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The current paper is a translation of Katharine Beals' review of the book "The death and life of the great American school system" by Diane Ravich. The article analyses the views on the causes of the inefficiency of the American school system expressed by Ravich, as well as the ways of its improvement suggested by her. A change of stance compared to her previous works is also noted. Translator: Vinogradova K.N.

The article examines the impact of various environmental factors on ABO blood group antigens. Circumstantial data suggests that several factors influence the number of ABO antigens in a person's body. Some of these factors include disease, diet, heterozygote advantage, and heterozygote disadvantage. Many studies have found a physiological relationship between the antigens and metabolism. Body size and shape also influence the number of ABO antigens in a person's body. A relationship between the number of ABO antigens and morphology has been observed in some populations.

Empathy is a multifaceted concept that is vital to effective social functioning; yet, it is impaired in high schizotypy groups. Furthermore, empathy has been found to be a mediator in the relationship between schizotypy and social functioning, highlighting the importance of empathy as a driver in social outcomes. Despite this, the four-factor structure of a widely-used measure of empathy-the Interpersonal Reactivity Index (IRI)-has been found to be psychometrically weak in high schizotypy samples. As such, this study aimed to assess differences in the item-level network of the IRI between high ( n = 427) and low schizotypy groups ( n = 470). The results reveal that there are significant differences in the structure of these networks, though they evidence similar strengths. Within the high schizotypy group, the network structure was consistent with the four-factor structure of the IRI subscales; items from each subscale clustered together and were distinct from those in the other subscales. By contrast, the low schizotypy group evidenced six clusters that did not mirror the IRI subscales. These results suggest that the item-level structure of the IRI is dependent upon the level of schizotypy of the sample, with the high schizotypy group's network functioning similarly to what would be expected from the original four-factor structure., Competing Interests: The authors declare no conflicts of interest.

Objectives: Evidence suggests that emotional awareness-the ability to identify and label emotions-may be impaired in schizophrenia and related to positive symptom severity. Exposure to childhood maltreatment is a risk factor for both low emotional awareness and positive symptoms., Methods: The current investigation examines associations between a performance-based measure of emotional awareness, positive symptom severity, and childhood maltreatment exposure in 44 individuals with a schizophrenia-spectrum disorder and 48 healthy comparison participants using the electronic Levels of Emotional Awareness Scale (eLEAS), Positive and Negative Syndrome Scale (PANSS) and Childhood Trauma Questionnaire (CTQ)., Results: Patients demonstrated significant deficits in emotional awareness overall, which was true for both self and others. In patients, lower emotional awareness was significantly associated with more severe positive symptoms. Emotional awareness was significantly impaired in patients with schizophrenia with self-reported maltreatment exposure, relative to other groups. Severity of maltreatment was not significantly associated with emotional awareness or positive symptoms when looking continuously, and there was no significant indirect effect., Conclusion: These data suggest that emotional awareness impairments observed in schizophrenia may be exacerbated by exposure to childhood maltreatment, possibly putting individuals at greater risk for experiencing positive symptoms of psychosis., Competing Interests: RL has disclosed an outside interest in the Electronic Levels of Emotional Awareness Scale owned by Equanimity Health Technologies, LLC to the University of Arizona. Conflicts of interest resulting from this interest are being managed by The University of Arizona in accordance with its policies. The remaining authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2024 Beals, Torregrossa, Smith, Lane and Sheffield.)

Abstract: Pletcher, ER, Lovalekar, M, Coleman, LC, Beals, K, Nindl, BC, and Allison, KF. Decreased percent body fat but not body mass is associated with better performance on the Marine Corps Combat Fitness Test. J Strength Cond Res 37(4): 887-893, 2023-The military uses a variety of physical fitness tests to assess physical readiness. The Marine Corps designed the Combat Fitness Test (CFT) to emphasize functional fitness related to operational demands. The purpose of this study was to investigate the association between body mass (BM), fat free mass (FFM), and percent body fat (BF%) measured via air displacement plethysmography with CFT performance in male and female marines. Two-hundred 10 male (22.4 ± 2.6 years) and 84 female (22.6 ± 2.8 years) marines were grouped into quintiles according to BM (in kilograms), FFM (in kilograms), and BF%. Kruskal-Wallis test or 1-way analysis of variance were used to determine if significant differences in CFT total and component scores existed between the groups of subjects classified into quintiles of BM, FFM, and BF%. No significant differences in CFT scores were observed between BM quintile in either men or women. No significant differences in CFT scores were observed between FFM quintiles in men. Total CFT score ( p = 0.002), movement to contact (MTC; p = 0.014), maneuver under fire (MANUF; p = 0.008), and ammunition lift (AL; p = 0.014) were all significantly different among FFM quintiles in women. Total CFT score ( p = 0.007), MTC ( p = 0.001), and MANUF ( p = 0.022) were significantly different among BF% quintiles in men. Total CFT score ( p = 0.008), MTC ( p = 0.033), and AL ( p = 0.016) were significantly different among BF% quintiles in women. Male and female marines in the quintile with lowest BF% had better CFT scores than those in higher quintiles. Targeted physical training and nutrition considerations to optimize BF% may help improve military task performance., (Copyright © 2022 Written work prepared by employees of the Federal Government as part of their official duties is, under the U.S. Copyright Act, a “work of the United States Government” for which copyright protection under Title 17 of the United States Code is not available. As such, copyright does not extend to the contributions of employees of the Federal Government.)

Background: Musculoskeletal injuries (MSIs) are an important cause of morbidity in the military, especially among Special Forces. The aim of this analysis was to describe MSIs among two groups of Naval Special Warfare (NSW) personnel-Special Warfare Combatant-Craft Crewman (SWCC) Operators and Crewman Qualification Training (CQT) students., Methods: In this cross-sectional study, we describe self-reported MSIs that occurred during a one-year period and the calculated financial costs of MSIs. Group comparisons were conducted using Fisher's exact tests and independent samples t tests., Results: Data were available for 142 SWCC Operators (26.9 ± 5.9 years, 1.8 ± 0.1 meters, 85.4 ± 10.4 kilograms) and 187 CQT students (22.8 ± 3.2 years, 1.8 ± 0.2 meters, 81.4 ± 8.9 kilograms). The one-year cumulative MSI incidence was significantly lower among SWCC Operators (21.1%) compared to CQT students (37.4%, p = 0.002). The most common anatomic location for MSIs was the lower extremity (SWCC: 50.0% of MSIs, CQT: 66.3%). Physical training was the predominant activity when MSIs occurred (SWCC: 31.6%, CQT: 77.6%). The lifetime cost of all the MSIs included in the analysis was approximately $580,000 among 142 SWCC Operators and $1.2 million among 187 CQT students., Conclusion: MSIs, especially those affecting the lower extremity and occurring during physical training, cause considerable morbidity and financial burden among NSW personnel. Many of the musculoskeletal injuries are to musculotendinous tissue, which typically results from tissue overload or inadequate recovery. Further investigation of the preventable causes of these MSIs and development of a customized, evidence-based MSI prevention program is required to reduce the burden of these MSIs., (2023.)

A mode-specific swimming protocol to assess maximal aerobic uptake (VO 2 max sw ) is vital to accurately evaluate swimming performance. A need exists for reliable and valid swimming protocols that assess VO 2 max sw in a flume environment. The purpose was to assess: (a) reliability and (b) "performance" validity of a VO 2 max sw flume protocol using the 457-m freestyle pool performance swim (PS) test as the criterion. Nineteen males ( n = 9) and females ( n = 10) (age, 28.5 ± 8.3 years.; height, 174.7 ± 8.2 cm; mass, 72.9 ± 12.5 kg; %body fat, 21.4 ± 5.9) performed two flume VO 2 max sw tests (VO 2 max sw A and VO 2 max sw B) and one PS test [457 m (469.4 ± 94.7 s)]. For test-retest reliability (Trials A vs. B), moderately strong relationships were established for VO 2 max sw (mL·kg -1 ·min -1 )(r= 0.628, p = 0.002), O 2 pulse (mL O 2 ·beat -1 )(r = 0.502, p = 0.014), VEmax (L·min -1 ) (r = 0.671, p = 0.001), final test time (sec) (0.608, p = 0.004), and immediate post-test blood lactate (IPE (BLa)) (0.716, p = 0.001). For performance validity, moderately strong relationships ( p < 0.05) were found between VO 2 max sw A (r =-0.648, p = 0.005), O 2 pulse (r= -0.623, p = 0.008), VEmax (r = -0.509 p = 0.037), and 457-m swim times. The swimming flume protocol examined is a reliable and valid assessment of VO 2 max sw., and offers an alternative for military, open water, or those seeking complementary forms of training to improve swimming performance.

Abstract: Beckner, ME, Pihoker, AA, Darnell, ME, Beals, K, Lovalekar, M, Proessl, F, Flanagan, SD, Arciero, PJ, Nindl, BC, and Martin, BJ. Effects of multi-ingredient preworkout supplements on physical performance, cognitive performance, mood state, and hormone concentrations in recreationally active men and women. J Strength Cond Res 36(9): 2493-2501, 2022-Performance enhancement supplement research has primarily focused on the effectiveness of individual ingredients, rather than the combination. This study investigated the acute effects of 2 multi-ingredient preworkout supplements (MIPS), with beta-alanine and caffeine (BAC) and without (NBAC), compared with placebo (PLA) on anaerobic performance, endurance capacity, mood state, cognitive function, vascular function, and anabolic hormones. Thirty exercise-trained individuals (24.4 ± 4.9 years, 15 men and 15 women) completed a fatiguing exercise protocol on 3 separate occasions, 30 minutes after ingestion of BAC, NBAC, or PLA. Outcomes were analyzed using one-way or two-way repeated-measures analysis of variance, as appropriate (alpha = 0.05). Anaerobic power was greater when supplementing with NBAC (10.7 ± 1.2 W·kg -1 ) and BAC (10.8 ± 1.4 W·kg -1 ) compared with PLA (10.4 ± 1.2 W·kg -1 ) ( p = 0.014 and p = 0.022, respectively). BAC improved V̇ o2 peak time to exhaustion ( p = 0.006), accompanied by an increase in blood lactate accumulation ( p < 0.001), compared with PLA. Both NBAC and BAC demonstrated improved brachial artery diameter after workout ( p = 0.041 and p = 0.005, respectively), but PLA did not. L-arginine concentrations increased from baseline to postsupplement consumption of BAC ( p = 0.017). Reaction time significantly decreased after exercise for all supplements. There was no effect of supplement on mood states. Exercise-trained individuals looking to achieve modest improvements in power and endurance may benefit from consuming MIPS before exercise., (Copyright © 2020 National Strength and Conditioning Association.)

Background: Paranoia is associated with a multitude of social cognitive deficits, observed in both clinical and subclinical populations. Empathy is significantly and broadly impaired in schizophrenia, yet its relationship with subclinical paranoia is poorly understood. Furthermore, deficits in emotion recognition - a very early component of empathic processing - are present in both clinical and subclinical paranoia. Deficits in emotion recognition may therefore underlie relationships between paranoia and empathic processing. The current investigation aims to add to the literature on social cognition and paranoia by: (1) characterizing the relationship between paranoia and empathy, and (2) testing whether there is an indirect effect of emotion recognition on the relationship between empathy and paranoia., Methods: Paranoia, empathy, and emotion recognition were assessed in a non-clinical sample of adults ( n = 226) from the Nathan Kline Institute-Rockland (NKI-Rockland) dataset. Paranoia was measured using the Peters Delusions Inventory-21 (PDI-21). Empathy was measured using the Interpersonal Reactivity Index (IRI), a self-report instrument designed to assess empathy using four subscales: Personal Distress, Empathic Concern, Perspective Taking, and Fantasy. Emotion recognition was assessed using the Penn Emotion Recognition Test (ER-40). Structural equation modeling (SEM) was used to estimate relationships between paranoia, the four measures of empathy and emotion recognition., Results: Paranoia was associated with the Fantasy subscale of the IRI, such that higher Fantasy was associated with more severe paranoia ( p < 0.001). No other empathy subscales were associated with paranoia. Fantasy was also associated with the emotion recognition of fear, such that higher Fantasy was correlated with better recognition of fear ( p = 0.008). Paranoia and emotion recognition were not significantly associated. The Empathic Concern subscale was negatively associated with emotion recognition, with higher empathic concern related to worse overall emotion recognition ( p = 0.002). All indirect paths through emotion recognition were non-significant., Discussion: These results suggest that imaginative perspective-taking contributes to paranoia in the general population. These data do not, however, point to robust global relationships between empathy and paranoia or to emotion recognition as an underlying mechanism. Deficits in empathy and emotion recognition observed in schizophrenia may be associated with the broader pathology of schizophrenia, and therefore not detectable with subclinical populations., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2022 Beals, Sperry and Sheffield.)

Reminders of ingroup-perpetrated violence represent a psychological stressor that some people respond to defensively (e.g., justifying the violence), while others react non-defensively (e.g., accepting collective responsibility). To explain these divergent responses, we applied the biopsychosocial model of challenge and threat to the context of intergroup conflict. Participants (N = 130) read about either an ingroup (American) or outgroup (Australian) soldier torturing an Iranian captive. We recorded cardiovascular responses while participants video-recorded introductions to an Iranian confederate who they believed they would meet. In the ingroup (but not the outgroup) condition, cardiovascular responses of challenge (relative to threat) were associated with less psychological defensiveness of ingroup-perpetrated violence and greater support for diplomacy towards its victims. Self-reported challenge/threat appraisals demonstrated no such relationships. These findings suggest that motivational states of challenge and threat can differentiate defensive and non-defensive responses, and that these motivational states may be better captured with physiological rather than self-report measures., (Copyright © 2021 Elsevier B.V. All rights reserved.)

Background: Emergency department (ED) physicians and nurses frequently interact with emotionally evocative patients, which can impact clinical decision-making and behaviour. This study introduces well-established methods from social psychology to investigate ED providers' reported emotional experiences and engagement in their own recent patient encounters, as well as perceived effects of emotion on patient care., Methods: Ninety-four experienced ED providers (50 physicians and 44 nurses) vividly recalled and wrote about three recent patient encounters (qualitative data): one that elicited anger/frustration/irritation (angry encounter), one that elicited happiness/satisfaction/appreciation (positive encounter), and one with a patient with a mental health condition (mental health encounter). Providers rated their emotions and engagement in each encounter (quantitative data), and reported their perception of whether and how their emotions impacted their clinical decision-making and behaviour (qualitative data)., Results: Providers generated 282 encounter descriptions. Emotions reported in angry and mental health encounters were remarkably similar, highly negative, and associated with reports of low provider engagement compared with positive encounters. Providers reported their emotions influenced their clinical decision-making and behaviour most frequently in angry encounters, followed by mental health and then positive encounters. Emotions in angry and mental health encounters were associated with increased perceptions of patient safety risks; emotions in positive encounters were associated with perceptions of higher quality care., Conclusions: Positive and negative emotions can influence clinical decision-making and impact patient safety. Findings underscore the need for (1) education and training initiatives to promote awareness of emotional influences and to consider strategies for managing these influences, and (2) a comprehensive research agenda to facilitate discovery of evidence-based interventions to mitigate emotion-induced patient safety risks. The current work lays the foundation for testing novel interventions., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2020. No commercial re-use. See rights and permissions. Published by BMJ.)

Objectives: The purpose of this analysis was to describe and compare the incidence and pattern of musculoskeletal injuries in women and men during the United States Marine Corps Ground Combat Element Integrated Task Force work-up and assessment phases in sex-integrated units., Design: Descriptive cross-sectional study., Methods: Certified athletic trainers and Navy corpsmen reported injury data for 302 Marines (women: 27.8%, men: 72.2%). Injury frequency, location, cause, type, and activity during injury were described. Fisher's exact tests were used to compare proportions of injured women and men. The cost of injuries was calculated using the Web-based Injury Statistics Query and Reporting System., Results: A greater proportion of women (40.5%) sustained an injury compared with men (18.8%, p < 0.001). The lower extremity was the most frequent location for injury (women: 68% of injuries, men: 60%). The most frequent sub-location was the hip (24%) in women and foot/toes (26%) in men. Marching under load was the most common cause (women: 64%, men: 48%). Most injuries occurred during physical training (women: 78%, men: 66%), and were classified as pain/spasm/ache (women: 56%, men: 36%). The total lifetime cost of these injuries that occurred among 302 Marines was approximately $1.4 million U.S. dollars., Conclusions: The high risk of lower extremity injuries that occurred while marching under load during physical training, and the greater risk of injuries among women compared to men, indicates the need for further research to identify the components of combat Military Occupational Specialty specific training that could be modified to mitigate injuries., (Copyright © 2020 Sports Medicine Australia. All rights reserved.)

Concussions are common in military personnel and may result in increased risk of musculoskeletal injury. One plausible explanation for this risk could be that neuromotor deficiencies enhance injury risk after a concussion through altered muscular activation/contraction timing., Purpose: To compare military personnel with at least one concussion during the past 1 month to 2 yr (CONCUSSED) to military branch-matched, age-matched, and Special Operations Forces group-matched controls (CONTROL) on physiological, musculoskeletal, and biomechanical performance., Methods: A total of 48 (24 CONCUSSED, 24 CONTROL) male Air Force and Naval Special Warfare Operators age 19 to 34 yr participated in the study. Participants self-reported demographics/injury history and completed the following assessments: 1) physiological-body composition, anaerobic power and capacity, aerobic capacity and lactate threshold; 2) musculoskeletal-lower extremity isokinetic strength testing, including time to peak torque; and 3) biomechanical-single-leg jump and landing task, including landing kinematics of the hip, knee and ankle. A machine learning decision tree algorithm (C5.0) and one-way ANOVA were used to compare the two groups on these outcomes., Results: Despite nonsignificant differences using ANOVA, the C5.0 algorithm revealed CONCUSSED demonstrated quicker time to peak knee flexion angle during the single-leg landing task (≤0.170 s; CONCUSSED: n = 22 vs CONTROL: n = 14), longer time to peak torque in knee extension isokinetic strength testing (>500 ms; CONCUSSED: n = 18 vs CONTROL: n = 4) and larger knee flexion angle at initial contact (>7.7°; CONCUSSED: n = 18 vs CONTROL: n = 2)., Conclusion: The findings supported the hypothesis that CONCUSSED military personnel would demonstrate altered neuromuscular control in landing strategies and muscular activation. Future research should assess prospectively neuromuscular changes after a concussion and determine if these changes increase risk of subsequent musculoskeletal injuries.

Nagle, EF, Nagai, T, Beethe, AZ, Lovalekar, MT, Zera, JN, Connaboy, C, Abt, JP, Beals, K, Nindl, BC, Robertson, RJ, and Lephart, SM. Reliability and validity of a pool-based maximal oxygen uptake test to examine high-intensity short-duration freestyle swimming performance. J Strength Cond Res 33(5): 1208-1215, 2019-A modality-specific swimming protocol to assess maximal oxygen uptake (V[Combining Dot Above]O2maxsw) is essential to accurately prescribe and monitor swimming conditioning programs. Consequently, there is a need for a reliable and valid graded intensity swimming pool test to accurately assess V[Combining Dot Above]O2maxsw using indirect calorimetry. The purpose of this study was to assess (a) reliability of an intensity self-regulated swimming pool test of V[Combining Dot Above]O2maxsw and (b) validity of a V[Combining Dot Above]O2maxsw test using performance swim (PS) time as the criterion. Twenty-nine men (n = 15) and women (n = 14) (age, 23 ± 6.4 years; body mass index, 23.5 ± 3.0 kg·m) performed 2 swimming pool V[Combining Dot Above]O2maxsw trials (V[Combining Dot Above]O2maxsw A and V[Combining Dot Above]O2maxsw B), and 2 PS tests (45.7 m [31.20 ± 4.5 seconds] and 182 m [159.2 ± 25.5 seconds]). For test-retest reliability (trials A vs. B), strong correlations (p < 0.05) were found for V[Combining Dot Above]O2maxsw (ml·kg·min) (r = 0.899), O2 pulse (ml O2·beat) (r = 0.833), and maximum expired ventilatory volume (L·min) (r = 0.785). For performance validity, moderately strong correlations (p < 0.05) were found between V[Combining Dot Above]O2maxsw A and 45.7-m (r = -0.543) and 182-m (r = -0.486) swim times. The self-regulated graded intensity swimming pool protocol examined presently is a reliable and valid test of V[Combining Dot Above]O2maxsw. Studies should consider the suitability of a V[Combining Dot Above]O2maxsw test for military personnel, clinical populations, and injured athletes.

Special operation forces participating in mountain warfare/cold weather (MWCW) training have higher energy demands, but adequate fueling is difficult to achieve. The purpose of the study was to determine energy expenditure relative to energy intake and examine fueling patterns during 3 days of MWCW training in Naval Special Warfare Sea, Air, Land (SEAL) Qualification Training (SQT) students. Ten SQT students (age: 23.3 ± 1.8 years, height: 182.3 ± 6.4 cm, and weight: 83.6 ± 4.5 kg) were fitted for heart rate and accelerometer monitors during MWCW training. Total daily energy expenditure was determined using a combination of direct observation and heart rate-VO 2 regression. Total daily energy intake was collected using the Automated Self-Administered 24 (ASA24) assessment tool. Total daily energy expenditure for river crossing, alpine skills, and mountain patrol were 3,913 ± 293, 4,207 ± 400, and 5,457 ± 828 kcals, respectively. Reported total daily energy intakes were 2,854 ± 657 (river crossing) and 2,289 ± 680 kcals (mountain patrol), producing 1,044 ± 784 and 3,112 ± 1,420 kcal deficits, respectively. SQT students consumed 258 ± 95 g (3.1 ± 1.3 g·kg -1 ·day -1 ) of carbohydrates, 130 ± 55 g (1.6 ± 0.7 g·kg -1 ·day -1 ) of protein, and 113 ± 39 g (1.4 ± 0.5 g·kg -1 ·day -1 ) of fat. MWCW training evolutions elicited high total daily energy expenditure and inadequate energy intake, especially before and during active training sessions, which may lead to decreased work output, early onset fatigue, and increased risk of injury. Increasing total daily energy intake by providing fuel/fluids, primarily carbohydrates, during the planned breaks and "downtime" of each training evolution and focusing on provision of the balance of calories/macronutrients needed for a more complete and expedited recovery over dinner and evening snacks will help bridge the energy gap.

Optimizing tactical fitness is important for combat readiness and injury prevention, especially as women have entered ground combat military occupational specialties., Objectives: To assess characteristics of male and female Marines by Combat Fitness Test (CFT) performance clusters., Design: Cross-sectional study., Methods: Anthropometric, body composition (BF%, fat and fat-free mass [FM and FFM], and Fight load index [FLI], physiological (maximal oxygen uptake, lactate threshold and anaerobic power/capacity), and musculoskeletal (isokinetic strength of the knee, shoulder, torso, and isometric strength of the ankle) assessments were obtained from 294 male (M) and female (F) Marines. Hierarchical cluster analysis classified Marines based on performance of two CFT events (sec): Maneuver Under Fire (MANUF) and Movement to Contact (MTC). Following tests for normality, one-way ANOVA or Kruskal Wallis tests, followed by Bonferroni post-hoc tests, assessed characteristics across clusters and sex (alpha=0.05)., Results: Two clusters (C) were determined: C1: N=66F, 16M and C2: N=18F, 194M, with C2 demonstrating better performance on the MANUF and MTC. C1F demonstrated significantly greater BF% and FLI than C1M, C2F, and C2M. C2M demonstrated significantly greater knee flexion strength than C1F and C2F, but C1M was only significantly greater than C1F. C2M demonstrated significantly greater ankle eversion and inversion strength than C1F., Conclusions: Women with increased BF%, increased FM and reduced FFM relative to a fighting load may have decreased performance in combat-related tasks. Training programs based on an individual Marine's baseline body composition and fitness characteristics can enhance combat fitness and force readiness., (Copyright © 2018 Sports Medicine Australia. All rights reserved.)

Objectives: Musculoskeletal injuries (MSI) are an important concern in military populations. The purpose of this study was to describe the burden of MSI and associated financial cost, in a sample of US Air Force Special Operations Command Special Tactics Operators., Methods: In this cross-sectional study, medical records of the Operators were reviewed during the years 2014-2015. MSI that occurred during a 1-year period prior to the date of review were described. MSI attributes described included incidence, anatomic location, cause, activity when MSI occurred, type and lifetime cost of MSI estimated using the Web-based Injury Statistics Query and Reporting System., Results: A total of 130 Operators participated in the study (age: 29.1±5.2 years). The 1-year cumulative incidence of MSI was 49.2 injured Operators/100 Operators/year. The most frequent anatomic location and sublocation for MSI were the lower extremity (40.9% of MSI) and shoulder (20.9%), respectively. Lifting was a common cause of MSI (21.8%). A large per cent of MSI (55.5%) occurred while Operators were engaged in either physical or tactical training. Common MSI types were pain/spasm/ache (44.5%). Many MSI (41.8%) were classified as potentially preventable by an injury prevention training programme. The total lifetime cost of these MSI was estimated to be approximately US$1.2 million., Conclusion: MSI are an important cause of morbidity and financial cost in this sample of Air Force Special Tactics Operators. There is a need to develop a customised injury prevention programme to reduce the burden and cost of MSI in this population., Competing Interests: Competing interests: None declared.

Background: Self-reported data are often used in research studies among military populations., Objective: The accuracy of self-reported musculoskeletal injury data among elite military personnel was assessed for issues with recall., Design: Cross-sectional study., Setting: Applied research laboratory at a military installation., Participants: A total of 101 subjects participated (age 28.5±5.6 years). Study participants were active duty military personnel, with no conditions that precluded them from full duty., Primary and Secondary Outcome Measures: Self-reported and medical record reviewed injuries that occurred during a 1-year period were matched by anatomic location, injury side (for extremity injuries), and injury year and type. The accuracy of recall was estimated as the per cent of medical record reviewed injuries correctly recalled in the self-report. The effect of injury anatomic location, injury type and severity and time since injury, on recall, was also assessed. Injuries were classified as recent (≤4 years since injury) or old injuries (>4 years since injury). Recall proportions were compared using Fisher's exact tests., Results: A total of 374 injuries were extracted from the subjects' medical records. Recall was generally low (12.0%) and was not different between recent and old injuries (P=0.206). Injury location did not affect recall (P=0.418). Recall was higher for traumatic fractures as compared with less severe non-fracture injuries (P values 0.001 to <0.001). Recall for non-fracture injuries was higher for recent as compared with old injuries (P=0.033). This effect of time since injury on recall was not observed for fractures (P=0.522)., Conclusions: The results of this study highlight the importance of weighing the advantages and disadvantages of self-reported injury data before their use in research studies in military populations and the need for future research to identify modifiable factors that influence recall., Competing Interests: Competing interests: None declared., (© Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.)

Context:   Seventy-seven percent of musculoskeletal injuries sustained by United States Army Special Forces Operators are preventable. Identification of predictive characteristics will promote the development of screening methods to augment injury-prevention programs., Objective:   To determine physical and performance characteristics that predict musculoskeletal injuries., Setting:   Clinical laboratory., Patients or Other Participants:   A total of 95 Operators (age = 32.7 ± 5.1 years, height = 179.8 ± 6.9 cm, mass = 89.9 ± 12.7 kg)., Main Outcome Measure(s):   Laboratory testing consisted of body composition, aerobic and anaerobic capacity, upper and lower body strength and flexibility, balance, and biomechanical evaluation. Injury data were captured for 12 months after laboratory testing. Injury frequencies, cross-tabulations, and relative risks (RRs) were calculated to evaluate the relationships between physical characteristics and injury proportions. Between-groups differences (injured versus uninjured) were assessed using appropriate t tests or Mann-Whitney U tests., Results:   Less shoulder-retraction strength (RR = 1.741 [95% confidence interval = 1.003, 3.021]), knee-extension strength (RR = 2.029 [95% confidence interval = 1.011, 4.075]), and a smaller trunk extension : flexion ratio (RR = 0.533 [95% confidence interval = 0.341, 0.831]) were significant risk factors for injury. Group comparisons showed less trunk strength (extension: P = .036, flexion: P = .048) and smaller right vertical ground reaction forces during landing ( P = .025) in injured Operators. Knee strength, aerobic capacity, and body mass index were less in the subgroup of spine-injured versus uninjured Operators ( P values = .013-.036)., Conclusions:   Knee-extension and shoulder-retraction strength were risk factors for musculoskeletal injury in Operators. Less trunk-flexion and -extension strength, higher body mass index, lower aerobic capacity, and increased ground reaction forces during landing were characteristics that may also contribute to musculoskeletal injury. Having 2 or more risk factors resulted in a greater injury proportion (χ 2 = 13.512, P = .015); however, more research is needed. Athletic trainers working in the military or similar high-demand settings can use these data to augment screening and injury-prevention protocols.

Musculoskeletal injury (MSI) data typically are obtained from medical chart-review (MCR) or injury self-reports (ISR). MSI incidence may be under-counted if only one source is utilized, as MCR will not capture MSI for which medical care was not sought, and ISR may be affected by issues with recall., Objectives: The purposes of this study were to determine MSI incidence from two sources (MCR, ISR) and to estimate the incidence, after accounting for the under-counting in both sources, among a sample of U.S. Army soldiers., Design: Descriptive cross-sectional study., Methods: The estimated cumulative incidence during a one-year period was calculated from the two sources of MSI data using a novel statistical analysis (capture-recapture-CRC)., Results: MSI data were available for 287 soldiers (age: 27.5±6.3years (mean±standard deviation)). The one-year cumulative incidence of MSI was 17.8% (MCR), 19.5% (ISR), and 54.0% (CRC). CRC analysis showed that there was under-counting from both sources of data and the percent of CRC estimated MSI observed were 32.9% (MCR), 36.1% (ISR), and 57.4% (MCR and ISR combined). When analyzed by MSI type, percent of CRC estimated MSI counted from both sources was highest (75.0%) for fracture, followed by sprain (53.8%), strain (43.8%), and pain/spasm/ache (35.8%)., Conclusions: There was under-counting of MSI from both sources of data, and the under-counting varied by MSI type. There is a need for further investigation of the relative benefits of various sources of MSI data and the application of the capture-recapture analysis in military populations., (Copyright © 2017 Sports Medicine Australia. All rights reserved.)

Women can serve in all military occupational specialties (MOS); however, musculoskeletal and physiological characteristics that predict successful completion of ground combat MOS schools by female Marines are unknown., Objectives: To determine which demographic, musculoskeletal, and physiological characteristics predict graduation from infantry and vehicle ground combat MOS schools in female Marines., Design: Prospective cohort study., Methods: Prior to MOS school, the following were assessed in 62 female Marines (22.0±3.0yrs, 163.9±5.8cm, 63.4±7.2kg): isokinetic shoulder, trunk, and knee and isometric ankle strength; body composition; anaerobic power (AP)/capacity (AC); maximal oxygen uptake (VO 2 max); and field-based fitness tests (broad jump, medicine ball throw, pro-agility). Both absolute and normalized (%body mass: %BM) values were utilized for strength, AP, AC, and VO 2 max. Select tests from each Marine's most recent Physical Fitness Test (PFT: abdominal crunches, 3-mile run time) and Combat Fitness Test (CFT: Maneuver Under Fire, Movement to Contact) were recorded. Participants were classified as graduated (N=46) or did not graduate (N=16). Simple logistic regression was performed to determine predictors of MOS school graduation. Statistical significance was set a priori at α=0.05., Results: Absolute and normalized ankle inversion and eversion strength, normalized anaerobic capacity, absolute and normalized VO 2 max, right pro-agility, and PFT 3-mile run time significantly predicted MOS school graduation (p<0.05)., Conclusions: Greater ankle strength, better agility, and greater anaerobic and aerobic capacity are important for successful completion of ground combat MOS school in female Marines. Prior to entering ground combat MOS school, it is recommended that female Marines should train to optimize these mobility-centric characteristics., (Copyright © 2017 Sports Medicine Australia. Published by Elsevier Ltd. All rights reserved.)

Objectives: The aim of this analysis was to describe the incidence and common types of medical chart-reviewed musculoskeletal injuries, among four distinct groups of Naval Special Warfare (NSW) personnel: Sea, Air, and Land (SEAL) Operators, SEAL Qualification Training (SQT) students, Special Warfare Combatant-craft Crewman (SWCC) Operators, and Crewman Qualification Training (CQT) students., Design: Descriptive cross-sectional study., Methods: Medical records were reviewed for 920 NSW personnel. MSI were described and classified by frequency and incidence; anatomic location; injury type and cause; activity during injury; and potential for prevention., Results: The frequency of MSI was 23.1, 46.5, 31.6, and 17.0 per 100 participants per year among SEAL, SQT, SWCC, and CQT, respectively. Upper extremity MSI were the most common in SEAL, lower extremity MSI were common in the other groups. The most frequent MSI anatomic sub-locations varied across groups (SEAL: shoulder, 21.6% of MSI; SQT: foot and toes, 17.0%; SWCC: lumbopelvic spine, 21.7%; and CQT: knee, 30.3%). Pain/spasm/ache were the most common MSI type in SEAL (29.7%) and SWCC (21.7%), tendonitis/tenosynovitis/tendinopathy was the most common MSI type in SQT (21.0%), and tendonitis/tenosynovitis/tendinopathy and fracture were the most common in CQT (15.2% each). A considerable proportion of MSI were classified as potentially preventable-SEAL: 35.1%, SQT: 53.0%, SWCC: 36.7%, and CQT: 21.2%., Conclusions: MSI cause considerable morbidity among NSW Operators and students, with distinct patterns of distribution by anatomic location and injury type. Since many injuries may be preventable, targeted interventions may be able to mitigate MSI risk., (Copyright © 2017 Sports Medicine Australia. All rights reserved.)

Objectives: Previous research has examined lower extremity (LE) musculoskeletal injury (MSI) patterns and risk factors in Special Operations Forces (SOF) trainees, conventional military personnel, and athletes; however, it is unclear if SOF have the same patterns/risk factors. This study aimed to determine the association of musculoskeletal, balance, and physiological characteristics with LE MSI in SOF., Design: Cohort study., Methods: A total of 726 Air Force (N=140), Navy Sea, Air, and Land (N=301), and Special Warfare Combatant Crewmen (N=285) SOF (age=25.72±4.77years, height=178.34±6.63cm, weight=84.28±9.03kg) participated in laboratory testing, including: LE muscular strength and flexibility; balance; body composition; anaerobic power/capacity; and aerobic capacity. Medical charts were reviewed for LE MSI 365days following laboratory testing. Participants were assigned by injury status and laboratory data stratified by tertile. Chi-square statistics were calculated to determine the frequency of LE MSI across tertiles for each characteristic., Results: There was a significant association between LE MSI and: ankle inversion strength (weaker side: Χ(2)=17.703; stronger side: Χ(2)=18.911; p≤0.001); ankle eversion/inversion strength ratio (lower side: Χ(2)=13.456; higher side: Χ(2)=16.885; p≤0.001); hamstring flexibility (less flexible: Χ(2)=19.930; more flexible Χ(2)=15.185; p≤0.001); gastrocnemius-soleus flexibility (less flexible: Χ(2)=7.889, p=0.019); dynamic balance asymmetry (Χ(2)=7.444, p=0.024); Vestibular and Preference ratios (Χ(2)=9.124, p=0.010 and Χ(2)=6.572, p=0.037, respectively); and aerobic capacity (Χ(2)=13.935, p=0.001)., Conclusions: Characteristics associated with LE MSI are unique in SOF. Human performance program initiatives should include efforts to optimize ankle strength and flexibility, maintain moderate hamstring flexibility, expand dynamic balance strategies, and maximize aerobic capacity to reduce LE MSI risk., (Copyright © 2017 Sports Medicine Australia. All rights reserved.)

Musculoskeletal injuries have negatively impacted tactical readiness. The identification of prospective and modifiable risk factors of preventable musculoskeletal injuries can guide specific injury prevention strategies for Soldiers and health care providers., Objectives: To analyze physiological and neuromuscular characteristics as predictors of preventable musculoskeletal injuries., Design: Prospective-cohort study., Methods: A total of 491 Soldiers were enrolled and participated in the baseline laboratory testing, including body composition, aerobic capacity, anaerobic power/capacity, muscular strength, flexibility, static balance, and landing biomechanics. After reviewing their medical charts, 275 male Soldiers who met the criteria were divided into two groups: with injuries (INJ) and no injuries (NOI). Simple and multiple logistic regression analyses were used to calculate the odds ratio (OR) and significant predictors of musculoskeletal injuries (p<0.05)., Results: The final multiple logistic regression model included the static balance with eyes-closed and peak anaerobic power as predictors of future injuries (p<0.001)., Conclusions: The current results highlighted the importance of anaerobic power/capacity and static balance. High intensity training and balance exercise should be incorporated in their physical training as countermeasures., (Copyright © 2017 Sports Medicine Australia. All rights reserved.)

Prins, PJ, Goss, FL, Nagle, EF, Beals, K, Robertson, RJ, Lovalekar, MT, and Welton, GL. Energy drinks improve five-kilometer running performance in recreational endurance runners. J Strength Cond Res 30(11): 2979-2990, 2016-The purpose of this study was to evaluate exercise performance time and related physiological and perceptual responses of recreational endurance runners after they had ingested a commercially available energy drink (Red Bull, Red Bull GmbH, Fuschl am See, Austria) containing caffeine, glucose, and taurine. Recreational endurance runners (n = 18; 13 men and 5 women; age: 20.39 ± 3.27 years; weight: 71.25 ± 17.17 kg; height: 178.00 ± 7.57 cm; V[Combining Dot Above]O2max: 55.94 ± 7.66 ml·kg·min) participated in a double-blind, crossover, repeated-measures study where they were randomized to supplement with 500 ml of the commercially available energy drink Red Bull and a noncaffeinated, sugar-free placebo (PLA) 60 minutes before completing a 5-km time trial on a treadmill, separated by 7 days. Heart rate, rating of perceived exertion (RPE) (RPE-Overall; RPE-Chest; RPE-Legs), and affect were recorded at rest, 1 hour before ingestion, at 5-minute intervals during the 5-km time trial, and immediately after exercise. Session RPE and session affect were obtained 5 minutes after completion of the 5-km time trial. The distance covered at each 5-minute interval during the 5-km time trial was recorded. Performance improved with the energy drink compared with placebo (Red Bull: 1,413.2 ± 169.7 vs. PLA: 1,443.6 ± 179.2 seconds; p = 0.016), but there were no differences in RPE, affect, session RPE, session affect, or the distance covered at 5-minute splits between the two 5-km time trials (p > 0.05). These results demonstrate that consuming a commercially available energy drink before exercise can improve 5-km performance. These results may have application for altering pre-exercise nutritional strategies in recreational runners.

Background: The 2016 United States (U.S.) Report Card on Physical Activity for Children and Youth provides a comprehensive evaluation of physical activity levels and factors influencing physical activity among children and youth., Methods: The report card includes 10 indicators: Overall Physical Activity, Sedentary Behavior, Active Transportation, Organized Sport Participation, Active Play, Health-related Fitness, Family and Peers, School, Community and the Built Environment, and Government Strategies and Investments. Nationally representative data were used to evaluate the indicators using a standard grading rubric., Results: Sufficient data were available to assign grades to 7 of the indicators, and these ranged from B- for Community and the Built Environment to F for Active Transportation. Overall Physical Activity received a grade of D- due to the low prevalence of meeting physical activity guidelines. A grade of D was assigned to Health-related Fitness, reflecting the low prevalence of meeting cardiorespiratory fitness standards. Disparities across age, gender, racial/ethnic and socioeconomic groups were observed for several indicators., Conclusions: Continued poor grades suggest that additional work is required to provide opportunities for U.S. children to be physically active. The observed disparities indicate that special attention should be given to girls, minorities, and those from lower socioeconomic groups when implementing intervention strategies.

The purpose of this study was to describe the epidemiology of musculoskeletal injuries among Soldiers of the 101st Airborne (Air Assault) Division. A total of 451 subjects (age: 27.6 ± 6.2 years, gender: males 395/451 = 87.6%) volunteered. Musculoskeletal injury data were extracted from subjects' medical charts and injuries that occurred during 1 year were described. Injury frequency, injury anatomic location and sublocation, injury cause, activity when injury occurred, and injury type were described. Injury frequency was 29.5 injuries per 100 subjects per year. Most injures affected the lower extremity (60.2% of injuries) and common anatomic sublocations for injuries were the ankle (17.3%) and knee (15.0%). Frequent causes of injuries were running (13.5%) and direct trauma (9.0%). Physical training was associated with 29.3% of the injuries. A majority of injuries were classified as pain/spasm/ache (29.3%), without further elucidation of pathology. Other frequent injury types were sprain (21.8%) and strain (14.3%). The descriptive epidemiology of musculoskeletal injuries in this population underscores the need to explore the modifiable risk factors of potentially preventable lower extremity injuries associated with physical training and running. There is scope for the development of an optimized and targeted physical training program for injury prevention in this population., (Reprint & Copyright © 2016 Association of Military Surgeons of the U.S.)

Human performance training and prevention strategies are necessary to promote physical readiness and mitigate musculoskeletal injuries of the Naval Special Warfare (NSW) Operator. The purpose of this study was to measure the effectiveness of 2 training programs when performed during a training evolution of Operators. A total of 85 Operators (experimental: n = 46, age: 29.4 ± 5.5 years, height: 176.7 ± 6.4 cm, mass: 86.7 ± 11.6 kg; control: n = 39, age: 29.0 ± 6.0 years, height: 177.1 ± 6.3 cm, mass: 85.7 ± 12.5 kg) participated in a trial to measure the effectiveness of these programs to improve physical, physiological, and performance characteristics. Operators in the experimental group performed a 12-week block-periodized program, whereas those in the control group performed a nonlinear periodized program. Pretesting/posttesting was performed to assess body composition, aerobic capacity/lactate threshold, muscular strength, flexibility, landing biomechanics, postural stability, and tactically relevant performance. The experimental group demonstrated a significant loss in body fat, fat mass, and body mass compared with the control group, whereas aerobic capacity increased for the both groups. The experimental group demonstrated a significant increase in posterior shoulder flexibility and ankle dorsiflexion, whereas the control group had a significant reduction in shoulder, knee, and ankle flexibility. The experimental group also improved landing strategies and balance. Both groups improved upper and lower muscular power and upper-body muscular endurance, whereas only the experimental group demonstrated significant improvements in agility and total body muscular strength. Implementation of a population-specific training program provides structured and progressive training effectively and promotes physical readiness concurrently with tactical training without overload.

The purpose of this study was to evaluate the nutrient intake of male and female Soldiers in the 101 st Airborne Division (Air Assault) compared to sports nutrition standards for athletes, and to identify suboptimal eating characteristics that may impair physical performance and jeopardize military readiness. Male and female Soldiers from the 101 st Airborne Division (Air Assault) completed a 24-hour dietary recall and nutrition history questionnaire before anthropometric and body composition measurements were taken. Compared to sports nutrition guidelines, Soldiers of the 101 st under consume carbohydrates (males: 3.9 ± 2.0 vs. 5.0 g/kg, p < 0.001; females: 4.0 ± 2.1 vs. 5.0 g/kg, p = 0.001), male Soldiers eat too much fat (32.4% of kcal vs. <30% of kcal, p = 0.000) and saturated fat (males: 10.5 ± 3.9% of kcal vs. 10.0% of kcal, p = 0.044), and both males and females follow a meal pattern that may not optimize energy availability throughout the day. Eating too much fat and under fueling carbohydrate may negatively impact the adaptations to physical training and compromise overall health. Although Soldiers continue to participate in arduous training programs, future research should be aimed at determining the energy and macronutrient needs to fuel and recover from specific types of military training., (Reprint & Copyright © 2015 Association of Military Surgeons of the U.S.)

Naval Special Warfare (NSW) Operators are expected to maintain a high degree of physical readiness requiring continual operational training. The physiological and psychological demands associated with operational training can result in physiological consequences evidenced by hormonal alterations justifying the need for periodized training to maintain or improve physical readiness. This study examined the pattern and time course of hormone changes during 12-week block-periodized training program (BP) in NSW Operators undergoing routine training. Eighteen NSW Operators (31 ± 6 years, 86.6 ± 9.0 kg, 176.2 ± 5.9 cm, 17.5 ± 6.5% fat) participated in a 12-week BP during routine operational training. Salivary free testosterone (FT), dehydroepiandrosterone sulfate (DHEA-S), and cortisol (C) were obtained at 4 time points coincident with changes in intensity and volume. In the second block of training in which intensity and volume were increased, FT and C increased by 20.3 ± 7.4 and 20.8 ± 9.9%, respectively. Free testosterone and C returned to baseline values concomitant with the decrease in intensity and volume at the conclusion of the third block of training. No significant differences were observed in FT-to-C ratio over the course of training. DHEA-S increased 23.1 ± 11.0% following block 1, with a further increase observed following block 2 (57.0 ± 17.4%). Our data indicate training following BP produces a pattern and time course of hormone changes congruent with changes in intensity and volume suggesting BP as a potential training model for NSW Operators and other Special Forces Operators involved in operational training.

Background: The National Physical Activity Plan Alliance partnered with physical activity experts to develop a report card that provides a comprehensive assessment of physical activity among United States children and youth., Methods: The 2014 U.S. Report Card on Physical Activity for Children and Youth includes 10 indicators: overall physical activity levels, sedentary behaviors, active transportation, organized sport participation, active play, health-related fitness, family and peers, school, community and the built environment, and government strategies and investments. Data from nationally representative surveys were used to provide a comprehensive evaluation of the physical activity indicators. The Committee used the best available data source to grade the indicators using a standard rubric., Results: Approximately one-quarter of children and youth 6 to 15 years of age were at least moderately active for 60 min/day on at least 5 days per week. The prevalence was lower among youth compared with younger children, resulting in a grade of D- for overall physical activity levels. Five of the remaining 9 indicators received grades ranging from B- to F, whereas there was insufficient data to grade 4 indicators, highlighting the need for more research in some areas., Conclusions: Physical activity levels among U.S. children and youth are low and sedentary behavior is high, suggesting that current infrastructure, policies, programs, and investments in support of children's physical activity are not sufficient.