Military Health System

ABSTRACT This paper draws on various data from long‐term immersion in combat sports to explore the period experiences of cis women fighters. We blend theoretical ideas from the social scientific literature on menstruation and the sociology of medicalization, pain and injury. Based on rich empirical data and theoretical tools, we argue that the “ontological pervasiveness” of periods resulted in women “fighting” parts of their own biology within traditional male‐dominated spaces—by mitigating, managing and minimizing their periods through various strategies. There were specific and potentially damaging consequences that flowed from this. While we center women's bodies, we argue that a key problem is not the bleeding body per se, but rather the way female biology is hidden and ignored. This is particularly evident in how period blood is marked out as symbolically different—rendered shameful and in need of concealment—in contrast to the routinized, accepted and even valorized forms of bleeding that occur through participation in such sports. By “suffering in silence,” the tensions between their roles as fighters—as constructed following latent masculinized norms that still frame most sports—and women remained largely unacknowledged.

Jet fuel inhalation represents one of the most significant exposures among service members; however, health outcomes are unclear, and the processes linking exposures and respiratory effects are undefined. A systematic literature review of human, animal, and mechanistic studies was conducted to assess and synthesize the scientific evidence on the adverse respiratory effects of jet fuel exposure. Animal studies provided moderate evidence that jet fuel inhalation resulted in adverse effects through cytotoxicity, tissue damage, inflammation, airway remodeling, and lung function changes, which was corroborated by mechanistic data. This was further supported by slight epidemiologic evidence that jet fuel exposure is associated with increased respiratory symptoms and disease. Evidence indicates that jet fuel exposure is likely to produce adverse respiratory effects, which may have important implications for exposed service members and veterans.

Deployment to Afghanistan and Southwest Asia has been associated with adverse respiratory health outcomes. However, the impact of inhalational exposures (eg, vapor, dust, gas, fumes), which are known correlates of reduced lung function and future chronic lung disease, during military service time outside this deployment period has not been assessed. To assess military inhalational exposures during nonwartime routine activities and their associations with chronic respiratory symptoms. This cross-sectional study used data from the US Department of Veterans Affairs Service and Health Among Deployed Veterans study. US veterans who served between October 7, 2001, and February 28, 2017; deployed to Afghanistan or Southwest Asia; and living near 6 Veterans Affairs sites were randomly selected from Defense Manpower Data Center records. Participants completed interviewer-administered multi-item questionnaires about 29 exposures related to active duty military service time when not deployed. Onsite visits occurred between April 27, 2018, and March 13, 2020, and analyses were performed between April 1, 2023, and February 10, 2025. Inhalation exposures during active duty military service time. The main outcomes were chronic respiratory symptoms of dyspnea, wheeze in the previous 12 months, and chronic bronchitis. Using factor analysis, the 29 exposures were reduced to 20 items and categorized into 5 factors. Responses were scored ordinally (0, 1, 2) according to exposure prevalence and duration. Generalized linear modeling was used to explore associations between exposures and chronic respiratory symptoms. The sample included 1712 veterans (median [IQR] age, 37 [33-45] years; 1522 male [88.9%]) who had military service other than during their deployment to Afghanistan or Southwest Asia. The median (IQR) total active duty military service duration was 77 (57-128) months, with 82.8% of their service time spent outside the theater of conflict. The prevalence of dyspnea, chronic bronchitis, and wheeze was 7.0% (117 participants), 7.1% (121 participants), and 15.2% (260 participants), respectively. The most commonly reported exposure categories were combustion and ground dust (1014 participants [59.2%]), aircraft maintenance (812 participants [47.4%]), and heavy equipment maintenance (783 participants [45.7%]). Adjusted multivariable analyses identified significant associations between heavy equipment maintenance exposures and dyspnea (odds ratio [OR], 1.33; 95% CI, 1.06-1.68) and wheeze (OR, 1.29; 95% CI, 1.10-1.52). Aircraft maintenance exposures were significantly associated with wheeze (OR, 1.22; 95% CI, 1.01-1.47). No statistically significant associations were found between these exposures and chronic bronchitis. This cross-sectional study shows significant associations between heavy equipment maintenance and aircraft maintenance inhalation exposures outside of deployment with chronic respiratory symptoms among US veterans. These findings suggest that certain military inhalational exposures may contribute to the development of chronic lung disease and that policy interventions to reduce such exposures may protect the long-term respiratory health of military personnel.

Abstract It has been empirically established that genome mixing between divergent species can trigger meiotic aberrations, ultimately leading to the emergence of asexual reproduction through the production of unreduced gametes in various metazoan lineages. Yet, it remains poorly understood how such asexual hybrids cope with co-inherited differences in sex determination systems, diverged regulatory networks, and chromosomal incompatibilities— especially in the context of increased ploidy. Addressing these questions requires high-quality, chromosome-level reference genomes of the parental species involved in hybrid formation. Here, we present the first chromosome-level genome assemblies for three hybridizing Cobitis species ( C. elongatoides , C. taenia , and C. tanaitica ), providing a comprehensive framework to investigate the genetic and cytogenetic basis of hybrid sterility and the transition to asexuality. By integrating genome scaffolding, male/female pooled sequencing, and molecular cytogenetics, we uncover extensive structural variation among homologous chromosomes of the three species, despite their overall syntenic conservation. Population-level Pool-Seq analyses further revealed that each species possesses a distinct, non-homologous sex chromosome, highlighting sex chromosome turnover even among recently diverged lineages. These assemblies enabled the design of chromosome-specific painting probes, which we applied to meiotic metaphase I spreads of diploid hybrids. This approach revealed striking differences in the pairing success of orthologous chromosomes, with some (e.g., Ch01B) frequently forming bivalents, while others (e.g., Ch01A, Ch05, Ch20) failed to do so and remained unpaired. Our results demonstrate that chromosome-specific features, shaped by structural evolution and sex-linked divergence, contribute unequally to hybrid meiotic failure. Together, this work provides a high-resolution genomic and cytogenetic framework to understand how interspecific hybridization gives rise to clonality, and how the architecture of inherited parental genomes shapes the success or breakdown of meiosis in hybrid vertebrates.

Spinal cord pathology is a diverse topic with a broad range of causes. Etiologies include trauma, inflammatory processes, infections, vascular disease, neoplasm, degenerative conditions and toxin exposure. Regardless of etiology, spinal pathology often presents as rapidly progressive paraparesis. Transverse Myelitis (TM) is a rare, acute segmental inflammatory spinal cord disorder characterized with motor, sensory, and/or autonomic dysfunction. This process usually occurs post-infection, but may also be related to acute neuro-inflammatory disorders. This paper will present a case of TM refractory to medication and describe the diagnosis of Spinal Dural Arteriovenous Fistula (SDAVF). SDAVF is a rare condition in which there is an arteriovenous fistula formed on the dural surface of the spinal cord which typically drains via retrograde flow through the medullary vein, thereby causing enlargement of coronal venous plexus.

The ADvanced VIrtual Support for OpeRational Forces (ADVISOR) program is a synchronous telemedicine system developed in 2017 to provide 24/7 remote expert support to U.S. Military and NATO clinicians engaged in medical care in austere locations. Infectious disease (ID) remains the highest consulted service since 2018 and is currently staffed by 10 adult and pediatric ID physicians within the Military Health System. We conducted a retrospective review of the ID ADVISOR calls between 2017 and 2022 to identify trends and better prepare military ID physicians to address urgent ID consultations in overseas settings. Health records of the ID consultations between July 2017 and January 2022 were reviewed for local caregiver and patient demographics, case descriptions, consultant recommendations, and outcomes. A "not research" determination was made by the Brooke Army Medical Center Human Research Protections Office. ID physicians received 57 calls for 60 urgent patient consultations. Most calls were from countries in the Middle East or in Southwest Asia (United States Central Command (USCENTCOM)), followed by countries in Africa (United States Africa Command (USAFRICOM)). The majority of patients were active duty U.S. Military and were generally male with median age of 25 years. All consults involved an initial phone consultation and 30% continued over email. Ninety percent of the calls were initiated by physicians, and the median time from injury or illness-onset to consult was 3 days. Seventy percent of the consult questions involved treatment and further diagnostics, but one-third of cases required assistance with management of disease prevention. Multidrug-resistant or nosocomial infections, animal or bite exposure, malaria and malaria prevention, febrile illness, and blood-borne pathogen exposure accounted for 63% of the consults. Collaboration with other specialties took place in a minority of cases, and follow-up contact was recommended 20% of the time. Most recommendations involved adjusting drug regimens or further testing. Medical evacuation was only recommended in five of the cases. Although there was limited ability for follow-up, no known deaths occurred. A high proportion of calls to the ID ADVISOR line are relevant to the overlapping content areas of infection prevention, force protection, and outbreak response. Most patients requiring urgent ID consultation were managed successfully without evacuation. The current military-unique ID fellowship curriculum is consistent with the encountered diagnoses per the ID ADVISOR line, and high-yield individual topics have been identified.

Background: The preferred patient-reported outcome measure for the assessment of shoulder conditions continues to evolve. Previous studies correlating the Patient-Reported Outcomes Measurement Information System (PROMIS) computer adaptive tests (CATs) to the American Shoulder and Elbow Surgeons (ASES) score have focused on a singular domain (pain or physical function) but have not evaluated the combined domains of pain and physical function that compose the ASES score. Additionally, previous studies have not provided a multivariable prediction tool to convert PROMIS scores to more familiar legacy scores. Purpose: To establish a valid predictive model of ASES scores using a nonlinear combination of PROMIS domains for physical function and pain. Study Design: Cohort study (Diagnosis); Level of evidence, 3. Methods: The Military Orthopaedics Tracking Injuries and Outcomes Network (MOTION) database is a prospectively collected repository of patient-reported outcomes and intraoperative variables. Patients in MOTION research who underwent shoulder surgery and completed the ASES, PROMIS Physical Function, and PROMIS Pain Interference at varying time points were included in the present analysis. Nonlinear multivariable predictive models were created to establish an ASES index score and then validated using “leave 1 out” techniques and minimal clinically important difference /substantial clinical benefit (MCID/SCB) analysis. Results: A total of 909 patients completed the ASES, PROMIS Physical Function, and PROMIS Pain Interference at presurgery, 6 weeks, 6 months, and 1 year after surgery, providing 1502 complete observations. The PROMIS CAT predictive model was strongly validated to predict the ASES (Pearson coefficient = 0.76-0.78; R2 = 0.57-0.62; root mean square error = 13.3-14.1). The MCID/SCB for the ASES was 21.7, and the best ASES index MCID/SCB was 19.4, suggesting that the derived ASES index is effective and can reliably re-create ASES scores. Conclusion: The PROMIS CAT predictive models are able to approximate the ASES score within 13 to 14 points, which is 7 points more accurate than the ASES MCID/SCB derived from the sample. Our ASES index algorithm, which is freely available online (https://osf.io/ctmnd/), has a lower MCID/SCB than the ASES itself. This algorithm can be used to decrease patient survey burden by 11 questions and provide a reliable ASES analog to clinicians.