Introduction Cumulative low-level blast exposure during military training may be a significant occupational hazard, increasing the risk of poor long-term outcomes in brain function. US Public Law 116-92 section 717 mandates that US Department of Defense agencies document the blast exposure of each Service member to help inform later disability and health care decisions. However, which empirical measures of training blast exposure, such as the number of incidents, peak overpressure, or impulse, best inform changes in the neurobehavioral symptoms reflecting brain health have not been established. Materials and Methods This study was approved by the US Army Special Operations Command, the University of North Carolina at Chapel Hill, and the VA Puget Sound Health Care System. Using methods easily deployable across different organizational structures, this study sought to identify and measure candidate risk factors related to career occupational blast exposure predictive of changes in neurobehavioral symptom burden. Blast dosimetry-symptom relationships were first evaluated in mice and then tested in a military training environment. In mice, the righting time neurobehavioral response was measured after exposure to a repetitive low-level blast paradigm modeled after Special Operations training. In the military training environment, 23 trainees enrolled in a 6-week explosive breaching training course, 13 instructors, and 10 Service member controls without blast exposure participated in the study (46 total). All participants provided weekly Neurobehavioral Symptom Inventory (NSI) surveys. Peak blast overpressure, impulse, total number of blasts, Time in Low-Level Blast Occupation, and Time in Service were analyzed by Bayesian analysis of regression modeling to determine their probability of influence on the post-training symptoms reported by participants. Results We tested the hypothesis that cumulative measures of low-level blast exposure were predictive of changes in neurobehavioral symptoms. In mice, repetitive blast resulted in reduced righting times correlated with cumulative blast impulse. In Service members, peak blast overpressure, impulse, total number of blasts, Time in Low-Level Blast Occupation, and Time in Service all showed strong evidence of influence on NSI scores after blast exposure. However, only models including baseline NSI scores and cumulative blast impulse provided significant predictive value following validation. Conclusions These results indicate that measures of cumulative blast impulse may have utility in predicting changes in NSI scores. Such paired dosimetry-symptom measures are expected to be an important tool in safely guiding Service members’ occupational exposure and optimizing force readiness and lethality.

中文翻译：

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累积爆炸脉冲可预测军事训练期间低水平爆炸暴露后慢性神经行为症状的变化

简介 军事训练期间累积的低强度爆炸暴露可能是一种重大职业危害，会增加大脑功能长期不良结果的风险。美国公法 116-92 第 717 条规定，美国国防部机构必须记录每位军人的爆炸经历，以帮助为以后的残疾和医疗保健决策提供信息。然而，尚未确定哪些训练爆炸暴露的经验测量（例如事件次数、峰值超压或冲动）最能反映反映大脑健康的神经行为症状的变化。材料和方法 这项研究得到了美国陆军特种作战司令部、北卡罗来纳大学教堂山分校和 VA 普吉特湾医疗保健系统的批准。本研究使用可在不同组织结构中轻松部署的方法，试图识别和测量与职业职业爆炸暴露相关的候选风险因素，以预测神经行为症状负担的变化。首先在小鼠中评估爆炸剂量测定与症状的关系，然后在军事训练环境中进行测试。在小鼠中，在接受特种作战训练后模拟的重复低水平爆炸范式后，测量了小鼠的纠正时间神经行为反应。在军事训练环境中，23名学员参加了为期6周的爆炸突破训练课程，13名教官和10名未接触过爆炸的军人对照参加了研究（总共46人）。所有参与者每周提供神经行为症状量表 (NSI) 调查。通过回归模型的贝叶斯分析来分析峰值爆炸超压、脉冲、爆炸总数、低级爆炸职业时间和服务时间，以确定它们对参与者报告的训练后症状的影响概率。结果我们测试了这样的假设：低水平爆炸暴露的累积测量可以预测神经行为症状的变化。在小鼠中，重复爆炸导致与累积爆炸脉冲相关的翻正时间减少。在服役人员中，峰值爆炸超压、脉冲、爆炸总数、低级爆炸职业时间和服役时间均显示出对爆炸暴露后 NSI 评分有影响的有力证据。然而，只有包含基线 NSI 评分和累积爆炸脉冲的模型在验证后才提供显着的预测价值。结论 这些结果表明累积爆炸脉冲的测量可能有助于预测 NSI 分数的变化。这种配对的剂量测量-症状测量预计将成为安全指导军人职业暴露和优化部队战备和杀伤力的重要工具。