Diarrhea outbreak during U.S. military training in El Salvador

Infectious diarrhea remains a major risk to deployed military units worldwide in addition to their impact on travelers and populations living in the developing world. This report describes an outbreak of diarrheal illness in the U.S. military’s 130^th Maneuver Enhancement Brigade deployed in San Vicente, El Salvador during a training and humanitarian assistance mission. An outbreak investigation team from U.S. Naval Medical Research Unit – Six conducted an epidemiologic survey and environmental assessment, patient interviews, and collected stool samples for analysis in an at risk population of 287 personnel from May 31^st to June 3^rd, 2011. Personnel (n = 241) completed an epidemiological survey (87% response rate) and 67 (27%) reported diarrhea and/or vomiting during the past two weeks. The median duration of illness was reported to be 3 days (IQR 2–4 days) and abdominal pain was reported among 30 (49%) individuals. Presentation to the medical aid station was sought by (62%) individuals and 9 (15%) had to stop or significantly reduce work for at least one day. Microscopy and PCR analysis of 14 stool samples collected from previously symptomatic patients, Shigella (7), Cryptosporidium (5), and Cyclospora (4) were the most prevalent pathogens detected. Consumption of food from on-base local vendors (RR = 4.01, 95% CI = 1.53–10.5, p-value <0.001) and arriving on base within the past two weeks (RR = 2.79, 95% confidence [CI] = 1.35–5.76, p-value = 0.001) were associated with increased risk of developing diarrheal disease. The risk of infectious diarrhea is great among reserve military personnel during two week training exercises. The consumption of local food, prepared without proper monitoring, is a risk factor for deployed personnel developing diarrheal illness. Additional information is needed to better understand disease risks to personnel conducting humanitarian assistance activities in the Latin America Region.     

Postexercise protein supplementation improves health and muscle soreness during basic military training in Marine recruits.

Elevated postexercise amino acid availability has been demonstrated to enhance muscle protein synthesis acutely, but the long-term impact of postexercise protein supplementation on variables such as health, muscle soreness, and function are unclear. Healthy male US Marine recruits from six platoons (US Marine Corps Base, Parris Island, SC; n = 387; 18.9 +/- 0.1 yr, 74.7 +/- 1.1 kg, 13.8 +/- 0.4% body fat) were randomly assigned to three treatments within each platoon. Nutrients supplemented immediately postexercise during the 54-day basic training were either placebo (0 g carbohydrate, 0 g protein, 0 g fat), control (8, 0, 3), or protein supplement (8, 10, 3). Subjects and observers making measurements and data analysis were blinded to subject groupings. Compared with placebo and control groups, the protein-supplemented group had an average of 33% fewer total medical visits, 28% fewer visits due to bacterial/viral infections, 37% fewer visits due to muscle/joint problems, and 83% fewer visits due to heat exhaustion. Recruits experiencing heat exhaustion had greater body mass, lean, fat, and water losses. Muscle soreness immediately postexercise was reduced by protein supplementation vs. placebo and control groups on both days 34 and 54. Postexercise protein supplementation may not only enhance muscle protein deposition but it also has significant potential to positively impact health, muscle soreness, and tissue hydration during prolonged intense exercise training, suggesting a potential therapeutic approach for the prevention of health problems in severely stressed exercising populations.     

Effect of intense military training on body composition

Individuals in a structural physical training program can show beneficial changes in body composition, such as body fat reduction and muscle mass increase. This study measured body composition changes by using 3 different techniques-skinfold thickness (SF) measurements, air displacement plethysmography (BOD-POD), and dual-energy x-ray absorptiometry (DXA)-during 9 months of intense training in healthy young men engaged in military training. Twenty-seven young men were recruited from a special faction of the Italian Navy. The program previewed three phases: ground combat, sea combat, and amphibious combat. Body composition was estimated at the beginning, in the middle, and at the end of the training. After the subjects performed the ground combat phase, body composition variables significantly decreased: body weight (P < 0.05), fat-free mass (FFM) (P < 0.001), and fat mass (FM) (P < 0.03). During the amphibious combat phase, body weight increased significantly (P < 0.01), mainly because of an increase in FFM (P < 0.001) and a smaller mean decrease in FM. There was a significant difference (P < 0.05) in circumferences and SF at various sites after starting the training course. Bland-Altman analysis did not show any systematic difference between FM and FFM measured with the 3 different techniques on any occasion. On any visit, FFM and FM correlation measured by BOD-POD (P = 0.90) and DXA was significantly greater than measured by SF. A significant difference was found in body mass index (BMI) measured during the study. BOD-POD and SF, compared with DXA, provide valid and reliable measurement of changes in body composition in healthy young men engaged in military training. In conclusion, the findings suggest that for young men of normal weight, changes in body weight alone and in BMI are not a good measure to assess the effectiveness of intense physical training programs, because lean mass gain can masquerade fat weight loss.     

The use of surface electromyographic techniques in assessing musculoskeletal disorders in production operations

The use of surface electromyographic (SEMG) techniques in evaluating production line workstations is illustrated through the use of two case studies. Evaluation procedures are introduced. The results illustrate how SEMG can be used to document the strain upon muscles of the neck and shoulders and how workstations may be altered to comply with government regulations.     

Finger temperatures during military field training at 0 to −29 °C

1. Skin and rectal temperatures were recorded continuously in 70 measurements during typical tasks of infantry and artillery training at 0 to −29 °C. The duration of the measurements varied from 55 min to 9.5 h.

2. The distribution of finger skin temperatures was quite similar at ambient temperature ranges 0 to −10 °C and −10 to −20 °C, while at −20 to −30 °C the finger temperatures were clearly lower.

3. At different ambient temperature ranges, 20–69% of finger temperatures were low enough to cause cold thermal sensations.

4. Sensation of cold was experienced at a finger temperature of 11.6±3.7 °C (mean±SD).     

The use of animals in live-tissue trauma training and military medical research

Uncontrolled hemorrhage is the most common preventable cause of death for soldiers wounded in combat. In live-tissue trauma training (LTTT), animals (mostly goats and pigs) are used to train physicians and paramedical personnel in how to treat severe traumatic injuries, including severe blood loss. Military personnel insist that such realistic training is necessary and has to date saved countless lives of soldiers. Animal rights groups, however, argue that the practice is inhumane and should be replaced with alternative methods. In this essay, the author explains how and why animals are used for LTTT and in military medical research (MMR), as well as why he feels that the continued use of animals for LTTT and MMR is justified. The author hopes to encourage wider discussion of this topic within the scientific, defense and animal welfare circles, leading to further refinements in the welfare and protection of animals used for these important, though often controversial, purposes.     

Theory and rationale for surface EMG-assisted stretching as an adjunct to chronic musculoskeletal pain rehabilitation

A clinical protocol is reviewed, which utilizes supportive intervention, education, and surface EMG biofeedback to facilitate movement and to maximize effective stretching with chronic musculoskeletal pain patients. Support for this clinical protocol is provided with an overview of the physiological basis of stretching, surface EMG patterns associated with stretching, and the effects of pain and emotional factors on stretching and movement inhibition.     

Effects of two different eight-week training programs on military physical performance

Various physical demands are placed on soldiers, whose effectiveness and survivability depend on their combat-specific physical fitness. Because sport training programs involving weight-based training have proven effective, this study examined the value of such a program for short-term military training using combat-relevant tests. A male weight-based training (WBT) group (n = 15; mean +/- SD: 27.0 +/- 4.7 years, 173.8 +/- 5.8 cm, 80.9 +/- 12.7 kg) performed full-body weight-based training workouts, 3.2-km runs, interval training, agility training, and progressively loaded 8-km backpack hikes. A male Army Standardized Physical Training (SPT) group (n = 17; mean +/- SD: 29.0 +/- 4.6 years, 179.7 +/- 8.2 cm, 84.5 +/- 10.4 kg) followed the new Army Standardized Physical Training program of stretching, varied calisthenics, movement drills, sprint intervals, shuttle running, and distance runs. Both groups exercised for 1.5 hours a day, 5 days a week for 8 weeks. The following training-induced changes were statistically significant (P < 0.05) for both training groups: 3.2-km run or walk with 32-kg load (minutes), 24.5 +/- 3.2 to 21.0 +/- 2.8 (SPT) and 24.9 +/- 2.8 to 21.1 +/- 2.2 (WBT); 400-m run with 18-kg load (seconds), 94.5 +/- 14.2 to 84.4 +/- 11.9 (SPT) and 100.1 +/- 16.1 to 84.0 +/- 8.4 (WBT); obstacle course with 18-kg load (seconds), 73.3 +/- 10.1 to 61.6 +/- 7.7 (SPT) and 66.8 +/- 10.0 to 60.1 +/- 8.7 (WBT); 5 30-m sprints to prone (seconds), 63.5 +/- 4.8 to 59.8 +/- 4.1 (SPT) and 60.4 +/- 4.2 to 58.9 +/- 2.7 (WBT); and 80-kg casualty rescue from 50 m (seconds), 65.8 +/- 40.0 to 42.1 +/- 9.9 (SPT) and 57.6 +/- 22.0 to 44.2 +/- 8.8 (WBT). Of these tests, only the obstacle course showed significant difference in improvement between the two training groups. Thus, for short-term (i.e., 8-week) training of relatively untrained men, the Army's new Standardized Physical Training program and a weight-based training experimental program can produce similar, significant, and meaningful improvements in military physical performance. Further research would be needed to determine whether weight-based training provides an advantage over a longer training period.     

Effect of training with and without a load on military fitness tests and marksmanship

The purpose of this study was to determine whether military-style training performed while carrying a weighted vest and backpack (Load condition) resulted in superior training adaptations (specifically, changes in military fitness and marksmanship) than did more conventional training (No-Load condition). A total of 33 college-aged men and women (16 Load, 17 No-Load) completed all testing and 9 weeks of training (1 h·d, 4 d·wk). No-Load training consisted of military calisthenics, sprints, agility drills, and running. Load training was similar except that running was replaced with stair climbing, and Load increased across the 9 weeks to 20 kg for women and 30 kg for men. Pretraining and posttraining, all subjects performed an uphill treadmill test with full load to determine peak oxygen consumption (VO(2)peak), the marine physical fitness test (PFT) and combat fitness test (CFT) without load, other fitness tests, and an indoor marksmanship test using a laser-fitted carbine. The marksmanship test was performed with full load and done before and immediately after a 200-m shuttle run performed in 60 seconds. Both groups significantly improved their VO(2)peak, PFT, and CFT scores by similar amounts. Pretraining, shooting score decreased significantly after the 200-m run and then rapidly recovered, with no difference between groups. A similar, but nonsignificant, pattern in shooting scores was seen in both groups posttraining. In conclusion, loaded training did not produce measurable advantages compared with unloaded training in this population. A strenuous anaerobic challenge caused a temporary reduction in marksmanship.     

Differential responses of IGF-I molecular complexes to military operational field training.

Insulin-like growth factor (IGF) I and IGF binding proteins (IGFBPs) modulate metabolic activity and tissue repair and are influenced by nutritional status. IGF-I circulates in free, ternary [IGF-I + IGFBP-3 + acid labile subunit (ALS)], and binary (IGF-I + IGFBP) molecular complexes, and the relative proportions regulate IGF-I extravascular shifting and bioavailability. This study examined the hypothesis that sustained physical activity and sleep deprivation superimposed on a short-term energy deficit would alter the IGFBP concentrations and alter the proportions of IGF-I circulating in ternary vs. binary molecular complexes. Components of the IGF-I system (total and free IGF-I; IGFBP-1, -3, and ALS; nonternary IGF-I and IGFBP-3), biomarkers of metabolic and nutritional status (transferrin, ferritin, prealbumin, glucose, free fatty acids, glycerol, beta-hydroxybutyrate), and body composition were measured in 12 men (22 +/- 3 yr, 87 +/- 8 kg, 183 +/- 7 cm, 20 +/- 5% body fat) on days 1, 3, and 4 during a control and experimental (Exp) period. During Exp, subjects performed prolonged work (energy expenditure of approximately 4500 kcal/day) with caloric (1600 kcal/day) and sleep (6.2 h total) restriction. IGF-I and IGFBP-3 were measured by immunoassay before and after immunoaffinity depletion of ALS-based complexes (i.e., ternary complex removal). Exp produced losses in body mass (-3.0%), lowered total IGF-I (-24%), free IGF-I (-42%), IGFBP-3 (-6%), nonternary IGF-I (-27%), and IGFBP-3 (-16%), and increased IGFBP-1 (256%). No Exp effects were observed for ALS. No changes were observed in the proportion of IGF-I circulating in free ( approximately 1.2%), ternary ( approximately 87.4%), or nonternary ( approximately 11.4%) molecular complexes. During Exp, glucose concentrations were lower on day 3, but days 1 and 4 were statistically similar. In conclusion, during a short-term energy deficit in young, healthy men, 1). IGF-I system components differentially respond (both in direction and magnitude) to a given metabolic perturbation and 2). the relative proportion of IGF-I sequestered in ternary vs. nonternary molecular complexes appears to be well maintained.     

Estimating disturbance effects from military training using developmental instability and physiological measures of plant stress

We used developmental instability, water potential, and variable fluorescence to determine if populations of winged sumac (Rhus copallinum) were being negatively effected by military training disturbance. We established nine sites that represented a land-use disturbance gradient with three impact levels (low, medium, and high), the effects mostly due to mechanized infantry training maneuvers. Although mean values of developmental instability, water potential, and variable fluorescence differed significantly among sites, the patterns did not consistently differentiate sites relative to the disturbance gradient. At the population level, some measures of developmental instability and variable fluorescence were positively correlated. All nine sites consisted of habitat mosaics, with the abundance of higher quality habitat patches and canopy gaps closely related to habitat impacts. It may be that R. copallinum is selecting similar micro-environments at all sites and therefore minimizing inter-site variation in stress measures, despite large differences in overall habitat condition. Our results call for caution in developing ecological indicators using the response of physiological and morphological measures from a single plant species.