induced hearing loss (NIHL) is highly prevalent. In addition to NIHL, noise is linked to numerous non-auditory health effects. The Occupational Safety and Health Administration (OSHA) maintains the Integrated Management Information System (IMIS) database of compliance-related measurements performed in various industries across the USA. The goal of the current study was to describe and analyse personal noise measurements available through the OSHA IMIS, identifying industries with elevated personal noise levels or increasing trends in worker exposure over time., Methods: Through a Freedom of Information Act request, we obtained OSHA's noise measurements collected and stored in IMIS between 1979 and 2013 and analysed permissible exposure limit (PEL) and action level (AL) criteria measurements by two-digit industry code., Results: The manufacturing industry represented 87.8% of the 93 920 PEL measurements and 84.6% of the 58 073 AL measurements. The highest mean noise levels were found among the agriculture, forestry, fishing and hunting industry for PEL (93.1 dBA) and the mining, quarrying and oil and gas extraction group for AL (93.3 dBA). Overall, measurements generally showed a decreasing trend in noise levels and exceedances of AL and PEL by year, although this was not true for all industries., Conclusions: Our results suggest that, despite reductions in noise over time, further noise control interventions are warranted both inside and outside of the manufacturing industry. Further reductions in occupational noise exposures across many industries are necessary to continue to reduce the risk of occupational NIHL., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2019. No commercial re-use. See rights and permissions. Published by BMJ.)

The Military Health Services System (MHSS) is undergoing major modifications brought about by the Department of Defense health care reform program (TRICARE), a dynamic, multi-dimensional reform initiative affecting health care delivery to eligible beneficiaries. Military managers of the MHSS are currently being impacted by the changes secondary to the implementation of TRICARE. By reviewing needs assessments conducted with these managers, surveying currently available programs and curricula aimed at military health care manager development, and examining the TRICARE concept, it is clear that executive education must be adapted to fit the needs of those who will manage this newly designed and rapidly evolving health care system. This report summarizes current military executive education options and specifically examines the Naval Postgraduate School Executive (Medical) Management Education (EME) Program. This EME Program can support military medical treatment facility and lead agents (Health Service Regions) executive managers in the execution of their TRICARE mission.