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Background: Compared to the civilian population, military trainees are often at increased risk for respiratory infections. We investigated an outbreak of radiologically confirmed pneumonia that was recognized after 2 fatal cases of serotype 7F pneumococcal meningitis were reported in a 303-person military trainee company (Alpha Company). Methods: We reviewed surveillance data on pneumonia and febrile respiratory illness at the training facility; conducted chart reviews for cases of radiologically-confirmed pneumonia; and administered surveys and collected nasopharyngeal swabs from trainees in the outbreak battalion (Alpha and Hotel Companies), associated training staff, and trainees newly joining the battalion. Results: Among Alpha and Hotel Company trainees, the average weekly attack rates of radiologically-confirmed pneumonia were 1.4% and 1.2% (most other companies at FLW: 0-0.4%). The pneumococcal carriage rate among all Alpha Company trainees was 15% with a predominance of serotypes 7F and 3. Chlamydia pneumoniae was identified from 31% of specimens collected from Alpha Company trainees with respiratory symptoms. Conclusion: Although the etiology of the outbreak remains unclear, the identification of both S. pneumoniae and C. pneumoniae among trainees suggests that both pathogens may have contributed either independently or as cofactors to the observed increased incidence of pneumonia in the outbreak battalion and should be considered as possible etiologies in outbreaks of pneumonia in the military population., Published in BMC Infectious Diseases, 2 Jun 2011.

Although injuries are recognized as a leading health problem in the military, the size of the problem is underestimated when only acute traumatic injuries are considered,. Injury-related musculoskeletal conditions are common in this young, active population. Many of these involve physical damage caused by micro-trauma (overuse) in recreation, sports, training, and job performance. The purpose of this analysis was to determine the incidence of injury-related musculoskeletal conditions in the military services (2006) and describe a standardized format in which to categorize and report them. The subset of musculoskeletal diagnoses found to be injury-related in previous military investigations was identified. Musculoskeletal injuries among nondeployed, active duty service members in 2006 were identified from military medical surveillance data. A matrix was used to report and categorize these conditions by injury type and body region., Published in American Journal of Preventive Medicine, v38 n1S pS61-S70, January 2010.

To sustain progress toward injury reduction and other health promotion goals, public health organizations need a systematic approach based on data and an evaluation of existing scientific evidence on prevention. This paper describes a process and criteria developed to systematically and objectively define prevention program and policy priorities. Military medical surveillance data were obtained and summarized, and a working group of epidemiology and injury experts was formed. After reviewing the available data, the working group used predefined criteria to score leading military unintentional injury causes on five main criteria that assessed factors contributing to program and policy success: (1) importance of the problem, (2) effectiveness of existing prevention strategies, (3) feasibility of establishing programs and policies, (4) timeliness of implementation and results, and (5) potential for evaluation. Injury problems were ranked by total median score. Results: Causes with the highest total median scores were physical training (34 points), military parachuting (32 points), privately-owned vehicle crashes (31 points), sports (29 points), falls (27 points), and military vehicle crashes (27 points). Using a data-driven, criteria-based process, three injury causes (physical training, military parachuting, and privately owned-vehicle crashes) with the greatest potential for successful program and policy implementation were identified. Such information is useful for public health practitioners and policymakers who must prioritize among health problems that are competing for limited resources. The process and criteria could be adapted to systematically assess and prioritize health issues affecting other communities., Published in American Journal of Preventive Medicine, v38 n1S pS11-S18, 2010.

Medical information systems during past military deployments had limited injury surveillance capability as data were not accessible during deployments and did not capture causes of injury. This paper describes nonbattle injury (NBI) results from an ongoing surveillance program that identifies injury occurrences and causes during deployments for Operations Iraqi Freedom (Iraq) and Enduring Freedom (Afghanistan)., Published in Am J Prev Med, v38 nIS pS94-S107, January 2010.

Injuries are the leading cause of morbidity and mortality confronting U.S. military forces in peacetime or combat operations. Not only are injuries the biggest health problem of the military services, they are also a complex problem. The leading causes of deaths are different from those that result in hospitalization, which are different from those that result in outpatient care. As a consequence, it is not possible to focus on just one level of injury severity if the impact of injuries on military personnel is to be reduced. To effectively reduce the impact of a problem as big and complex as injuries requires a systematic approach. The purpose of this paper is to: (1) review the steps of the public health process for injury prevention; (2) review literature on evaluation of the scientific quality and consistency of information needed to make decisions about prevention policies, programs, and interventions; and (3) summarize criteria for setting objective injury prevention priorities. The review of these topics will serve as a foundation for making recommendations to enhance the effectiveness of injury prevention efforts in the military and similarly large communities. This paper also serves as an introduction to the other articles in this supplement to the American Journal of Preventive Medicine that illustrate the recommended systematic approach., American Journal of Preventive Medicine, v38 n1, ps1-s10, 2010.

TITLE: A Process to Identify Military Injury Prevention Priorities Based on Injury Type and Limited Duty Days. BACKGROUND: Injuries, one of the leading public health problems in an otherwise healthy military population, affect operational readiness, increase healthcare costs, and result in disabilities and fatalities. This paper describes a systematic, data-driven, injury prevention-decision making process to rank potential injury prevention targets. METHODS: Medical surveillance and safety report data on injuries for 2004 were reviewed. Non-fatal injury diagnoses (ICD-9-CM codes) obtained from the Defense Medical Surveillance System were ranked according to incident visit frequency and estimated limited duty days. Data on the top five injury types resulting in the greatest estimated limited duty days were matched with hospitalization and Service Safety Centers' accident investigation data to identify leading causes. Experts scored and ranked the causes using predetermined criteria that considered the importance of the problem, preventability, feasibility, timeliness of intervention establishment/results, and ability to evaluate. Department of Defense (DoD) and Service-specific injury prevention priorities were identified. RESULTS: Unintentional injuries lead all other medical conditions for number of medical encounters, individuals affected, and hospital bed days. The top ten injuries resulted in an estimated 25 million days of limited duty. Injury-related musculoskeletal conditions were a leading contributor to days of limited duty. Sports and physical training were the leading cause, followed by falls., Published in the American Journal of Preventive Medicine, v38 n1 supp1 pS19-S33, Jan 2010. Prepared in cooperation with Air Force Safety Center, Kirtland AFB, NM; Office of the Assistant Secretary of Defense for Health Affairs, Falls Church, VA; and others.

This study examined risk factors for time-loss injuries during U.S. Army Ordnance School Advanced Individual Training (AIT). Participants were soldiers (n= 3757 men, n=498 women) attending Ordnance AIT from January 2000 to June 2003. Injuries were obtained from an injury surveillance system in the medical clinic serving the AIT soldiers. Potential injury risk factors included entry-level fitness, demographics, and lifestyle variables. Fitness variables included maximal effort performance on push-ups, sit-ups and a 2-mile run. A health questionnaire provided data on age, race, rank, current self reported injury, current self reported illness, and tobacco use. Fitness variables were converted to four quartiles (Q) based on the distribution of scores (Q1=high performance to Q4=low performance). AIT entry and completion dates were obtained from an Army personnel system. Backward stepping Cox regression examined associations between time-loss injury and potential injury risk factors. Multivariate hazard ratios (MHR) and 95% confidence intervals (95%CI) were calculated. Cumulative time-loss injury incidence was 31% for men and 54% for women. For men, higher risk of injury resulting in time-loss was independently associated with race (MHR (Native American/Caucasian) = 1.4, 95%CI = 1.1-1.7), a current self reported injury (MHR (yes/no) = 2.2, 95%CI = 1.8-2.7), smoking before entering the Army (MHR (≤10 cigarettes/nonsmokers) = 1.3, 95%CI = 1.0-1.5, MHR (10-20 cigarettes/nonsmokers)= 1.5, 95%CI=1.2-1.7, MHR (20 cigarettes/nonsmokers) = 1.9, 95%CI = 1.6-2.2), lower sit-up performance (MHR (Q4/Q1) = 1.2, 95%CI = 1.0-1.5), and slower 2-mile run times (MHR (Q4/Q1)= 1.4, 95%CI = 1.2-1.7). For women, higher risk of injury was independently associated with race (MHR (Black/Caucasian) = 0.7, 95%CI = 0.5-0.9), a current self reported injury (MHR (yes/no) = 1.6, 95%CI = 1.1-2.3), and slower 2-mile run times (MHR (Q4/Q1) = 2.2, 95%CI = 1.5-3.1).

Dr. David Satcher, Surgeon General of the United States, declared in 1999 that suicide is a serious public health threat, launching a national effort to develop strategies to prevent suicide and the suffering it causes. The Army followed his direction and in December 1999, the Chief of Staff of the Army directed a review of the Army Suicide Prevention Program (ASPP). In 2000, the Army G-1, the Behavioral Health Proponent at the Army Office of the Surgeon General (OTSG), and the Office of Chief of Chaplains completed a review and determined that the ASPP was basically sound; however, it needed to emphasize greater leadership involvement and offer more advanced training. In 2001, the Army implemented the Suicide Prevention Campaign Plan that emphasized prevention and intervention measures, directed commanders to take ownership, and synchronized and integrated resources at an installation level. In compliance with the need for more advanced training, the Army G-1 funded intervention training in 2002 by contracting with Living Works and initiated the Applied Suicide Intervention Skills Training workshops with accompanying computer interactive computer disk. In 2005, the Army G-1 funded Question, Persuade, Refer workshops Army-wide to provide an additional resource in suicide prevention awareness and intervention training.

The purpose of this multi-disciplinary behavioral health (BH) epidemiological consultation (EPICON) to Fort Carson was fourfold: (1) to examine rates and trends in violent deaths involving Soldiers within tenant organizations of Fort Carson vs. Army and FORSCOM comparison groups; (2) to identify risk factors associated with the violent deaths; (3) to assess the adequacy of behavioral health programs, resources, and social support; and (4) to recommend strategies to enhance current programs and reduce the installation's incidence of violent death. Allegedly, 8 homicides in the previous 12 months were perpetrated by 6 Soldiers from units at Fort Carson. In response to this apparent clustering of violent behavior at Fort Carson, Colorado, Senior Mission Commander, MG Mark Graham, initiated a Task Force in October 2008 to investigate Soldiers currently or recently assigned to Fort Carson units alleged to have committed homicide, attempted homicide, or been accessories to a homicide since 2005. Based on broader concerns voiced by Army and Congressional Leadership, a wider review was initiated to assess the potential impact of Army waiver policies on the observed criminal activity and assess the adequacy of available BH resources.

The Skydex(R) seat pad was tested to see if it could reduce low back pain (LBP) among drivers performing long-distance driving missions from Kuwait into Iraq. One group of military drivers received the seat pads (SP group), while another did not (NSP group). Questionnaires were administered before the seat pads were issued and about 6 months after the seat pads were issued. Soldiers also completed a survey after each driving mission that asked them to rate their back pain (1O-point scale, 1= low pain, 10=extreme pain) before and after their driving missions. The study initially included 53 NSP Soldiers and 45 SP Soldiers, but loss to follow-up resulted in 13 NSP Soldiers and 43 SP Soldiers available for analysis. Questionnaire responses before and after issuing the seat pads indicated that more NSP Soldiers reported LBP in the 6-month period after the seat pads were issued (intervention period) compared with the 6-month period before the seat pads were issued (preintervention period). In contrast, more Soldiers in the SP group reported LBP during the pre-intervention period (compared with the NSP group), but during the intervention period, that number declined or remained the same. On the mission surveys, the NSP group doubled their subjective rating of back pain after the missions (2.4?1.7 to 4.9?2.2), while the SP group had identical before and after mission ratings (3.0?2.7 versus 3.0?2.8) (interaction p<0.01).

The Outreach Program (OP) at Fort Sill, Oklahoma provides continual behavioral health (BH) education and counseling awareness services to Soldiers using the principles of Combat and Operational Stress Control (COSC) in garrison. OP requested a program evaluation from the U.S. Army Center for Health Promotion and Preventive Medicine (USACHPPM) to describe the programs activities, the process of implementation, the program's effect on Soldiers access to BH services, and the program's impact on Soldiers BH outcomes for those who access services. USACHPPM based the findings on data previously gathered by OP staff and on existing Army epidemiological databases. In addition, USACHPPM conducted interviews with key OP staff to capture the implementation process and lessons learned. Over the course of the program, OP activities have reached more than 17,000 Soldiers, Unit Leaders, and Family Readiness Group (FRG) members at Fort Sill. These groups report high satisfaction with program activities. Soldiers and Unit Leaders who attended OP activities cited differential treatment by leadership as the largest barrier to seeking BH care. Overall, perceptions of barriers to BH care were lower in this group than those reported in the published literature. During program implementation, hospitalizations at Reynolds Army Community Hospital (RACH) for ICD-9 mental health diagnoses stabilized while ambulatory visits increased. This may be associated with the program's ability to intervene early and encourage Soldiers use of BH services for routine issues before they become emergencies. The OP is a valued and well received BH program which has the capability to affect a positive impact on Soldiers BH. The results of this evaluation support the continuation and expansion of the program at Fort Sill while also warranting further prospective investigation of social work outreach programs in garrison and their effect on Soldiers general wellbeing and mission readiness.

Although small arms ranges are known to be contaminated with lead, the full extent of metal contamination has not been described, nor has the oral bioavailability of lead in these soils. In this work, soil samples from ranges with diverse geochemical backgrounds were sieved to <250 microns and analyzed for total metal content. Soils had consistently high levels of lead and copper, ranging from 4549 to 24,484 micrograms/g and 223 to 2936 micrograms/g, respectively, while arsenic, antimony, nickel, and zinc concentrations were 100-fold lower. For lead bioavailability measurements,two widely accepted methods were used: an in vivo juvenile swine relative bioavailability method measuring lead absorption from ingested soils relative to equivalent lead acetate concentrations and an in vitro bioaccessibility procedure which measured acid-extractable lead as a percent of total lead in the soil. For eight samples, the mean relative bioavailability and bioaccessibility of lead for the eight soils was about 100% (108 + or - 18% and 95 + or - 6%, respectively) showing good agreement between both methods. Risk assessment and/or remediation of small arms ranges should therefore assume high bioavailability of lead., To be published in Environmental Science and Technology.

In response to a request from the Military Training Task Force of the Defense Safety Oversight Council, this study examined whether prescribing running shoes based on the shape of the plantar surface influenced injury risk in Marine Corps basic training. After foot examinations, Marine Corps recruits in an experimental group (E, n=408 men, 314 women) were prescribed motion-control, stability, or cushioned shoes for plantar shapes indicative of low, medium, or high arches, respectively. A control group (C, n=432 men, 256 women) received a stability shoe regardless of plantar shape. Injuries during training were determined from outpatient visits provided by the Armed Forces Health Surveillance Center. Other known injury risk factors (e.g., fitness, smoking, prior physical activity) were obtained from a questionnaire, existing databases, or the training units. Multivariate Cox regression controlling for other risk factors showed little difference between the E and C groups among men (hazard ratio(E/C)=1.04, 95% confidence interval=0.83?1.29) or women (hazard ratio(E/C)=0.82, 95% confidence interval = 0.65?1.14). This prospective study demonstrated that assigning shoes based on the shape of the plantar foot surface had little influence on injuries after control of other injury risk factors., Prepared in collaboration with Naval Health Research Center, San Diego, CA. The original document contains color images.

Footwear characteristics can have an influence on fatigue, overuse injuries and comfort. Shoes are an important consideration for members of the US Army Band who may perform hundreds of missions a year. These missions often include prolonged standing, marching, and can be conducted in unfavorable weather conditions. In a previous investigation, over 50% of the band members noted problems with their footwear such as lack of cushioning, support and breathability. In an effort to reduce injuries and improve comfort, one to two pairs of shoes with a presumed increase in cushioning and ventilation were provided to the band members (n=112) to wear for one year. Participant demographic and lifestyle data were collected from existing databases and a questionnaire. The McNemar test was used to compare injury incidence 1 year prior to receiving the shoes and 1 year after receiving the shoes. Potential risk factors for self-reported foot, knee, and back pain, numbness or discomfort attributed to band activities were explored using logistic regression. There were no differences in injury incidence one year before receiving the new shoes versus the year in which the band members wore the new shoes. Being assigned to the ceremonial group, poor shoe cushioning, wearing orthotics and those who replaced their shoes more frequently were associated with a higher risk of foot pain and discomfort; a poor fit in the heel was associated with a higher risk of knee pain and discomfort; marching for longer periods of time, performing other physical activities 5-7 days a week, poor shoe cushioning and reported feet too warm in hot weather was associated with a higher risk of back pain and discomfort. Combining the specific shoe characteristic ratings into groups revealed that approximately a quarter of the band members rated the fit of the shoes as poor and approximately one third rated comfort characteristics as poor., The original document contains color images.

Hantaviruses in the Americas may cause human disease involving the lungs, hence the name "hantavirus pulmonary syndrome" (HPS). Since May 1993, a total of 416 HPS cases (as of 1 February 2006) have been confirmed by the Centers for Disease Control and Prevention (CDC) in residents of 32 states, with 39 of these cases identified retrospectively with onset of illness prior to May 1993. One hundred and six (38%) of the HPS cases have had a fatal outcome. Sin Nombre virus (SNV) has been responsible for over 90% of the human hantavirus cases in the United States in the last nine years. Peromyscus maniculatus, the deer mouse, is the primary reservoir for SNV. This has also been confirmed by USACHPPM-West surveillance at 44 military installations, mostly in the western half of the United States, where 12% of the P. maniculatus sampled have been positive for SNV. The deer mouse is found in most of North America and frequently lives in buildings, including those on military installations. Hantaviruses that cause illness in humans are also found in other rodents, but the number of cases stemming from these hantaviruses is small when compared to SNV. Hantavirus is shed in rodent urine and feces. The primary route of infection, inhalation of airborne particles containing virus, is almost always associated with indoor environments. Removal of rodent contamination from indoor areas will reduce the risk of personnel acquiring hantavirus infection. The level of contamination, the type of activity in the facility, and the type of personnel performing the cleanup operations will dictate the methods used and the personal protective measures to be taken. The goal of any cleanup operation is to remove rodent contaminants without exposing cleaning personnel to hantavirus-laden particles in the air or on their hands and bodies. The risk of coming into contact with hantavirus increases with the amount of contamination present and the type of cleanup required. Obviously, it is easier to cle

The purpose of this research is to describe the Natural Resource Damage Assessment (NRDA) process, identify Department of Defense (DOD) roles and responsibilities, and propose approaches that may reduce the probability or consequences of claims directed at DOD. To promote an awareness of potential Natural Resource Damage (NRD) claim liabilities and methods that may be used to help reduce these claims.

The purpose of this assessment was to evaluate various types of composting operations to determine their technical and economic feasibility at Army installations. The assessment included site visits to two installations with dissimilar compost programs. Another objective was to determine how USACHPPM could assist Army installations in developing compost programs.

Injuries are the biggest health problem confronting U.S. military forces in peacetime and combat operations, resulting in over 1.8 million medical encounters annually across the Services and affecting more than 800,000 individual Service members. Not only are injuries the biggest health problem of the Services, but they are also a complex problem. The leading causes of deaths are different from those that result in hospitalization, which are different from those that result in outpatient care. As a consequence, it is not possible to focus on just one level of injury severity if the impact of injuries on military personnel is to be reduced. To effectively reduce the impact of a problem as big and complex as injuries requires a systematic approach. The purpose of this summary is to introduce the concepts behind a systematic approach to injury prevention. Specifically, the following will be presented: (1) the steps of the public health approach to injury prevention, (2) relevant literature on the evidence-based process for systematic evaluation of the scientific quality and consistency of information needed to make decisions to implement injury prevention policies, programs and interventions, and (3) criteria for setting objective injury prevention priorities. The review of these topics will serve as a foundation for making recommendations to enhance the effectiveness of injury prevention efforts in the military.

This project examined injuries and physical fitness before and after deployments of the 10th Mountain Division to Afghanistan (10thMt cohort, n=505 men) and 1st Cavalry Division to Iraq (1stCav cohort, n=3242 men). Deployed Soldiers' outpatient medical encounters were obtained from the Armed Forces Health Surveillance Center and examined for injuries during two consecutive 90-day periods before (Periods 1-2) and two consecutive 90-day periods after deployment (Periods 3-4). Army Physical Fitness Test (APFT) data were obtained from testing 4-6 months before and after deployment. Both deployed groups showed post deployment increases in injury incidence (10thMt=14.1%, 14.1%, 16.4%, 23.4%; 1stCav=15.1%, 12.4%, 35.4%, 43.4%; Periods 1-4, respectively). Limited APFT data (n=178, 10thMt; n=90, 1stCav) indicated that average post deployment body weights were higher (3-9 lb), but there was generally little difference in the pre- and post deployment push-up and sit-up scores. The 10thMt group had similar pre- and post deployment 2-mile run times, but the 1stCav demonstrated an average 5% slower post deployment run time. This project documented a post deployment increase in injuries. Further, in some cases, physical fitness may not return to pre deployment levels even 4 to 6 months post deployment, although an appropriate physical training program may ameliorate this effect., The original document contains color images.

This report documents the results of ambient air sampling of multiple classes of pollutants expected to be emitted by municipal waste open burn pit operations conducted at Balad Air Base, Iraq. The results were used to develop a screening health risk assessment (HRA) of military personnel located at the site and likely exposed to these pollutants. Findings indicate that measured exposure levels from burn pit operations are not routinely above deployment military exposure guidelines (MEGs) for exposures up to 1 year, levels which are not likely to cause short-term, onset health effects. A human HRA was performed under guidance outlined by the U.S. Environmental Protection Agency (U.S. EPA). These results indicate an "acceptable" health risk for both cancer and non-cancer long-term health effects. Recommendations are provided to reduce the generation of burn pit emissions, thereby reducing exposure to personnel., The original document contains color images.

As with previous military conflicts, nonbattle injuries (NBIs) are a major cause of mortality in Operations Enduring (OEF) and Iraqi Freedom (OIF). The purpose of this retrospective analysis was to 1) describe the incidence and rate of fatal NBls in OEF and OIF from their beginning through December 2006, 2) describe the causes and circumstances of fatal NBls, and 3) compare two Army data systems that report fatal NBI incidents. This analysis included all U.S. Army Soldiers who died from nonbattle injuries while deployed for OEF (October 2001 - December 2006) or OIF (March 2003 - December 2006). An NBI fatality case was defined as any Soldier (Regular Army, Army Reserve, or Army National Guard) who died due to a nonbattle injury sustained while in a deployed status for OEF or OIF, including while on midtour leave. This investigation included nonbattle injUry fatalities resulting from 1) unintentional injury incidents, 2) intentional incidents (e.g., homicides, suicides), and 3) physical training. NBls were responsible for 21 percent of all deaths in OEF and OIF. The leading causes of fatal injury were land transport vehicle accidents (41 percent), self-inflicted wounds (18 percent), and air transportrelated accidents (18 percent). Measures have been taken to improve the rate of NBI fatalities during these deployments. More prevention strategies must be researched, implemented, and continually taught to Soldiers in theater to reduce these potentially avoidable deaths.

In Basic Combat Training (BCT) running shoes are prescribed based on plantar foot shape (reflecting longitudinal arch height). In response to a request from the Military Training Task Force of the Defense Safety Oversight Council this study examined whether or not this prescription technique influenced injury risk. After foot examinations BCT recruits in an experimental group (E, n=1,079 men, 456 women) were prescribed motion control stability or cushioned shoes for foot shapes judged to represent low medium or high arches respectively. A control group (C, n=1,068 men, 464 women) received a stability shoe regardless of plantar foot shape. Injuries during BCT were determined from outpatient visits provided by the Army Medical Surveillance Activity. Other previously known injury risk factors (e.g. age fitness smoking) were obtained from a questionnaire and existing databases. Multivariate Cox regression controlling for other injury risk factors showed little difference between the E and C groups among men (risk ratio (CIE) = 1.1195% confidence interval = 0.91- 1.34) or women (risk ratio (CIE)=1.14 95% confidence interval = 0.91-1.44). This prospective study demonstrated that prescribing shoes on the basis of the shape of the plantar foot surface had little influence on injury risk even after control of known injury risk factors., The original document contains color images.

In a double-blinded study design, female Army basic trainees were randomized into either an iron supplement group (ISG, n=105) or a placebo group (PG, n=103). The ISG consumed 16 mg elemental iron daily. Prior to treatment, measures of physical activity, tobacco use, menstrual status, physical characteristics, body composition, physical fitness, and demographics were obtained. Blood was collected to identify subjects who were iron deficient (ID) or had iron deficiency anemia (IDA). Injury outcomes were obtained from outpatient medical surveillance data. Risk ratios (RR) and 95% confidence intervals (95%CI) were calculated. Cox regression indicated little difference in injury risk between the ISG and PG in multivariate analysis that included significant injury covariates (RR (ISG/PG)=1.14, 95%CI=0.79 1.64, p=0.48). For ID subjects (n=34), univariate Cox regression showed little difference in injury risk between the ISG and PG (RR (ISG/PG)=0.85, 95% CI=0.41-2.10, p=0.85). For IDA subjects (n=43), Cox regression also showed little difference in injury risk between the ISG and PG in multivariate analysis that included significant injury covariates (RR (ISG/PG)=0.87, 95%CI=0.36-2.07, p=0.75). Statistical power analysis indicated that sample sizes of 1,130 ID subjects and 1,680 IDA subjects (in each group) would be needed before these group differences (ISG vs. PG) were statistically significant at the p=0.05 level (power=80%). This study did not support the hypothesis that iron supplementation reduces injuries in BCT.

Upon arrival for Advanced Individual Training (AIT), service members at the Aberdeen Proving Ground, Maryland, Army Ordnance School (n=27,289 men and 3,856 women) completed a questionnaire that 1) collected demographic and lifestyle information 2) asked if they had a training-related injury that would interfere with their performance during AIT, and 3) asked about their use of tobacco products 30 days before Basic Combat Training (BCT). It was administered as new students arrived every week from 2000 through 2006. To examine potential temporal changes in demographic and lifestyle characteristics over the years, chi-square and linear trend statistics were used. Potential risk factors for self-reported injury and cigarette use were explored using logistic regression. A majority of the service members were male, between the ages of 17 and 24, Caucasian, of lower rank (E1), and had attended basic training at Fort Knox or Fort Jackson. An injury that the service member said would interfere with their training was reported by 8% of men and 17% of women. In the 30 days before BCT, 43% of the service members smoked one or more cigarettes and 35% reported smoking on 20 or more days. For men and women, higher risk of injury was associated with older age and having a current self-reported injury. The risk of smoking on 20 or more days was higher among 20 29 year old men and 20+ year old women, Caucasians, and smokeless tobacco users. Throughout the last 7 years, demographic and lifestyle changes have School, reflecting those seen in BCT., The original document contains color images.

A questionnaire was administered to 1,956 students in Army Airborne training as part of an effort by the Military Training Task Force (MTTF) of the Defense Safety Oversight Council (DSOC) to evaluate the parachute ankle brace (PAB). Information provided by the questionnaire identified potential injury risk factors and comments on the PAB. Risk factors for injuries in the past year included service branch, Airborne recycling, less physical activity, older age, greater body weight, higher BMI, and (among Army personnel) slower 2-mile run time. Risk factors for jump week injuries included higher rank, longer time in service, older age, Airborne recycling, height, more body weight, not wearing the PAB, aircraft exit problems, an injury in the past year, and (for Army men) fewer push-ups and slower 2-mile run time. Students who had worn the brace were more likely to have favorable comments on the PAB compared with those who had not worn it. Most negative PAB comments were related to the heel strap and an improvement has been proposed and is in production. Students complained that the PAB rubbed on the legs, shin, ankle, and calf; this might be associated with the heel strap or pulling the ankle strap to tight; this problem might be alleviated by the strap improvement and/or better guidance on appropriate tightness for the ankle straps. Students also complained of difficulty in keeping the feet and knees together when wearing the PAB. This could be a matter of perception or some adaptation and accommodation may be required in this area., The original document contains color images.

Ammunition manufacture is the second largest consumer of lead in the United States, after batteries, and represents approximately 80,000 metric tonnes per year. About 3000 small arms ranges exist, the berms of which act as reservoirs for spent ammunition, and the DoD has a vested interest in monitoring the status of these sites so that military personnel may continue to be trained in a sustainable environment. Risk management of lead at small arms ranges depends on the site end use, whether the range is open or closed, and whether the risk drivers are human or ecologic. EPA risk assessment guidelines allows for applications of site specific bioavailability for lead, where this bioavailability differs from the assumed default of 60%. Assessing the site specific bioavailability of lead has historically been carried out using the in vivo juvenile swine model, but significant reduction in cost and time could be achieved by using less expensive, less technical, and less time consuming in vitro models. This study compared bioavailability of lead from small arms range soils from eight different sites, using both an established in vivo and in vitro method. The in vivo method was based on the measured absorption of soil-lead (compared to lead acetate) by swine dosed daily for 14 days, using the ratio of the blood dose-response slopes for each compound. For the in vitro method lead was extracted from an aliquot of soil for one hour at 37 deg C using glycine-HCl buffer at pH 1.5. The extractable lead was expressed as a percentage of the total lead in the sample. The initial aims of the study were to compare a projected range of bioavailability in a range of soils, creating a linear comparison between both methods. However, all eight soils carefully selected for testing were determined to have high bioavailability, regardless of source, pH, CEC, or organic matter., Prepared in collaboration with the Department of Veterinary Medicine, University of Missouri, Springfield, and the Department of Geology, University of Colorado, Boulder.

The U.S. Army Center for Health Promotion and Preventive Medicine (USACHPPM) maintains an injury surveillance system for deployed Soldiers. U.S. Transportation Command's Regulating and Command & Control Evacuation System (TRAC2ES) data for Soldiers medically air evacuated from U.S. Central Command while deployed for Operation Iraqi Freedom (OIF; March 2003-December 2007) and Operation Enduring Freedom (OEF; October 2001-December 2007) was coded for cause of injury. Additional sources of injury data were the Standard Inpatient Data Records and Defense Casualty Information Processing System data. Descriptive statistics were used to show non-battle injury (NBI) rates over time, the frequencies of NBIs and fatalities, all injuries compared to disease diagnosis groups, and causes of NBIs. Injury matrices were used to describe the frequency of NBIs by body region and nature of injury. For OIF, NBI rates decreased over time from a high in 2003. The OEF NBI rates increased over time. For OIF and OEF combined, injuries (battle and non-battle combined) comprised 52% of all battle/non-battle/disease incidents. Leading causes of NBIs were sports/physical training, falls/jumps, and motor vehicle accidents. Recommendations are to continue surveillance of deployment injuries and identify modifiable risk factors that contribute to the leading causes of injury to inform injury prevention practice and policy.

In response to a request from the Military Training Task Force of the Defense Safety Oversight Council, this study examined whether prescribing running shoes based on the shape of the plantar surface influenced injury risk in Marine Corps basic training. After foot examinations, Marine Corps recruits in an experimental group (E, n=408 men, 314 women) were prescribed motion-control, stability, or cushioned shoes for plantar shapes indicative of low, medium, or high arches, respectively. A control group (C, n=432 men, 256 women) received a stability shoe regardless of plantar shape. Injuries during training were determined from outpatient visits provided by the Armed Forces Health Surveillance Center. Other known injury risk factors (e.g., fitness, smoking, prior physical activity) were obtained from a questionnaire, existing databases, or the training units. Multivariate Cox regression controlling for other risk factors showed little difference between the E and C groups among men (hazard ratio(E/C)=1.04, 95% confidence interval=0.83-1.29) or women (hazard ratio(E/C)=0.82, 95% confidence interval = 0.65-1.14). This prospective study demonstrated that assigning shoes based on the shape of the plantar foot surface had little influence on injuries after control of other injury risk factors., The original document contains color images.

A questionnaire was administered to 1,956 students in Army Airborne training as part of an effort by the Military Training Task Force (MTTF) of the Defense Safety Oversight Council (DSOC) to evaluate the parachute ankle brace (PAB). Information provided by the questionnaire identified potential injury risk factors and comments on the PAB. Risk factors for injuries in the past year included service branch, Airborne recycling, less physical activity, older age, greater body weight, higher BMI, and (among Army personnel) slower 2-mile run time. Risk factors for jump week injuries included higher rank, longer time in service, older age, Airborne recycling, height, more body weight, not wearing the PAB, aircraft exit problems, an injury in the past year, and (for Army men) fewer push-ups and slower 2-mile run time. Students who had worn the brace were more likely to have favorable comments on the PAB compared with those who had not worn it. Most negative PAB comments were related to the heel strap and an improvement has been proposed and is in production. Students complained that the PAB rubbed on the legs, shin, ankle, and calf; this might be associated with the heel strap or pulling the ankle strap to tight; this problem might be alleviated by the strap improvement and/or better guidance on appropriate tightness for the ankle straps. Students also complained of difficulty in keeping the feet and knees together when wearing the PAB. This could be a matter of perception or some adaptation and accommodation may be required in this area., The original document contains color images.

In May 2005, the U.S. Army Center for Health Promotion and Preventive Medicine was tasked by the Deputy Assistant Secretary of the Army for Environment, Safety and Occupational Health to develop an injury surveillance system for deployed Army Soldiers. A primary objective was to develop a system capable of identifying types and potentially preventable causes of injuries requiring medical air evacuation. The primary data source for air evacuated injured Soldiers was the U.S. Transportation Command Regulating and Command and Control Evacuation System (TRAC2ES) which included standardized diagnosis codes and a free-text patient history from which details for injury causes could be obtained. TRAC2ES data were linked to data from the Defense Casualty Reporting System (DCIPS) and the Army Safety Management Information System (ASMIS) to obtain additional details for the injury causes and circumstances. Since information on injury causes was in free-text fields, coders reviewed each air evacuation case and applied a standardized coding scheme (STANAG) to classify causes of injury. The final enhanced air evacuation data system included 1) linked data from TRAC2ES, DCIPS and ASMIS and 2) coded causes and types of injuries. This system provided high quality, analysis-ready data and is well suited for deployment injury surveillance.

Previous studies have demonstrated that the parachute ankle brace (PAB) reduces ankle injuries during military airborne operations. This investigation reevaluated the PAB controlling for extrinsic risk factors. Injury incidence among airborne students wearing the PAB was compared to those not wearing the PAB. Covariate data were collected on extrinsic risk factors including wind speed, type of jump (administrative-nontactical versus combat load) and time of day (day versus night). A total of 596 injuries occurred in 102,784 jumps. After controlling for covariates in a multivariate model, students who did not wear the brace were 1.90 (95%CI=1.24-2.90) times more likely to experience an ankle sprain, 1.47 (95%CI=0.82-2.63) times more likely to experience an ankle fracture, and 1.75 (95%CI=1.25-2.48) times more likely to experience an ankle injury of any type. Injuries to other parts of the lower body (exclusive of the ankle) were not significantly influenced by the brace. The incidences of parachute entanglements were similar among students wearing and not wearing the PAB. Thus, after controlling for covariates known to effect injury rates, the PAB protected against ankle injuries and especially ankle sprains while not influencing parachute entanglements and other lower body injuries exclusive of the ankle., The original document contains color images.

While physiologic risk factors for injury in military training populations have been well-established, knowledge of behavioral risk factors is limited. This study investigated the association of health risk behaviors with injuries sustained by men and women in Army basic training. Self-reported questionnaire data on health risk behaviors collected on entry to training were linked to medical data on injuries occurring during the 9-week training period. Multivariate survival analysis tested the association of training-related injury with a risk-taking index consisting of five individual health risk behaviors (cigarette use, smokeless tobacco use, alcohol use, weight control practices, and diet/lifestyle choices). Analyses were conducted separately for men and women, and models controlled for demographic, physical fitness, and physiologic characteristics. Among this sample of 1,156 young mean and 746 women (median age: 19), cumulative injury incidence was 4.2 trainees/1,000 trainee-days for mean and 9.3 trainees/1,000 trainee-days for women. Males in both the lowest (Hazard ratio (HR)=1.73, 95%CI:1.47,2.05) and highest (HR=1.92, 95%CI:1.57,2.34) risk-taking index categories had greater risk of training-related injury compared to persons within one standard deviation of the mean risk index score. Cigarette use was independently associated with training-related injury; males in the medium risk cigarette use index category had 1.8 times the risk of a training-related injury compared to the low risk category (HR=1.77, 95%CI:1.31 ,2.40). An association between the combined risk-taking index and injury was not seen among females. However, females in the high risk cigarette use category (HR=1.53, 95%CI:1.1 0,2.12) and females in the medium (HR=1.08, 95%CI:1.03, 1.14) and high risk (HR: 1.52, 95%CI:1.21, 1.93) diet/lifestyle categories had higher risk of training-related injury compared to females in low risk categories., Doctoral dissertation

This retrospective study was conducted to assess the nature and causes of serious oral-facial illnesses and injuries among U.S. Army personnel deployed to Iraq and Afghanistan in 2006. Information for this study came from the U.S Air Force Transportation Regulating and Command & Control Evacuation System (TRAC2ES) database for medical evacuations (MEDEVACS) for 2006. The study found 113 oral-facial MEDEVACS out of Iraq (cumulative incidence: 10.2/10,000 soldiers per year) and 19 out of Afghanistan (cumulative incidence: 11.1/ 10,000 soldiers per year), a total of 132 MEDEVACS. Fifty nine percent (n=78) of oral-facial MEDEVACS were due to battle injuries caused almost entirely by acts of war. Nearly 24 percent (n=31) of oral4acial MEDEVACS were due to non battle injuries, primarily fractures of the face bones, mainly because of fighting, blunt trauma, falls, motor vehicle accidents or sports. Seventeen percent of all oral-facial MEDEVACS (n=23) were due to diseases of the oral cavity, salivary glands, and jaw.

Injury rates and potential risk factors were examined in the 284 members of the US Army Band in response to a request from the Band Commander. Collected data included 1) information obtained directly from the Band (fitness test scores, height, weight, etc.), 2) medical data from the Defense Medical Surveillance System, 3) audiograms of Band member from the Defense Occupational and Environmental Health Readiness System-Hearing Conservation database, 4) focus group interviews of Band members, 5) questionnaire responses from all Band members and, 6) observations on Band activities. Results led to 10 recommendations including: increase physical activity and physical fitness of low fit Band members, provide enhanced hearing protection, conduct annual hearing tests, reduce environmental heat exposures, provide ergonomic devices, provide functional movement and pain management training, reduce standing and marching, provide appropriate shoes, provide uniforms for hot and humid conditions, and change chairs. Implementing some or all of the suggested interventions is likely to reduce injuries and musculoskeletal symptoms., The original document contains color images.

Recently, catnip, Nepeta cataria L. (Lamiaceae), essential oil has been formulated and marketed as an alternative repellent for protection against biting arthropods by several vendors. We isolated the major active components of catnip oil, E,Z- and Z,E-nepetalactone, and quantitatively measured their antibiting ef cacy compared with the repellents N,N-diethyl-3-methylbenzamide (deet) and chiral (1S,2S)-2-methylpiperidinyl-3-cyclohexene-1-carboxamide (SS220) against the yellowfever mosquito, Aedes aegypti (L.), by using an in vitro assay and human volunteers at 24 nmol compound/cm2 (cloth or skin). Of all compounds tested in an in vitro assay, SS220 ranked as the most effective, whereas catnip oil and the nepetalactone compounds did not differ signi cantly from each other or from deet. However, in human volunteer bioassays, neither E,Z and Z,E-nepetalactone nor racemic nepetalactone deterred mosquito biting as effectively as SS220 or deet. All compounds differed signi cantly from the control. We conclude that catnip oil and nepetalactone isomers are signi cantly less effective than deet or SS220 in deterring the biting of Ae. aegypti., Pub. in Journal Medicine entomology, v42 n4, p343-646, 2005.

This white paper describes two stages of a process for setting injury prevention priorities and making evidence-based recommendations for programs and policies. This process is designed to (1) identify the largest, most severe injury problems for the Services; (2) describe the existing scientific evidence for leading injury issues and make program and policy recommendations based on this evidence, and; (3) prioritize injury prevention programs and policies using a set of criteria that enables an objective evaluation of proposed prevention initiatives based on factors that contribute to the eventual success or failure of programs and policies. The paper should be useful to decisions makers, Commanders, and medical and safety professionals at the DoD, Military Service, and Major Command levels who have responsibility for preventing injuries and/or enhancing troop readiness, interpreting and/or tracking medical, safety, or readiness trends, or directing and managing research and development and health resources., The original document contains color images.

The goal of this study was to begin the development of a computer-based software tool to automate the survey and reporting functions for ergonomic assessments. Ten Department of Defense installations participated in the beta test. The program was tested for user acceptability in the areas of system design, checklist design and content, report design and content, and proficiency. The beta test showed that the tool developed is a good first step in the development of an ergonomic checklist tool. The beta test users responded that the tool met many of the requirements needed for an ergonomic survey checklist, and that with a little practice and effort the majority of users can become proficient with the system. This proficiency will allow users to maximize their time spent in ergonomic efforts. The beta test also showed that the tool needs further development relative to the reporting function before further implementation can proceed.

This paper reviews the literature and existing databases for information on secular trends in the physical fitness of young Americans and describes changes in fitness during Basic Combat Training (BCT). The VO2max of male youth and new Army recruits has not changed while that of female youth and new recruits has improved slightly from at least 1975 to 1998. Performance has declined on endurance running tasks in a similar time period. It may be that youth and recruits are not as proficient at applying their physiological capability to performance tasks like timed runs, possibly because of factors such as reduced experience with ruining, lower motivation, and/or environmental factors. Limited data on Army recruits demonstrate an increase in strength from 1978 to 1998 that is consistent with an increase in the frequency of self-reported youth strength training and an estimated increase in fat-free body mass over the same time period. Data on muscular endurance is not consistent. Among young Americans there is strong evidence that body weight and body mass index (BMI) have progressively increased since about 1980 and this increase continues into the 2000s. Available evidence suggests that the increases in BMI and body weight are associated with an increase in caloric intake. Most physical fitness trends can be modeled using linear regression and there is little reason to think the trends cited above will not continue into the future. During BCT, men improved their push-up, sit-up, and 2-mile run performance by an average of 56%, 47%, and 17%, respectively; women improved an average of 189%, 77% and 18%, respectively. To track future trends in BMI, cardiorespiratory endurance, and muscular endurance in the Army, appropriate surveillance systems should be developed to systematically collect Army Physical Fitness Test data.

This paper reviewed the concept of physical fitness and outlined suggestions for a pre-enlistment physical fitness test. The components of physical fitness were identified by reference to factor analysis studies and to physiological concepts related to the components of physical fitness. The physiological validity and reliability of relatively simple tests of physical fitness were considered. Criteria against which physical fitness tests have been validated include a) performance on military tasks, b) injuries and c) attrition. The review resulted in three suggested courses of action. Course of Action 1 (COA1) was to keep the current Reception Station Physical Fitness Test consisting of push-ups (PU), sit-ups and a i-mile run. Course of Action 2 (COA2) involved a physical fitness test battery based on 1) findings in the literature, 2) the assumptions that the major components of physical fitness should be measured and 3) the assumption that fitness tests should be related to some criterion measure. The COA2 test consisted of an incremental dynamic lift (IDL), PUs and a 1-mile run. Course of Action 3 (COA3) recommended a research project that involves 6 major steps: 1) determining a set of critical military criteria, 2) determining a battery of physical fitness tests that are assumed to measure the fitness components associated with these criteria, 3) obtaining performance data on a representative sample of soldiers 4) validating and cross-validating the fitness measures against the military criteria, 5) selection of fitness test score that represent acceptable performance on the criterion tasks, 6) periodic re-evaluation of the fitness tests. The current entry-level physical fitness test (COA1) possesses some validity since individuals who do not pass the test are more likely to be injured or to attrite from service but the relationship with job performance is weaker and muscle strength is not measured by the test battery.

Attrition is the failure of an enlisted service member to be retained in service within the first term of enlistment. This paper emphasizes health/fitness-related aspects of attrition but also covers demographic and psychosocial factors. Overall 3-year military attrition steadily rose from 26% in 1985 to 31% in 1995. Demographic and psychosocial risk factors for attrition include lower educational attainment, female gender, White ethnicity, lower Armed Forces Qualification Test scores, lower moral character (less conformance to laws, rules and regulations), moral waivers, pre-service job instability, and less time in the Delayed Entry Program. The age-attrition relationship appears to be bimodal with higher attrition when youngest, decreasing in 19-23 year olds, and rising again after that. Attrition for mental health reasons is associated with pre-service physical/sexual abuse, previous mental health counseling, previous treatment with medication, previous psychiatric hospitalization, low motivation, pessimism toward training, depression, lack of self-reliance, and referral to a mental health facility. Attrition is also higher among those waivered for hearing problems, skin disorders, back disorders, and prior knee injuries. Other health-related risk factors include pre-service injury, injuries during basic training, a history of prior cigarette smoking, low physical activity prior to service, greater body weight, higher body mass index and lower physical fitness. Strategies to reduce attrition include prescreening by biographical questionnaires, compensatory screening, individual behavioral health counseling, and realistic job previews. Senior leadership initiatives have a powerful effect on attrition. Attrition also appears to be reduced by increasing physical fitness prior to basic training, the Physical Training and Rehabilitation Program, and the Pre-Initial Entry Training Program (for National Guard).

To address a broad range of related issues associated with chemical risk assessment and operational risk decision making. While this report focuses on a specific group of chemical warfare agents (GA GB, GD, GF, VX and HD) and exposure routes (i.e., inhalation, ocular, percutaneous), the concepts and reconiniendations extend to other chemicals (i.e., other warfare agents and toxic industnal chemicals (TICs)) as well as other exposure routes (i.e., ingestion). The guidance and reconiniendations address a variety of questions that have been asked of the U.S. Army Center for Health Promotion and Preventive Medicine (USACHPPM) over the past several years by operational, medical, and research/acquisition audiences. The concepts and recommendations in this report are also being used by USACHPPM to update previous guidance put forth in USACHPPM Technical Guide 230, Chemical Exposure Guidelines for Deployed Military Personnel., The original document contains color images.

From October 1999 to July 2004, all new recruits who arrived for Basic Combat Training (ECT) participated in the Fitness Assessment Program (FAP). The FAP involved an entry-level physical fitness test that new recruits took when they arrive at the Reception Station. Those passing the test entered BCT. Those failing the test entered a special physical training unit where they exercised until they could pass the test and then enter BCT. This report examines the FAP in terms of the number of recruits initially screened out by the test, the effects of the screening test on attrition, and cost effectiveness. Historical data on the proportion of trainees who failed the test was obtained from Ft Jackson, South Carolina. Attrition was compared in 2 groups of recruits, one that failed the test and went directly into BCT (No Pre-Conditioning (NPC) group) and another that trained to the test standards before entering BCT (Pre-Conditioning (PC) group). Cost effectiveness estimates were based on a figure of $27,628 per recruit. From early 1998 through Fiscal Year 2003, the proportion of recruits failing the screening test ranged from 4% to 7% for men and 10% to 24% for women. When BCT attrition was considered, discharges were over 3 times higher in the male NPC group than in the PC group (25% vs. 8%); the trend was similar among the women but the difference was half as large (29% vs. 19%). When attrition in the special physical training unit was included with BCT attrition, the proportion of discharges was more than twice as high in the male NPC group than in the male PC group (25% vs. 12%); the female NPC and PC groups had a similar proportion of discharges (29% vs. 27%, NPC and PC, respectively).

LTG Dennis Cavin, Commander of Accessions Command, tasked the U.S. Army Physical Fitness School (USAPFS) and the Center for Accession Research (CAR) to develop and test the ability of a standardized physical training (PT) program to improve fitness and reduce injuries and attrition during BCT. The program developed by the USAPFS followed the principles in Army Field manual 21-20 plus incorporated injury reduction principles involving reduced running mileage and a greater variety of exercises. LTG Cavin also wanted to determine if the new fitness program coupled with an administrative change might eliminate the necessity for the Fitness Assessment Program (FAP) or reduce the number of trainees who enter the FAP. New recruits who fail a basic fitness test at the Reception Station enter the FAP and train until they can pass the test and enter BCT. The proposed administrative change was to conduct the basic fitness test at Week 2 of BCT rather than in the Reception Station. This report examines attrition, fitness and injuries 1) during implementation of the standardized physical training program, and 2) among low-fit trainees who did and did not enter the FAP prior to BCT.

Presented at the AWWA Water Quality Technology Conference, 17 November 2004; Arsenic I. The original document contains color images.

International Conference on Industrial Hygiene, 1 October 2004, Montreal, Quebec, Canada. The original document contains color images.

The original document contains color images.

Based on previous contamination incidents, civilian and military water supply personnel have improved their drinking water surveillance practices. One of the biggest challenges though is that no single device can detect all chemical, biological, and radiological contaminants in the distribution system. The absence of a universal detector has forced water utility managers to increase their awareness and rely on conventional and unconventional system indicators. In particular, managers rely upon monitoring physiochemical parameters (e.g., chlorine, pH, conductivity, and turbidity), pressure readings at various points in the distribution system, and visual surveillance of water system assets. While these monitoring practices are useful, many water utilities do not have the funds to install real-time monitoring devices at every point or even a few points throughout their system. This paper provides (1) insight into why consumers report complaints, (2) a list of chemical and biological contaminants and their physiochemical and aesthetic water quality effects, (3) examples of how consumer complaints have been used to identify intentionally and unintentionally contaminated water, (4) a structured approach for investigating complaints, and (5) guidance on harnessing consumer feedback to better gauge water quality and potential for contaminations in the distribution system., Presented at the AWWA Water Quality Technology Conference (2004), held in San Antonio, TX, in November 2004.

The revised arsenic maximum contaminant level (MCL) of 0.010 mg/L is expected to impact many water utility systems, particularly those in western states, where high levels of naturally-occurring arsenic are more common. An Army installation was faced with treating groundwater (GW) to reduce arsenic and fluoride concentrations. Various water treatment technologies were evaluated based on engineering, economic, and regulatory criteria. Water conservation and source water quality issues also impacted treatment technology selection. Ultimately, activated alumina was deemed most feasible, and will be pilot tested to verify arsenic and fluoride removal efficiencies and to develop full-scale design data., Presented at the AWWA Water Quality Technology Conference held in San Antonio, TX on 14 Nov 2004.

During the first few days of Basic Combat Training (BCT), new recruits take an initial assessment run and they Me ranked from fast to slow. Four roughly equally sized "ability groups" Me established from these rankings and recruits run together in these groups for their aerobic training. There is no formal guidance on how fast or how far these ability groups should run. This paper provides this guidance and a rationale for systematically progressing ability group runs. The major considerations in the development of the guidance were 1) minimizing injuries, 2) the initial fitness level (maximum oxygen uptake or VO2max) of recruits, 3) improvements in run times during BCT, 4) running speeds of the slower individuals in each ability group 5) running speeds that must be achieved to "pass" the 2-mile run in BCT, 6) the gender composition of the ability groups, and 7) recommendations from the trainers.

This study examined injury and physical fitness outcomes in Basic Combat Training (BCT) during implementation of Physical Readiness Training (PRT). PRT is the U.S. Army's emerging physical fitness training program. An experimental group (EG, n = 1,284), which implemented the PRT program, was compared to a control group (CG, n = 1,296), which used a traditional BCT physical training program during the 9-week BCT cycle. Injury cases were obtained from recruit medical records and physical fitness was measured using the U.S. Army Physical Fitness Test (APFT, consisting of push-ups, sit-ups, and a two-mile run). Injury rates were examined using Cox regression after controlling for initial group differences in demographics, fitness, and other variables. Compared to the EG, the adjusted relative risk of a time-loss overuse injury in the CG was 1.5 (95% confidence interval [CI] = 1.0-2.1, p < 0.0l) for men and 1.4 (95% CI = 1.1-1.8, p < 0.01) for women. There were no differences between groups for traumatic injuries. On the first administration of the final APFT, the EG had a greater proportion of recruits passing the test than the CG (men: 85% vs. 81 %, p = 0.04; women: 80% vs. 70%, p < 0.01). After all APFT retakes, the EG had significantly fewer APFT failures than the CG among the women (1.6% vs. 4.6%, p < 0.01), but not the men (1.6% vs. 2.8%, p = 0.18); the gender-combined EG had a higher pass rate (1.6% vs. 3.7%, p < 0.01). In summary, the PRT program resulted in a lower risk of overuse injuries, higher first time pass rate on the APFT, and a lower rate of APFT failure when compared to traditional physical training in BCT. These outcomes suggest that the PRT program should be employed in all BCT units., Published in the International Journal of Sports Medicine, v24 p372-381, 2003.