Naval Information Warfare Systems Command

Operational experience from the Russo-Ukrainian War revealed frequent use of tourniquets that were not medically indicated and an increase in ischemic complications from prolonged tourniquet application as a consequence of extended evacuation times. In response to this, the Committee on Tactical Combat Casualty Care (CoTCCC) convened a working group to evaluate whether tourniquet reassessment and conversion practices should extend to the All Service Member (ASM) level. With input from NATO and partner nations, the Working Group developed a standardized, time-based algorithm that provides plain language guidance for reassessment, repositioning, and conversion. The proposed change replaces the term replacement with repositioning, affirms a reassessment window within 2 hours for nonmedical personnel, and limits conversion beyond 2 hours to medical personnel. These updates will expand lifesaving capability to nonmedical responders, reduce preventable morbidity and mortality from tourniquet use, and align TCCC principles with current operational realities.

Surf breaks are vital cultural resources on coastlines worldwide, but are vulnerable to myriad threats, including climate change and coastal development; as such, efforts to protect them have proliferated. Hitherto, spatial protections (e.g., marine protected areas; MPAs) have been pursued for surf breaks as single, individual reserves. This situation is comparable to the early days of biodiversity MPAs, which eventually progressed to networked reserve design, initially culminating in California’s 124 net- worked MPAs. Here, we apply the analogy of networked biodiversity reserve design to networked reserves for surf break protection. We examine the proposition that the effectiveness of surfing resource conservation can be improved by a “networked” approach. We conclude that specific characteristics of surf breaks, including their size, type, carrying capacity, quality, value, accessibility, spacing, vulnerability, and cultural and historic significance could all be considered and balanced to yield more effective, equitable conservation outcomes.

To determine (1) the incidence rate of lower extremity (LE) bone stress injuries (BSIs) in United States Air Force Special Warfare (AFSPECWAR) trainees during the first 120 days of training, and (2) factors associated with sustaining a LE BSI. Retrospective cohort study. AFSPECWAR Airmen (n = 2,290, mean age = 23.7 ± 3.6 years) entering an intensive 8-week preparatory course "SW-Prep" between October 2017 and May 2021. We compared anthropometric measurements, previous musculoskeletal injury (MSKI), fitness measures, and prior high-impact sports participation in those that did and did not suffer a BSI during the 120-day observation period using independent t-tests and chi-square tests. A multivariable binary logistic regression was used to determine factors associated with suffering a BSI. A total of 124 AFSPECWAR trainees suffered a BSI during the surveillance period, yielding an incidence proportion of 5.41% and an incidence rate of 1.4 BSIs per 100 person-months. The multivariate logistic regression revealed that lower 2-minute sit-up scores, no prior history of participation in a high-impact high-school sport, and a history of prior LE MSKI were associated with suffering a BSI. A receiver operator characteristic curve analysis yielded an area under the curve (AUC) of 0.727. BSI incidence proportion for our sample was similar to those seen in other military settings. Military trainees without a history of high-impact sports participation who achieve lower scores on sit-ups tests and have a history of LE MSKI have a higher risk for developing a LE BSI during the first 120 days of AFSPECWAR training.

We present around view system enhanced by deep learning techniques. The around view system is an essential component in autonomous driving and parking systems. Traditional around view systems have been designed using handcrafted algorithms. Moreover, utilizing pre-generated look-up tables (LUTs) has not been effective in reducing errors that occur during driving. We propose an algorithm that leverages deep learning-based methods to correct while driving. By using deep learning for feature matching, we can update the LUT to decrease the errors between different viewpoints.

Military performance must be evaluated, and one of the most critical concepts to measure involves the lethal capabilities of a military force. However, there are multiple challenges that complicate any accurate performance assessment, including theoretical issues of measurement due to statistical irregularities and practical limitations due to the military context. Here, we describe the lethality paradox, which states that measuring lethality could be a self-defeating exercise despite its necessity. Specifically, the value of any collected metric may be inherently reduced by the act of measurement while, also, creating operational vulnerabilities for a military force. This paradox is conceived as an extension of Goodhart’s Law and incorporates the same challenges of a personnel gaming a set standard rather than developing the skill set supposedly measured by this standard. Our discussion identifies the limitations and applications of Goodhart’s Law to lethality while also concluding with several proposed solutions to different paradoxical challenges.

Vaccine technology has improved substantially since the first smallpox vaccine, developed more than 200years ago. As technology improves, vaccines can be produced more safely and reliably for many different pathogens. A recent breakthrough saw the first full deployment of mRNA vaccines to fight a pandemic. Despite the technological and logistical feat of developing a viable vaccine in an abbreviated time frame, there have been many questions about this new approach to vaccine development. The current review will provide descriptions about different types of vaccines as well as answers to some common questions about mRNA vaccines. The purpose is to provide military medical professionals with the information needed to better convey the importance and function of these new vaccines to service members. There were no explicit inclusion or exclusion criteria for articles describing mRNA vaccine technology. References included here were intended to illustrate important principles or empirical evidence in demonstrating the safety, efficacy, and function of mRNA vaccines. The review describes three different types of vaccines: whole-pathogen, subunit, and nucleic acid. Each vaccine type has different implications for the development and production of a vaccine line. For example, whole-pathogen and subunit vaccines often require growing significant amounts of the vaccine sample in laboratory before the material can be incorporated into the vaccine. Nucleic acid vaccines instead provide cells the opportunity to produce key proteins without needing to reproduce the virus and attenuate it in a laboratory setting. This approach has a notable advantage of speed in moving from genome sequencing to vaccine production, but it also creates some potential confusion. The discussion covers three questions with regard to this confusion. First, was the vaccine developed too quickly? Speed here is a byproduct of the new technology and unprecedented government interdepartmental cooperation. No steps were skipped in development or production. Second, does the vaccine modify DNA? No, the mRNA vaccines never enter the cell nucleus and therefore cannot modify DNA. The discussion clarifies how mRNA enters cells and produces the key proteins required to stimulate an immune system response. Third, how long will immunity last? Because mRNA vaccines are new, long-term immunity cannot be projected without significant further study. Still, the discussion does cover issues in determining vaccine efficacy in clinical laboratory trials versus field effectiveness in the real world. These mRNA vaccines are the newest and most sophisticated defensive tool military medicine has against emerging biological threats. Evolving dangers, such as synthetic biology and engineered pathogens, further enhance the importance of having defensive countermeasures that can be rapidly deployed in response. Current evidence suggests high safety and effectiveness for a biological countermeasure, decades in the making, and military medical personnel should feel confident using and recommending this technology to ensure force health protection.

Point-of-care ultrasound (POCUS) is an integral aspect of critical care and emergency medicine curriculums throughout the country, but it has been slow to integrate into internal medicine residency programs. POCUS has many benefits for internal medicine providers, guiding diagnostic decisions and aiding in procedures. Additionally, POCUS is a convenient and portable resource specifically for internal medicine providers in the military when practicing in deployed or critical care settings. Critical care and emergency medicine clinicians are excellent resources to lead these courses. We sought to develop a new POCUS curriculum for internal medicine residents within the Naval Medical Center Portsmouth Internal Medicine Residency program with the support of emergency medicine and critical care medicine staff to lead and oversee the training. The project's aim was to increase internal medicine resident confidence with POCUS by 20% and proficiency with POCUS as evidenced by pretest and posttest analysis by 10%. The program consisted of a 2-day, 9-hour, introductory course, combining lecture with hands-on scanning taught by emergency medicine physicians who had completed emergency ultrasound fellowship-level training. This was followed by a longitudinal component of hands-on scanning throughout the academic year built into the residents' schedules. Emergency and critical care medicine ultrasound staff reviewed all studies for quality assurance (QA). The residents were given both precourse and post-course knowledge tests and confidence surveys, which utilized a 5-point Likert scale. The knowledge assessments were analyzed with a paired t-test, and the Likert scale data were analyzed using the Wilcoxon signed-rank test. The Naval Medical Center Portsmouth Institutional Review Board deemed this project nonhuman subjects' research. Twenty participants were enrolled, with 10 (50%) of those enrolled completing all course requirements. The average precourse knowledge assessment score was 76.60%, and postcourse assessment score was 80.95% (+4.35%, P = .33). The confidence survey scores were initially 73.33% and improved to 77.67% (+4.34%, P = .74). A curriculum comprised of a 9-hour workshop followed by a longitudinal hands-on experience can provide improvement in internal medicine resident POCUS knowledge and confidence. This model emphasizes the benefit of emergency and critical care cooperation for ultrasound training and provides an emphasis on medicine-relevant scans and longitudinal training.