Costs and Consequences: Hepatitis C Seroprevalence in the Military and Its Impact on Potential Screening Strategies

UNLABELLED: Knowledge of the contemporary epidemiology of hepatitis C viral (HCV) infection among military personnel can inform potential Department of Defense screening policy. HCV infection status at the time of accession and following deployment was determined by evaluating reposed serum from 10,000 service members recently deployed to combat operations in Iraq and Afghanistan in the period 2007-2010. A cost model was developed from the perspective of the Department of Defense for a military applicant screening program. Return on investment was based on comparison between screening program costs and potential treatment costs avoided. The prevalence of HCV antibody-positive and chronic HCV infection at accession among younger recently deployed military personnel born after 1965 was 0.98/1000 (95% confidence interval 0.45-1.85) and 0.43/1000 (95% confidence interval 0.12-1.11), respectively. Among these, service-related incidence was low; 64% of infections were present at the time of accession. With no screening, the cost to the Department of Defense of treating the estimated 93 cases of chronic HCV cases from a single year\u27s accession cohort was $9.3 million. Screening with the HCV antibody test followed by the nucleic acid test for confirmation yielded a net annual savings and a$3.1 million dollar advantage over not screening. CONCLUSIONS: Applicant screening will reduce chronic HCV infection in the force, result in a small system costs savings, and decrease the threat of transfusion-transmitted HCV infection in the battlefield blood supply and may lead to earlier diagnosis and linkage to care; initiation of an applicant screening program will require ongoing evaluation that considers changes in the treatment cost and practice landscape, screening options, and the epidemiology of HCV in the applicant/accession and overall force populations

Hepatitis B Seroprevalence in the U.S. Military and its Impact on Potential Screening Strategies

INTRODUCTION: Knowledge of the contemporary epidemiology of hepatitis B virus (HBV) infection among military personnel can inform potential Department of Defense (DoD) screening policy and infection and disease control strategies. MATERIALS AND METHODS: HBV infection status at accession and following deployment was determined by evaluating reposed serum from 10,000 service members recently deployed to combat operations in Iraq and Afghanistan in the period from 2007 to 2010. A cost model was developed from the perspective of the Department of Defense for a program to integrate HBV infection screening of applicants for military service into the existing screening program of screening new accessions for vaccine-preventable infections. RESULTS: The prevalence of chronic HBV infection at accession was 2.3/1,000 (95% CI: 1.4, 3.2); most cases (16/21, 76%) identified after deployment were present at accession. There were 110 military service-related HBV infections identified. Screening accessions who are identified as HBV susceptible with HBV surface antigen followed by HBV surface antigen neutralization for confirmation offered no cost advantage over not screening and resulted in a net annual increase in cost of $5.78 million. However, screening would exclude as many as 514 HBV cases each year from accession. CONCLUSIONS: Screening for HBV infection at service entry would potentially reduce chronic HBV infection in the force, decrease the threat of transfusion-transmitted HBV infection in the battlefield blood supply, and lead to earlier diagnosis and linkage to care; however, applicant screening is not cost saving. Service-related incident infections indicate a durable threat, the need for improved laboratory-based surveillance tools, and mandate review of immunization policy and practice

Prospective Assessment Of Health Disparities And Injury Risk Factors At Basic Combat Training At Ft. Jackson

Numerous recruits for Basic Combat Training (BCT) for the Army fail to complete the course due to injury and time lost. This study was designed to provide a more thorough list of risk factors involved in injury and attrition through real-time data analysis throughout a cycle of BCT. Throughout BCT, a researcher was placed in the Battalion Aid Station (BAS) and recorded the reason for the visit, whether it was a new or existing condition, injury location, medical history, and how long this injury has been an issue. Several risk factors were tested: sex, age, and ethnicity/race. It was found that 39.87% of the Female recruits and 28.34% of the Male recruits visited the BAS. The age that produced the highest percentage of Male recruit visits over 30 years old (37.50%) and the Female recruits was 18-20 years old (46.38%). Non-Hispanic Native Hawaiian and Pacific Islander Males had the highest rate of BAS visits at 40.00% and Non-Hispanic Black Females had the highest rate at 45.42%. The visits to the BAS were higher for Female recruits; older male and younger female recruits

THE DISABLED SOLDIER: A CASE FOR DISABLED AMERICANS IN THE U.S. ARMED SERVICES

Despite the rising demands and functions of non-kinetic warfare, the military bars most disabled Americans from entry. Artificial intelligence, complex decision-making, and fifth-generation-warfare elements stress a multidimensional force and cognitive skills over dominant kinetic traits. This thesis investigates the feasibility requirements, national security implications, and benefits to the Department of Defense of expanding active military service to disabled Americans. After reviewing U.S. and international integration of disabled persons, the defined needs and skills for emerging warfare, academic studies of disabled talents, and military policy, this thesis reveals the feasibility of inclusion. Recommendations include mainstreaming persons with disabilities within the existing military model, making changes to defense policy, establishing a pilot program or corps, and undertaking future research.Civilian, Department of Homeland SecurityApproved for public release. Distribution is unlimited

Potential Biomarkers Selection for Bipolar Disorder Identification

A biomarker is a measurable indicator of the severity or presence of some disease. A biomarker is anything that can be used as an indicator of a particular disease state or some other physiological state of an organism. The space Decomposition-Gradient-Regression (DGR) method has been developed (Li et al., 2012; Li et al., 2015) to select biomarkers for schizophrenia. This study performs the DGR approach on data for bipolar disorder patients, which contains 56 biomarkers and 8 infectious agent’s antibodies. Serum specimens were collected from 132 United States military service members (118 males and 14 females) with a diagnosis of bipolar disorder from 1992 to 2005 and their matched healthy controls.. Trefoil Factor3 (TFF3), Gliadin, prolactin (PRL), Apolipoprotein A-II (Apo A-II) and Immunoglobulin A (IGA) were found to be significant predictors of Bipolar Disorder (BD) in males. Macrophage-Derived Chemokine (MDC), Alpha-1-Antitrypsin (AAT), Gliadin, Beta-2-Microglobulin (B2M) and Monocyte Chemotactic Protein 2 (MCP-2) might be used to identify bipolar disorder in females. A predictive biomarker panel for BD offers the potential to aid in the diagnosis, initiate treatment earlier and ideally alter the course of disease with reduced morbidity and functional impairment

Cost-Effectiveness of a Weight Loss Intervention: An Adaptation of the Look AHEAD Lifestyle Intervention in the US Military

Objective: To assess whether a counselor-initiated adaptation (CI) of the Look AHEAD Intensive Lifestyle Intervention (ILI) in a military setting was cost-effective relative to a self- paced adaptation (SP). Methods: We performed cost-effectiveness analysis from a payer perspective alongside a 2014- 2017 randomized behavioral weight loss trial among 248 active-duty military personnel stationed at a US Air Force Base in Texas. We calculated incremental cost-effectiveness ratios (ICERs) for weight loss, reductions in waist circumference, and quality-adjusted life years (QALYs). Results: After 12 months, the CI adaptation cost more per participant compared to the SP adaptation ($1,081 vs.$120), but achieved greater weight loss (1.86 vs. 0.06kg), reductions in waist circumference (1.85 vs. 0.48 cm), and more QALYs (0.871 vs. 0.856). The ICER for CI relative to the SP adaptation was $61,268 per additional QALY. At willingness-to-pay thresholds of$50,000 and $100,000 per QALY the CI adaptation was 45 and 49% likely to be cost- effective. Conclusions: The CI delivery of the Look AHEAD ILI may offer a cost-effective approach to tackle excess weight in the US military

A Conceptual Model of the Psychological Health System for U.S. Active Duty Service Members: An Approach to Inform Leadership and Policy Decision Making

The influence of individual-level factors such as pretraumatic risk and protective factors and the availability of unit-level and enterprise-level factors on psychological health outcomes have been previously considered individually, but have not been considered in tandem across the U.S. Military psychological health system. We use the existing literature on military psychological health to build a conceptual system dynamics model of the U.S.Military psychological health system “service-cycle” from accession and deployment to future psychological health screening and treatment. The model highlights a few key observations, challenges, and opportunities for improvement for the system that relate to several topics including the importance of modeling operational demand combined with the population’s psychological health as opposed to only physical health; the role of resilience and post-traumatic growth on the mitigation of stress; the positive and negative effects of pretraumatic risk factors, unit support, and unit leadership on the service-cycle; and the opportunity to improve the system more rapidly by including more feedback mechanisms regarding the usefulness of pre- and post-traumatic innovations to medical leaders, funding authorities, and policy makers.Department of Defens

Outcomes of highly active antiretroviral therapy in the context of universal access to healthcare: the U.S. Military HIV Natural History Study

<p>Abstract</p> <p>Background</p> <p>To examine the outcomes of highly-active antiretroviral therapy (HAART) for individuals with free access to healthcare, we evaluated 2327 patients in a cohort study composed of military personnel and beneficiaries with HIV infection who initiated HAART from 1996 to the end of 2007.</p> <p>Methods</p> <p>Outcomes analyzed were virologic suppression (VS) and failure (VF), CD4 count changes, AIDS and death. VF was defined as never suppressing or having at least one rebound event. Multivariate (MV) analyses stratified by the HAART initiation year (before or after 2000) were performed to identify risk factors associated with these outcomes.</p> <p>Results</p> <p>Among patients who started HAART after 2000, 81% had VS at 1 year (N = 1,759), 85% at 5 years (N = 1,061), and 82% at 8 years (N = 735). Five years post-HAART, the median CD4 increase was 247 cells/ml and 34% experienced VF. AIDS and mortality rates at 5 years were 2% and 0.3%, respectively. In a MV model adjusted for known risk factors associated with treatment response, being on active duty (versus retired) at HAART initiation was associated with a decreased risk of AIDS (HR = 0.6, 95% CI 0.4-1.0) and mortality (0.6, 0.3-0.9), an increased probability of CD4 increase ≥ 50% (1.2, 1.0-1.4), but was not significant for VF.</p> <p>Conclusions</p> <p>In this observational cohort, VS rates approach those described in clinical trials. Initiating HAART on active duty was associated with even better outcomes. These findings support the notion that free access to healthcare likely improves the response to HAART thereby reducing HIV-related morbidity and mortality.</p

Automated Quantification of White Blood Cells in Light Microscopic Images of Injured Skeletal Muscle

Muscle regeneration process tracking and analysis aim to monitor the injured muscle tissue section over time and analyze the muscle healing procedure. In this procedure, as one of the most diverse cell types observed, white blood cells (WBCs) exhibit dynamic cellular response and undergo multiple protein expression changes. The characteristics, amount, location, and distribution compose the action of cells which may change over time. Their actions and relationships over the whole healing procedure can be analyzed by processing the microscopic images taken at different time points after injury. The previous studies of muscle regeneration usually employ manual approach or basic intensity process to detect and count WBCs. In comparison, computer vision method is more promising in accuracy, processing speed, and labor cost. Besides, it can extract features like cell/cluster size and eccentricity fast and accurately. In this thesis, we propose an automated quantifying and analysis framework to analyze the WBC in light microscope images of uninjured and injured skeletal muscles. The proposed framework features a hybrid image segmentation method combining the Localized Iterative Otsu’s threshold method assisted by neural networks classifiers and muscle edge detection. In specific, both neural network and convoluted neural network based classifiers are studied and compared. Via this framework, the CD68-positive WBC and 7/4-positive WBC quantification and density distribution results are analyzed for demonstrating the effectiveness of the proposed method