Timothy L A Doyle, B C Nindl, J A Wills, K J Koltun, A C Fain
{"title":"Biomechanical and physiological biomarkers are useful indicators of military personnel readiness: a multi-institutional, multinational research collaboration.","authors":"Timothy L A Doyle, B C Nindl, J A Wills, K J Koltun, A C Fain","doi":"10.1136/military-2024-002739","DOIUrl":"10.1136/military-2024-002739","url":null,"abstract":"<p><p>A ubiquitous problem facing military organisations is musculoskeletal injury (MSKI) risk identification. Recently, two research groups, each with their own funding, collaborated to address this problem. Combining their respective areas of expertise in biomechanics and physiological biomarkers, the group explored this problem in the laboratory and in the field. They have developed a machine learning model in a US Marine Corps (USMC) officer cadet cohort that identifies MSKI risk from a single jump test, identified a minimum inertial measurement unit sensor array to quantity jump and squat performance and have identified sex differences in overuse, lower-limb injury risk. This machine learning model was able to correctly predict lift to place within 4 kg using a testing data set and less than 1 kg in the training set of data. Such collaborative approaches are encouraged to address complicated research problems. To assemble an effective team, consider forming groups that best complement each other's areas of expertise and prioritise securing separate funding to ensure each group can act independently. By doing this, the group has assessed the suitability and feasibility of various wearable technologies, used machine learning to gain insights into USMC physiological training adaptations, and developed an understanding of MSKI risk profiles within this cohort.</p>","PeriodicalId":48485,"journal":{"name":"Bmj Military Health","volume":" ","pages":"433-437"},"PeriodicalIF":1.7,"publicationDate":"2025-09-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142478054","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Jitu Patel, M Boardman, B Files, F Gregory, S Lamb, S Sarkadi, M Tešić, N Yeung
{"title":"Give us a hand, mate! A holistic review of research on human-machine teaming.","authors":"Jitu Patel, M Boardman, B Files, F Gregory, S Lamb, S Sarkadi, M Tešić, N Yeung","doi":"10.1136/military-2024-002737","DOIUrl":"10.1136/military-2024-002737","url":null,"abstract":"<p><p>Defence has a significant interest in the use of artificial intelligence (AI)-based technologies to address some of the challenges it faces. At the core of future military advantage will be the effective integration of humans and AI into human-machine teams (HMT) that leverages the capabilities of people and technologies to outperform adversaries. Realising the full potential of these technologies will depend on understanding the relative strengths of humans and machines, and how we design effective integration to optimise performance and resilience across all use cases and environments.Since the first robot appeared on the assembly line, machines have effectively augmented human capability and performance; however, they fall short of being a team member-someone you can ask to give you a hand! Working in teams involves collaboration, adaptive and dynamic interactions between team members to achieve a common goal. Currently, human-machine partnership is typically one of humans and machines working alongside each other, with each conducting discrete functions within predicable process and environments. However, with recent advances in neuroscience and AI, we can now envisage the possibility of HMT, not just in physical applications, but also complex cognitive tasks.This paper provides a holistic review of the research conducted in the field of HMT from experts working in this area. It summarises completed and ongoing studies and research in the UK and USA by a broad group of researchers. This work was presented in the HMT thematic session at the Sixth International Congress on Soldiers' Physical Performance (ICSPP23 London).</p>","PeriodicalId":48485,"journal":{"name":"Bmj Military Health","volume":" ","pages":"392-396"},"PeriodicalIF":1.7,"publicationDate":"2025-09-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142886427","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Ritva S Mikkonen, J R Drain, J Vaara, B Nindl, H Kyröläinen
{"title":"Importance of strength training for sustaining performance and health in military personnel.","authors":"Ritva S Mikkonen, J R Drain, J Vaara, B Nindl, H Kyröläinen","doi":"10.1136/military-2024-002744","DOIUrl":"10.1136/military-2024-002744","url":null,"abstract":"<p><p>The physical capacity of male and female warfighters is challenged on the modern battlefield by heavy loads and high-intensity work. When designing training programmes for warfighters, approaches for developing strength and power alongside endurance must be considered. Strength training often requires facilities that may not be available during deployments while multiple stressors may impair or decrease overall performance. Understanding the effect of military environments on warfighter performance and acknowledging the variation in demands for individuals during field training and deployments, including possible sex differences, is essential to promote the development of adequate physical reserves (strength, power and endurance), attenuate risk for injury and promote health during and after military careers. The purpose of this narrative review is to discuss considerations for programming physical training in a military environment where 'one size does not fit all'. In addition, a brief description of physiological contributions (neural and muscular) to strength development is included.</p>","PeriodicalId":48485,"journal":{"name":"Bmj Military Health","volume":" ","pages":"413-417"},"PeriodicalIF":1.7,"publicationDate":"2025-09-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142510603","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Luana C Main, T D Maroni, T Ojanen, J R Drain, B Nindl
{"title":"Soldier performance management: insights from boots on ground research and recommendations for practitioners.","authors":"Luana C Main, T D Maroni, T Ojanen, J R Drain, B Nindl","doi":"10.1136/military-2024-002742","DOIUrl":"10.1136/military-2024-002742","url":null,"abstract":"<p><p>Theoretically, the serial measurement of biomarkers to monitor physiological responses to military training could be used to mitigate musculoskeletal injury risk and better understand the recovery status of personnel. To date, the cost and scalability of these initiatives have impeded their uptake by defence organisations. However, advances in technology are increasing the accessibility of a range of health and performance biomarkers. This paper presents a synthesises of findings from the literature and discussions with informed stakeholders to provide contextually relevant advice for future efforts to monitor military personnel, together with key considerations to ensure actionable outcomes from the data captured. The aim of this review is, therefore, twofold; first, to demonstrate how wearable devices and biomarkers have been used in defence research to assess the context-specific, occupational demands placed on personnel; and second, to discuss their potential to monitor military workloads, optimise training programming and understand soldier adaptation to multi-stressor environments.</p>","PeriodicalId":48485,"journal":{"name":"Bmj Military Health","volume":" ","pages":"408-412"},"PeriodicalIF":1.7,"publicationDate":"2025-09-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142967118","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Anna Casey, N Pattyn, K Hogenelst, N C Armstrong, Y Fonken, S L Kemp
{"title":"Human augmentation to deliver an enhanced and resilient people capability for Defence.","authors":"Anna Casey, N Pattyn, K Hogenelst, N C Armstrong, Y Fonken, S L Kemp","doi":"10.1136/military-2025-002964","DOIUrl":"10.1136/military-2025-002964","url":null,"abstract":"<p><p>From first tools, to flight, to advances in medicine and biotechnology, enhancing our innate abilities has been a constant goal and militaries the world over have long sought to advance the limits of human performance in their warfighters. Human augmentation (HA) encompasses a wide range of technologies that straddle a diversity of scientific disciplines and maturity levels, including wearable assistive technologies such as exoskeletons, neurotechnology, pharmacology, telexistence and genetics. Recent and rapid advances in life sciences and biotechnology and the convergence of fields such as artificial intelligence, robotics and medicine present us with a radically different opportunity for optimising and enhancing human performance. HA can be considered a potentially important strategy underpinning our ability to fight and win wars, by making soldiers more lethal and better able to survive. This paper is based on the HA thematic session held at the 6th International Congress on Soldiers' Physical Performance (ICSPP) in London in 2023. It considers aspects of HA of interest to participating nations and provides a state-of-the-art review of HA from a military perspective by experts engaged in this area. It considers the development of capability requirements, ethical, legal and social aspects and candidate HA technologies, one with ancient roots but modern applications for Defence (pharmacological augmentation) and one emerging area (non-invasive brain stimulation). HA offers a number of benefits, opportunities and challenges to the Defence community. Deployment of these technologies must take place within the boundaries of a nation's core values and beliefs, the rules-based international order and the freedoms that underpin their militaries' moral and ethical foundations.</p>","PeriodicalId":48485,"journal":{"name":"Bmj Military Health","volume":" ","pages":"453-457"},"PeriodicalIF":1.7,"publicationDate":"2025-09-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144884117","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Preface to the special issue of <i>BMJ Military Health</i> on future soldier: delivering human advantage.","authors":"Anna Casey, T J O'Leary, J P Greeves","doi":"10.1136/military-2025-002967","DOIUrl":"https://doi.org/10.1136/military-2025-002967","url":null,"abstract":"","PeriodicalId":48485,"journal":{"name":"Bmj Military Health","volume":"171 5","pages":"385-386"},"PeriodicalIF":1.7,"publicationDate":"2025-09-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145126270","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Iain Templeman, E Parish, J Rimmer, G Clarke, T Troth, M S Goodson, J W Soares, S V Harding
{"title":"'It takes a village': deciphering the role of the gut microbiome in the health and performance of military personnel.","authors":"Iain Templeman, E Parish, J Rimmer, G Clarke, T Troth, M S Goodson, J W Soares, S V Harding","doi":"10.1136/military-2024-002746","DOIUrl":"10.1136/military-2024-002746","url":null,"abstract":"<p><p>The human gut microbiome can be impacted by a range of environmental and lifestyle factors including diet, antibiotics, physical fitness and acute and chronic stressors. There is also evidence to suggest that specific compositional and/or functional features of the gut microbiome are mediators of aspects of health and performance including disease susceptibility, cognitive and physical states and the immune response. Therefore, understanding microbe-to-microbe and nutrient-to-microbe interactions in the gut and how they interact with host biology (eg, via the gut-brain axis) could enable better design of interventions aimed at modulating the gut microbiome to improve the health and performance of the military. Accordingly, this review summarises a thematic session hosted at the 6th International Conference on Soldier Physical Performance which provided an overview of military-relevant research related to the gut microbiome. It articulates a timely opportunity to leverage this rapidly advancing area to improve personnel health and military performance.</p>","PeriodicalId":48485,"journal":{"name":"Bmj Military Health","volume":" ","pages":"387-391"},"PeriodicalIF":1.7,"publicationDate":"2025-09-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141749309","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
George Kerans, D N Naumann, N Perkins, A Johnston, A Bainbridge, A Ramasamy, N Tai, D M Bowley, E Antoniuk
{"title":"Embedded unexploded ordnance encountered during combat casualty care: a review of clinical management for UK deployed service personnel.","authors":"George Kerans, D N Naumann, N Perkins, A Johnston, A Bainbridge, A Ramasamy, N Tai, D M Bowley, E Antoniuk","doi":"10.1136/military-2024-002950","DOIUrl":"https://doi.org/10.1136/military-2024-002950","url":null,"abstract":"<p><p>Explosive remnants of war (ERW) include landmines, unexploded ordnance (UXO) and abandoned explosive ordnance. Nearly every conflict in modern times has left behind large amounts of ERW, and they remain a persistent problem and a deadly threat that can kill and injure those who encounter or disturb them. A rare UXO hazard may present when military medics begin to assess and treat survivors of combat injury and discover UXO 'loose' (on the patient's gear or stored in their pockets) or rarely 'embedded' in the patient's body. UXO threats to treating clinicians have been documented throughout history, including the most recent significant conflicts. With the threat of large-scale combat operations, it is timely for the UK Defence Medical Services to discuss how to manage this rare, but high-risk situation. This article scrutinises the anatomy of UXO, examines clinical priorities during management of UXO in survivors of combat injury and considers how to establish an effective medical treatment facility to cope with this unique situation, including the risk from a Chemical, Biological, Nuclear and Radiological perspective. We aim to summarise the current literature regarding the treatment of a patient after a UXO has been discovered, to inform clinical management for deployed service personnel in the modern battlespace.</p>","PeriodicalId":48485,"journal":{"name":"Bmj Military Health","volume":" ","pages":""},"PeriodicalIF":1.7,"publicationDate":"2025-09-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145092715","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Major Joseph Cardis RAMC: an ordinary man in an extraordinary world.","authors":"Oliver O'Sullivan","doi":"10.1136/military-2025-003143","DOIUrl":"https://doi.org/10.1136/military-2025-003143","url":null,"abstract":"","PeriodicalId":48485,"journal":{"name":"Bmj Military Health","volume":" ","pages":""},"PeriodicalIF":1.7,"publicationDate":"2025-09-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145092786","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Robert Zhan, R Chamley, W Moody, R Aswathi, A Williams, S White
{"title":"Case of sarcoidosis and coronary artery disease presenting with heart failure: highlighting the benefits of repatriation to Role 4 medical facilities in complex cases.","authors":"Robert Zhan, R Chamley, W Moody, R Aswathi, A Williams, S White","doi":"10.1136/military-2025-003097","DOIUrl":"https://doi.org/10.1136/military-2025-003097","url":null,"abstract":"","PeriodicalId":48485,"journal":{"name":"Bmj Military Health","volume":" ","pages":""},"PeriodicalIF":1.7,"publicationDate":"2025-09-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145024507","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}