i

MILITARY QUANTITATIVE PHYSIOLOGY: 

PROBLEMS and CONCEPTS in MILITARY

OPERATIONAL MEDICINE
ii

The Coat of Arms

1818

Medical Department of the Army

A 1976 etching by Vassil Ekimov of an

original color print that appeared in

The Military Surgeon, Vol XLI, No 2, 1917

FPO
iii

The history of the research scientist in what is now the Army 

Medical Service Corps extends from its beginnings in the Sanitary 

Corps at the beginning of World War I, to a dramatic surge of 

activity and scientific advances during World War II, to a handful 

of dedicated uniformed researchers who continue to lead science 

for the soldier today. Their work has contributed to the scientific 

foundation of modern medicine. Army physiology, along with its 

civilian counterpart, came into full bloom in the 20th century, aided 

by the rapid development in chemistry and physics, and in other 

areas of medicine, technology, and economic growth. In the 21st 

century, the convergence of information and computer sciences 

with biomedicine is promoting a new breed of scientists who will 

apply their basic understanding of human physiology to advance 

comprehensive and predictive models that will reduce injuries, 

improve and sustain performance, and, ultimately, improve a 

soldier’s success on the battlefield. The military scientist has a 

unique capacity to simultaneously excel on the national scientific 

stage and to translate and interpret findings that benefit soldiers 

and civilians alike. In addition, uniformed scientists have and will 

continue to deploy to combat operations in support of our nation’s 

wars. From these operational experiences, military scientists gain 

important perspectives that shape their relevant research. 
iv

Textbooks of Military Medicine

Published by the

Office of The Surgeon General

Department of the Army, United States of America

and

US Army Medical Department Center and School

Fort Sam Houston, Texas

Editor in Chief

Martha K. Lenhart, MD, PhD

Colonel, MC, US Army

Director, Borden Institute

Assistant Professor of Surgery

F. Edward Hébert School of Medicine

Uniformed Services University of the Health Sciences
v

The TMM Series

Published Textbooks

 Medical Consequences of Nuclear Warfare (1989)

 Conventional Warfare: Ballistic, Blast, and Burn Injuries 

(1991)

 Occupational Health: The Soldier and the Industrial Base 

(1993)

 Military Dermatology (1994)

 Military Psychiatry: Preparing in Peace for War (1994)

 Anesthesia and Perioperative Care of the Combat 

Casualty (1995)

 War Psychiatry (1995)

 Medical Aspects of Chemical and Biological Warfare 

(1997)

 Rehabilitation of the Injured Soldier, Volume 1 (1998)

 Rehabilitation of the Injured Soldier, Volume 2 (1999)

 Medical Aspects of Harsh Environments, Volume 1 (2002)

 Medical Aspects of Harsh Environments, Volume 2 (2002)

 Ophthalmic Care of the Combat Casualty (2003)

 Military Medical Ethics, Volume 1 (2003)

 Military Medical Ethics, Volume 2 (2003)

 Military Preventive Medicine, Volume 1 (2003)

 Military Preventive Medicine, Volume 2 (2005)

 Recruit Medicine (2006)

 Medical Aspects of Biological Warfare (2007)

 Medical Aspects of Chemical Warfare (2008)

 Care of the Combat Amputee (2009)

 Combat and Operational Behavioral Health (2011)

 Military Quantitative Physiology: Problems and Concepts

 in Military Operational Medicine (2012)
vi

Predictive models to help lighten the soldier load, improve load distribution, tailor appropriate physical training, select 

the right equipment, and choose appropriate biomechanical techniques will all facilitate soldier load carriage performance. 

These tools will allow service members to conduct missions more effectively at lower energy costs and with fewer injuries.

Photograph: Courtesy of the US Air Force. Photographer: TSgt Efron Lopez. 
vii

MILITARY QUANTITATIVE PHYSIOLOGY:

PROBLEMS and CONCEPTS in MILITARY

OPERATIONAL MEDICINE

Senior Editors

Karl E. Friedl, PhD

Colonel, Medical Service Corps, US Army

Director, Telemedicine and Advanced Technology Research Center

US Army Medical Research and Materiel Command

and

William R. Santee, PhD

Research Physical Scientist

Biophysics and Biomedical Modeling Division

US Army Research Institute of Environmental Medicine

Office of The Surgeon General

United States Army

Falls Church, Virginia

Borden Institute

Fort Detrick, Maryland

2012
viii

Editorial Staff: Vivian Mason Joan Redding

Volume Editor Senior Production Editor

Douglas Wise Bruce G. Maston

Senior Layout Editor Illustrator

This volume was prepared for military medical educational use. The focus of the information is 

to foster discussion that may form the basis of doctrine and policy. The opinions or assertions 

contained herein are the private views of the authors and are not to be construed as official or as 

reflecting the views of the Department of the Army or the Department of Defense.

Chapter 7 (Water Requirements and Soldier Hydration), chapter 10 (Blast Injury: Translating 

Research Into Operational Medicine), and chapter 11 (Load Carriage in Military Operations: A 

Review of Historical, Physiological, Biomechanical, and Medical Aspects) were originally published in monograph form by the Borden Institute in 2010.

Dosage Selection:

The authors and publisher have made every effort to ensure the accuracy of dosages cited herein. 

However, it is the responsibility of every practitioner to consult appropriate information sources 

to ascertain correct dosages for each clinical situation, especially for new or unfamiliar drugs 

and procedures. The authors, editors, publisher, and the Department of Defense cannot be held 

responsible for any errors found in this book.

Use of Trade or Brand Names:

Use of trade or brand names in this publication is for illustrative purposes only and does not 

imply endorsement by the Department of Defense.

Neutral Language:

Unless this publication states otherwise, masculine nouns and pronouns do not refer exclusively 

to men.

certain parts of this publication pertain to copyright restrictions.

all rights reserved.

no copyrighted parts of this publication may be reproduced or

transmitted in any form or by any means, electronic or mechanical (including

photocopy, recording, or any information storage and retrieval system), without permission in writing from the publisher or copyright owner.

Published by the Office of The Surgeon General

Borden Institute

Fort Detrick, MD 21702-5000

PRINTED IN THE UNITED STATES OF AMERICA

19, 18, 17, 16, 15, 14, 13, 12 5 4 3 2 1 

 Library of Congress Cataloging-in-Publication Data

Military quantitative physiology : problems and concepts in military operational 

medicine / senior editors, Karl E. Friedl and William R. Santee.

 p. ; cm. -- (TMM series)

Includes bibliographical references and index.

I. Friedl, Karl, 1954- II. Santee, William R. III. Borden Institute (U.S.) IV. 

Series: Textbooks of military medicine.

[DNLM: 1. Stress, Physiological. 2. Military Medicine--methods. 3. Military 

Personnel. 4. Models, Biological. 5. Occupational Exposure--prevention & 

control. 6. Physical Exertion--physiology. QT 162.S8]

616.9’8023--dc23

 2012019782
ix

Contents

Contributors xi

Foreword by The Surgeon General xiii

Preface xv

1. Predicting Human Limits—The Special Relationship Between Physiology Research 1

 and the Army Mission

Karl E. Friedl

2. Modeling the Physiological and Medical Effects of Exposure to Environmental 39

 Extremes

William R. Santee, Matthew J. Reardon, and Kent B. Pandolf

3. Measuring and Predicting Sleep and Performance During Military Operations 73

Adam Fletcher, Nancy J. Wesensten, Katie Kandelaars, and Thomas J. Balkin

4. Performance-Maintaining and Performance-Enhancing Drugs and Food Components 93

Harris R. Lieberman, Jessica Cail, and Karl E. Friedl

5. In Vivo Diagnostics and Metrics in the Assessment of Laser-Induced Retinal Injury 129

Harry Zwick, James W. Ness, Michael Belkin, and Bruce E. Stuck

6. Nutrition and Military Performance 157

Danielle S. Day, Andrew Young, and Eldon W. Askew

7. Water Requirements and Soldier Hydration 181

Scott J. Montain and Matthew Ely

8. Evaluation of the Thermal Environment 205

William R. Santee and William T. Matthew

9. Protection of the Skin 239

Richard A. Keller and William R. Santee

10. Blast Injury: Translating Research Into Operational Medicine 267

James H. Stuhmiller

11. Load Carriage in Military Operations: A Review of Historical, Physiological, 

 Biomechanical, and Medical Aspects 303

Joseph Knapik and Katy Reynolds

12. Injury Control 339

Paul J. Amoroso, Nicole S. Bell, Susan P. Baker, and Laura Senier

Abbreviations and Acronyms xix

Index xxiii
x
xi

Contributors

PAUL J. AMOROSO, MD, MPH

Colonel (Ret), Medical Corps, US Army; Madigan Army Medical 

Center, 9040 Fitzsimmons Drive, Tacoma, Washington 98431-1100; 

currently retired

ELDON W. ASKEW, PhD

Colonel (Ret), Medical Service Corps, US Army; Professor and 

Director, Division of Nutrition, University of Utah, College of 

Health, 250 South 1850 East #214, Salt Lake City, Utah 84112

SUSAN P. BAKER, ScD, MPH 

Professor, Department of Health Policy and Management, Bloomberg School of Public Health, The Johns Hopkins University, 624 

North Broadway, Baltimore, Maryland 21205-1999

THOMAS J. BALKIN, PhD

Department Chief, Department of Behavioral Biology, Walter 

Reed Army Institute of Research, 503 Robert Grant Avenue, Silver 

Spring, Maryland 20910-7500

MICHAEL BELKIN, MD

Goldschleger Eye Research Institute, Sheba Medical Center, Tel 

Aviv University, Tel Hashomer 52621, Israel

NICOLE S. BELL, ScD, MPH

Vice President, Social Sectors Development Strategies, Inc, 2330 

South Third Street, Tacoma, Washington 98433-1038

JESSICA CAIL, PhD

Visiting Professor of Psychology, Social Science Division, Pepperdine University, 24255 Pacific Coast Highway, Malibu, California 

90263; formerly, Experimental Psychologist, Military Nutrition 

Division, US Army Research Institute of Environmental Medicine, 

Natick, Massachusetts

DANIELLE S. DAY, PhD

Assistant Professor, Department of Physical Therapy and Exercise 

Physiology, University of Massachusetts-Lowell, 301 Solomont 

Way, Suite 5, Lowell, Massachusetts 01853

MATTHEW ELY, MS

Researcher, US Army Research Institute of Environmental Medicine, Building 42, Kansas Street, Natick, Massachusetts 01760-5007

ADAM FLETCHER, PhD

Executive Director, Integrated Safety Support, 1/192 Argyle Street, 

Fitzroy 3065, Australia; formerly, Research Psychologist, Department 

of Behavioral Biology, Walter Reed Army Institute of Research, 503 

Robert Grant Avenue, Silver Spring, Maryland 20910-7500

KARL E. FRIEDL, PhD

Colonel, Medical Service Corps, US Army; Director, Telemedicine 

and Advanced Technology Research Center, US Army Medical 

Research and Materiel Command, Building 1054, Patchel Street, 

Fort Detrick, Maryland 21702-5012; formerly, Commander, US 

Army Research Institute of Environmental Medicine, Natick, 

Massachusetts 

KATIE KANDELAARS, PhD

Consultant, Integrated Safety Support, 1/192 Argyle Street, Fitzroy 3065, Australia; formerly Researcher, The Centre for Sleep Research, University of South Australia, Level 7, Playford Building, 

City East Campus, Frome Road, Adelaide 5000, South Australia

RICHARD A. KELLER, MD

Colonel (Ret), Medical Corps, US Army; Dermatology Surgery 

Section, Ochsner Clinic Foundation, 1514 Jefferson Highway, 

New Orleans, Louisiana 70121; formerly, Fellow, Mohs Micrographic Surgery, Department of Dermatology, Brooke Army 

Medical Center, Fort Sam Houston, Texas 78234-6200

JOSEPH KNAPIK, ScD 

Major (Ret), Medical Service Corps, US Army; Research Physiologist, Injury Prevention Program, US Army Public Health Command (Provisional), 5158 Blackhawk Road, Aberdeen Proving 

Ground, Maryland 21005-5425

HARRIS R. LIEBERMAN, PhD

Research Psychologist, Military Nutrition Division, US Army Research Institute of Environmental Medicine, Building 42, Kansas 

Street, Natick, Massachusetts 01760-5007

WILLIAM T. MATTHEW, BS

Biophysicist (Ret), Biophysics & Biomedical Modeling Division, 

US Army Research Institute of Environmental Medicine, Building 

42, Kansas Street, Natick, Massachusetts 01760-5007; currently, PO 

Box 25, Woodville, Massachusetts 01784

SCOTT J. MONTAIN, PhD

Research Physiologist, Military Nutrition Division, US Army Research Institute of Environmental Medicine, Building 42, Kansas 

Street, Natick, Massachusetts 01760-5007

JAMES W. NESS, PhD 

Colonel, Medical Service Corps, US Army; Program Director, 

Engineering Psychology, Department of Behavioral Sciences and 

Leadership, US Military Academy, West Point, New York 10996

KENT B. PANDOLF, PhD, MPH

Senior Research Scientist, US Army Research Institute of Environmental Medicine, Building 42, Kansas Street, Natick, Massachusetts 01760-5007; currently retired

MATTHEW J. REARDON, MD, MPH, MS, MSEE

Senior Consultant, Occupational & Environmental Medicine 

Consulting Services, LLC, 6 Office Park Circle, Suite 100, Birmingham, Alabama 35223-2512; Colonel, US Army Reserve, Deputy 

Medical Director, Anniston Chemical Agent Disposal Facility, US 

Army Chemical Materials Agency, 7 Frankford Avenue, Anniston, 

Alabama 36201; and Command Surgeon, 87th US Army Reserve 

Support Command, 1400 Golden Acorn Drive, Birmingham, 

Alabama 35244

KATY REYNOLDS, MD

Colonel (Ret), Medical Corps, US Army; currently, 8820 Burning 

Tree Road, Pensacola, Florida 32514

WILLIAM R. SANTEE, PhD

Research Physical Scientist, Biophysics & Biomedical Modeling 

Division, US Army Research Institute of Environmental Medicine, 

Building 42, Kansas Street (Office MCMR-EMB), Natick, Massachusetts 01760-5007

LAURA SENIER, PhD, MPH, MA

Assistant Professor, Department of Community & Environmental 

Sociology and Department of Family Medicine, University of Wisconsin–Madison, 1450 Linden Drive, Madison, Wisconsin 53706 
xii

BRUCE E. STUCK, MS

Director, Ocular Trauma Research Division, US Army Institute 

of Surgical Research, 3400 Rawley East Chambers Avenue, San 

Antonio, Texas 78234-6315; currently retired

JAMES H. STUHMILLER, PhD

Senior Vice President and General Manager, Simulation, Engineering, and Testing, L-3 Communications, 10770 Wateridge 

Circle, San Diego, California 92121

NANCY J. WESENSTEN, PhD

Supervisory Psychologist, Department of Behavioral Biology, Walter Reed Army Institute of Research, 503 Robert Grant Avenue, 

Silver Spring, Maryland 20910-7500

ANDREW YOUNG, PhD

Chief, Military Nutrition Division, US Army Research Institute 

of Environmental Medicine, Building 42, Kansas Street, Natick, 

Massachusetts 01760-5007

HARRY ZWICK, PhD

Formerly, Team Leader, Retinal Assessment Team, US Army 

Medical Research Detachment, Brooks City-Base, San Antonio, 

Texas 78235-5108; currently retired
xiii

Foreword

Few human activities demand or deserve as much attention of the citizens of a nation as the array of man-made 

and natural “environmental” threats faced by the soldiers and other warriors defending that nation—those that 

pose the risk of disease, injury, combat wounds, and even death. Scientists charged with understanding these 

threats and mitigating the potential effects must use the most advanced techniques and sophisticated analysis 

possible in this endeavor. This book is the Army’s first detailing research in computational physiology models 

and highlighting pivotal research. It outlines the extent to which basic and applied biomedical scientists, clinicians, modelers, and others strive to understand the extent of these threats, and provide intellectual and materiel 

options to mitigate these risks. 

Quantification of this information is critical, as medical standards aimed at protecting soldiers must represent 

the best available science. Development of protective equipment requires data-driven support of new approaches 

that clearly demonstrate effectiveness while addressing affordability and cost. Virtual prototyping has led to 

valid and useful models of human tolerances focused on ensuring that our service members are provided with 

modern warfighting systems that safely and effectively contribute to mission accomplishment. Without compelling data, efforts at providing America’s warriors with the best materiel and doctrinal solutions to the adverse 

conditions under which they must operate—and protections against harm that might result—are severely limited 

and potentially restrict the full range of soldier technological capabilities.

Throughout history, work of this nature has extended well beyond military applications alone; it reaches 

outside of the military environment because of its dual-use nature. Thermal strain, load carriage, hydration 

guidelines, performance nutrition, fatigue, and physical training injury prevention are all topics in which the 

military is recognized as having unique expertise. Countermeasures to more specific military hazards, such 

as blast and laser injuries, have contributed to the civilian community in establishing protective criteria in a 

wide array of applications, such as airbag inflation rates and international protection standards for commercial 

lasers. The efforts described in this text represent the government’s largest intramural performance physiology 

research program and include important academic and industry collaborations. Cutting-edge modeling—applying mathematics and physics to understand important life science problems related to training, eating, resting 

and protection—has resulted in enhanced systems to augment decision-making in new and complex situations.

The lengthy institutional investment in these investigations by the US military has led to iterative, ongoing 

contributions by the leaders in each field of endeavor. Simulations and models also incorporate metaanalysis of 

previous studies, thus including lessons learned from years of research and providing increasingly more vigorous 

evaluations with each new dataset. For example, the US Army Research Institute of Environmental Medicine 

(USARIEM) hydration tables are used worldwide, preventing heat injuries caused by inadequate water intake. 

Future refinements with personalized monitors that signal individual water needs, perhaps through a wearable 

system, will provide further protection of health and optimize performance. 

It is with great pride that Army Medicine serves as the focus for compiling and formally disseminating these 

critical insights. This is a significant book, not only for the technical information that it contains, but also as 

documentation of the collective works of numerous dedicated Army scientists—all committed to the protection 

of the nation’s defenders and the global human family. 

 Lieutenant General Eric B. Schoomaker, MD, PhD

The Surgeon General and Commanding General

United States Army Medical Command

Washington, DC

December 2011
xiv
xv

Preface

Where is the Life we have lost in living?

Where is the wisdom we have lost in knowledge?

Where is the knowledge we have lost in information?

— T. S. Eliot, The Rock, 1934

This book summarizes major Army research efforts to quantify and model militarily relevant physiology. These chapters highlight the translation of this research into useful predictive tools. The tools are of 

importance to medical planners, materiel developers, commanders, and, in many cases, every soldier. These 

chapters detail the experimental basis for many of the predictive tools that are currently in use. This book 

is written for military clinicians and medical researchers who may be reasonably expected to explain some 

of this background, as well as those who will extend the research. The sophisticated research and models 

should be opaque to most of the ultimate users, with models and algorithms derived from this research built 

into larger Army models and systems, and used to make better equipment and provide better guidelines 

for hazard management. 

Nevertheless, many people will find this book interesting because it details research on topics that affect 

everyone in everyday life, including how we sleep, eat, and exercise, as well as more specific topics such as the 

effects of caffeine on performance, risks associated with laser pointers, and even Army blast models that have 

influenced safety thresholds for car airbag deployments. Every person should be interested in these areas of 

medical research! 

The military physiology problem set has not changed greatly since the Revolutionary War and should continue 

to guide an ever-accelerating effort to combine models for high priority predictions pertinent to fatigue, physical 

performance, cognitive performance, injury risk, and human limits in the face of militarily relevant stressors 

and threats. What is new in this century is the explosive advance of computing technology and neurobiology. 

This provides new understanding of how to make knowledge more useful and available to soldiers who expect 

to be able to obtain this knowledge through their personal mobile devices or as an automatic readout of choices 

from other electronic monitors and systems. 

Military medicine is now racing to catch up with these rapid advances and new expectations in science 

and technology. This cultural shift with the transition from discovery science to information science should 

be apparent in these chapters. This revolution in medical research has also been called “convergence science,” 

characterized by the increased reliance on mathematics, physics, and computer engineering to solve problems 

in the life sciences. The Army began committed support to the development of medical decision support tools 

in the past decade, led by Jaques Reifman and his team in the Bioinformatics Center at the US Army Medical 

Research and Materiel Command. The Department of Defense (DoD) has now initiated funding for a new core 

program (starting in 2010) that includes support to computational biology modeling efforts. 

The first year of this effort expands on the topic of one of the chapters in this book (Chapter 11, Load Carriage in Military Operations: A Review of Historical, Physiological, Biomechanical, and Medical Aspects) with 

the concerted development of a comprehensive model of load carriage led by the US Army Research Institute 

of Environmental Medicine (USARIEM). Future advances in applied physiology require this problem-solving 

convergence approach, as well as new appreciation for data sharing, cloud computing, more comprehensive 

supermodels, and an integrating focus on the neurobiology of the warfighter. 

The Army’s real-world problems and interesting test environments are the unique strength of military physiology research, where investigators can lead academic collaborators in valuable field studies with soldiers pushing 

to the limits of human performance. These conditions are not only often messy for purposes of scientific design, 

but also possibly unattainable in a laboratory setting. Four examples (chapters 5, 6, 10, and 11) highlight the 
xvi

fascinating and unique research captured in this book. 

Bruce Stuck (Chapter 5, In Vivo Diagnostics and Metrics in the Assessment of Laser-Induced Retinal Injury) 

is a national resource. As the single central repository of more than 40 years of research on health and performance consequences of laser eye exposure, he has charted constantly evolving laser hazards that affect eye safety 

and protection for our troops, as well as consequences to performance in aviation and other militarily relevant 

scenarios. This research has been foundational in national standards for laser safety and contributed to current 

international treaties on blinding lasers.

Colonel (Ret) Wayne Askew (Chapter 6, Nutrition and Military Performance) is a pioneer who was able to 

break funding silos by sharing precious nutrition research dollars to investigate hydration in environmental 

extremes—a natural companion topic to Army nutrition problems—and establishing transdisciplinary studies of 

Ranger students involving energy metabolism extremes and performance outcomes. The results of these studies 

addressed real soldier problems, but at the same time also advanced basic science in human osmoregulation 

and energy metabolism. 

Jim Stuhmiller (Chapter 10, Blast Injury: Translating Research Into Operational Medicine) is an early pioneer in 

today’s convergence science who has been dedicated to pulling together data and tools into more comprehensive 

predictive models that address real soldier protection standards. Thirty years ago, he recognized the need for 

the DoD to model the combined biophysical stressors related to military equipment, along with environmental, 

metabolic, and other factors that influence model validity. It is unlikely that the DoD would have a valid blast 

overpressure model and method for health hazard assessments today without his vision and the dedication of 

his team. Without these models, there would be ongoing safety concerns about an entire generation of effective 

high-powered weapons systems that were instead permitted to be fielded on the basis of better scientifically 

based standards derived from the predictive models. 

Major (Ret) Joe Knapik (Chapter 11, Load Carriage in Military Operations: A Review of Historical, Physiological, 

Biomechanical, and Medical Aspects) represents one of the finest examples of our dedicated military physiologists who lived and breathed practical solutions to military physiology problems. His chapter on load carriage 

reflects one of his areas of interest and an entire career of laboratory and field experiments, personal experience, 

and comprehensive scope of the field. His efforts have spanned the medical and human systems communities 

to advance the development of load carriage systems while conducting studies with the preventive medicine 

community to reduce physical injuries. His pioneering efforts provide the foundation for a new major load carriage modeling initiative that will produce a sophisticated virtual prototyping capability to materiel developers. 

This book started long ago as a third volume in the Textbooks of Military Medicine environmental extremes 

series, but was restructured to address the modern requirements for quantitative models and predictive tools. 

This book should help mark the culmination of an earlier era of research, summarizing the important accomplishments and providing the platform to launch to the next level. Future work should take full advantage of 

the biomedical research captured in these chapters, in combination with new capabilities in information science 

and cyber infrastructure, to take an integrative approach to solving real-world problems for soldiers. 

For example, laboratory sleep studies have uncovered basic principles for sleep and performance, but 

soldiers sleep in the heat in Southwest Asia and in a hypoxic environment at altitude in some parts of Afghanistan; these environmental factors can have dramatic effects on the quality of restorative sleep. Sleep is 

affected by other ambient operational conditions such as noise and light, as well as overlapping psychological 

concerns or the amount of caffeinated energy drinks consumed earlier in the day. Heat and altitude affect 

appetite and energy consumption for soldiers, with secondary effects on water consumption. The skin is a 

critical protective barrier and regulator for our internal physiology, responding to external challenges (eg, 

temperature and psychological stress) and threats (eg, ultraviolet radiation) and having regulatory functions 

(eg, sweating and skin blood flow responses). These dermal influences are all interactive with other factors 

covered in this book, ranging from antioxidant nutrition to body size and adiposity to hydration status. 

These complicated interactions have not yet been captured in any single model. This places a demand on 

the reader, because the chapters represent discontinuous efforts, including independent modeling efforts 

in various states of maturity. 

Readers are challenged to use some imagination going from chapter to chapter to mentally bridge the artificial 

divisions established around disciplines and problem sets, and to think about how we move away from this 

balkanization to address an integrated soldier health and performance model, just as military medicine needs to 
xvii

move to an overall strategy of integrative health. Advances in neurobiology will likely be central to the organizing structure of increasingly convergent and integrating solutions. 

Karl Friedl

 Director

 Telemedicine and Advanced Technology Research Center

US Army Medical Research and Materiel Command

Fort Detrick, Maryland 

 William Santee

 Research Physical Scientist

Biophysics & Biomedical Modeling Division

US Army Research Institute of Environmental Medicine

 Natick, Massachusetts

Fort Detrick, Maryland

December 2011
xviii