Leaning in to Address Sleep Disturbances and Sleep Disorders in Department of Defense and Defense Health Agency

Letter to the Editor, Military Medicine, 187, 5/6:155, 202217 USC 105 interim-entered record; under review.The article of record as published may be found at http://dx.doi.org/10.1177/0018720820906050In their article entitled, “Engaging Stakeholders to Optimize Sleep Disorders Management in the U.S. Military: A Qualitative Analysis,” Abdelwadoud and colleagues conducted focus groups of service members, primary care managers (PCMs), and administrative stakeholders about their perceptions, experiences, roles in sleep management, stated education needs, and management of sleep disorders.1 The qualitative methods are rigorous, and the findings reinforce and nuance prior results, especially regarding key requirements from PCMs. We feel compelled, however, to further nuance the authors’ conclusion that “current military sleep management practices are neither satisfactory nor maximally effective” and offer specific examples of actions taken by the Department of Defense (DoD) and Defense Health Agency (DHA) in recognition of the significance of optimal sleep in combat readiness and overall health of service members. We offer here a succinct list of concrete efforts to support and implement substantial clinical, operational, research, or educational efforts by the DoD or DHA to improve sleep in service members and associated clinical challenges in this unique population.Identified in text as U.S. Government work

A large genome-wide association study of age-related macular degeneration highlights contributions of rare and common variants.

This is the author accepted manuscript. The final version is available from Nature Publishing Group via http://dx.doi.org/10.1038/ng.3448Advanced age-related macular degeneration (AMD) is the leading cause of blindness in the elderly, with limited therapeutic options. Here we report on a study of >12 million variants, including 163,714 directly genotyped, mostly rare, protein-altering variants. Analyzing 16,144 patients and 17,832 controls, we identify 52 independently associated common and rare variants (P < 5 × 10(-8)) distributed across 34 loci. Although wet and dry AMD subtypes exhibit predominantly shared genetics, we identify the first genetic association signal specific to wet AMD, near MMP9 (difference P value = 4.1 × 10(-10)). Very rare coding variants (frequency <0.1%) in CFH, CFI and TIMP3 suggest causal roles for these genes, as does a splice variant in SLC16A8. Our results support the hypothesis that rare coding variants can pinpoint causal genes within known genetic loci and illustrate that applying the approach systematically to detect new loci requires extremely large sample sizes.We thank all participants of all the studies included for enabling this research by their participation in these studies. Computer resources for this project have been provided by the high-performance computing centers of the University of Michigan and the University of Regensburg. Group-specific acknowledgments can be found in the Supplementary Note. The Center for Inherited Diseases Research (CIDR) Program contract number is HHSN268201200008I. This and the main consortium work were predominantly funded by 1X01HG006934-01 to G.R.A. and R01 EY022310 to J.L.H

CONTRACT TYPE CASE HISTORY OF THE CVN-78 AND CVN-79 PORTFOLIO ACQUISITIONS

Analyzing whether a correlation existed between these two acquisition portfolios, we proposed and answered our four research questions. Our primary research questions and answers determined the advantages and disadvantages of contract type and whether policy initiatives shaped the acquisition strategies for the Ford-class aircraft carriers. Also, we wanted to determine how the selection of contract type can shape future acquisitions, especially when acquiring new and immature technologies. From our research, we discovered that the major difference between the acquisitions of CVN-78 and CVN-79 occurred during the detail design and construction contracts. For CVN-78, a hybrid cost type contract was awarded and was composed of multiple cost reimbursable type contracts. On the other hand, the contract selected for detail design and construction of CVN-79 was fixed price incentive fee. Additionally, policy initiatives like Better Buying Power (BBP) highly encouraged the use of incentive type contracts, especially fixed price contracts. From our research, we determined one of the reasons for the schedule and cost overruns experienced by the Ford-class aircraft carrier occurred during the acquisition of advanced yet immature technologies. MDAPs must strategically align contract type selection with technical and developmental risk in order to mitigate cost and schedule overruns. However, it must be noted that the selection of contract type alone does not indicate causation.Civilian, Department of the NavyCivilian, Defense Contract Management AgencyApproved for public release. Distribution is unlimited