xix

Abbreviations and Acronyms

ABBREVIATIONS and ACRONYMS

A

a: absorptivity

Ac: area of surface contact 

AD: Dubois body surface area 

ADEA: US Army Development and Employment Agency

ADHD: attention-deficit hyperactivity disorder 

AEST: Australian Eastern Standard Time

AFCCC: Air Force Combat Climatological Center 

AIS: Abbreviated Injury Scale 

AKO: Army Knowledge Online

ALICE: All-Purpose Lightweight Individual-Carrying 

Equipment

AMEDD: Army Medical Department 

ANAM: Automated Neuropsychological Assessment Metric 

ANSI: American National Standards Institute

ARDEC: Armament, Research, Development, and Engineering 

Center

ASHRAE: American Society of Heating, Refrigerating, and AirConditioning Engineers 

ATBM: Advanced Total Body Model

ATO: Army Technology Objective 

AVP: arginine vasopressin

AVS: Aidman Vision Screener

B

BABTA: Body Armor Blunt Trauma Assessment

BCC: basal cell carcinoma 

BDU: battle dress uniform 

BLPS: Ballistic and Laser Protective Spectacles

BOP: blast overpressure

BTD: Blast Test Device 

C

C: convection 

cb: heat of body tissue 

CCO: crew coordination objective

CET: corrected effective temperature

CFD: computational fluid dynamics

CHABA: Committee on Hearing, Bioacoustics, and Biomechanics 

CHO: carbohydrate

CHPPM: US Army Center for Health Promotion and Preventive 

Medicine (US Army Public Health Command)

CIVD: cold-induced vasodilation

CMI: Cornell Medical Index 

CNS: central nervous system 

COIL: chemical oxygen iodine laser

COTZ: Contains Only Titanium and Zinc (sun care product produced by Fallene Ltd, King of Prussia, Pa)

CPG: Clinical Practice Guideline 

CSI: cold strain index

CSLO: confocal scanning laser ophthalmoscopy

CTM: cold thermal model

D

DS: change in storage

DTb: change in body temperature

DA: data acquisition 

DCGS-A: Distributed Common Ground System–Army

Diff: difference

DLE: duration-limited exposure 

DLE1: duration-limited exposure based on heat storage 

DLE2: duration-limited exposure based on water depletion 

DoD: Department of Defense

DPM: Dynamic Physiological Model

DRDC: Defence Research and Development Canada 

DSHEA: Dietary Supplement Health and Education Act of 1994

DTIC: Defense Technical Information Center 

E

E: evaporative heat loss 

e: emissivity

EEG: electroencephalogram

EITACC: Equation Independent Transient Analysis Computer 

Code

EKG: electrocardiogram

ELTEP: Emerging Laser Threat Eye Protection

EMG: electromyogram

EMP: electromagnetic pulse

EMS: eosinophilia-myalgia syndrome 

ERGO: Energy-Rich Glucose Optimized (drink)

ESA: European Space Agency 

ET: effective temperature

EXEMSI ’92: Experimental Study for the European Manned Space 

Infrastructure, 1992

F

FACE: Functional Assessment of Care Environments

FDA: US Food and Drug Administration

FEM: finite element modeling

FM 100 Hue: Farnsworth Munsell 100 Hue

G

GABA: g-aminobutyric acid 

GI: gastrointestinal

GPS: Global Positioning System

H

hc: convective heat transfer coefficient 

HD: Humidex

he: evaporative heat transfer coefficient 

HEAR: Health Enrollment/Evaluation Assessment Report 

HHA: Health Hazard Assessment

HHI: heat humidity index

HI: humidity index

HIPPA: Health Insurance Portability and Accountability Act

HMMWV: high-mobility multipurpose wheeled vehicle (or 

“Humvee”)

Hr: radiant field 

hr: radiative heat transfer coefficient 

HRA: Health Risk Appraisal 

HSDA: heat strain decision aid 

5-HT1A: 5-hydroxytryptamine (serotonin) receptor 1A

I

IAC: information analysis center

ICD-9-CM: International Classification of Diseases, Ninth Revision, 

Clinical Modification 

ICDA: initial capability decision aid

IDEF: Integrated Definition 

IED: improvised explosive device

i

m: water vapor permeability index 

IMETS: Integrated Meteorological System

IND: Investigational New Drug

IR: infrared 

IREQ: insulation index of required clothing
xx

Military Quantitative Physiology: Problems and Concepts in Military Operational Medicine

IRSF: intraretinal scar formation

ISEMSI ’90: Isolation Study for the European Manned Space 

Infrastructure, 1990

ISS: Injury Severity Score 

ITBM: Interim Total Body Model

IWEDA: Integrated Weather Effects Decision Aid

J

JLST: Joint US Army Materiel Command and the US Army Medical Research and Development Command Laser Safety Team 

(also known as J AMC-AMRDC LST) 

JNLWD: Joint Non-Lethal Weapon Directorate

JNLWP: Joint Non-Lethal Weapon Program

K

K: conductance 

kph: kilometers per hour

L

LAIR: Letterman Army Institute of Research

LBE: load-bearing equipment

LED: light-emitting diode

LFTP: Live Fire Test Program

LMB: Lasers on the Modern Battlefield (conference)

LR: Lewis relationship 

LRRP: Long-Range Reconnaissance Patrol 

M

M: metabolism 

MAIS: Maximum Abbreviated Injury Scale 

MANPRINT: Manpower and Personnel Integration

MEDEVAC: medical evacuation 

M-Gator: Military Gator

MILES: Multiple Integrated Laser Engagement Simulator

MoHSM: mobile heat stress monitor

MOLLE: Modular Lightweight Load-Carrying Equipment

MOMRP: Military Operational Medicine Research Program

MOPP: Mission-Oriented Protective Posture (gear)

MOUT: Military Operations on Urban Terrain

MRE: Meals, Ready to Eat

MRI: magnetic resonance imaging

MRMC: US Army Medical Research and Materiel Command

MRS: magnetic resonance spectroscopy

MyWIDA: My Weather Impacts Decision Aid

N

NAA: N-acetylaspartate

NAMRL: Naval Aviation Medical Research Laboratory

NASA: National Aeronautics and Space Administration

NETPR: Neurotoxin Exposure Treatment (Parkinson’s) Research

NHP: nonhuman primate

NHTSA: National Highway Traffic Safety Administration

NIDDK: National Institute of Diabetes and Digestive and Kidney 

Diseases

NIH: National Institutes of Health 

NS: number of repeated exposures

NWS: National Weather Service

O

w: skin-wettedness

OCT: optical coherence tomography

OD: oculus dexter (pertains to the right eye)

OEF/OIF: Operation Enduring Freedom/Operation Iraqi 

Freedom

OS: oculus sinister (pertains to the left eye)

OSHA: Occupational Safety and Health Administration

OTC: over the counter 

OTV: outer tactical vest

P

P2NBC2: Physiological and Psychological Effects of the Nuclear/

Biological and Chemical Environment on Systems and Sustained Operations 

P4SR: predicted 4-hour sweat rate

PB: pyridostigmine bromide

PBPK: physiologically based pharmacokinetic (model)

PC: personal computer

PDA: personal digital assistant

PECS: Physical conditions, Emotional state, Cognitive capabilities, 

and Social status

PFB: pseudofolliculitis barbae

PHC: US Army Public Health Command (formerly CHPPM [US 

Army Center for Health Promotion and Preventive Medicine])

PIES: Proximity to battle (or assigned unit), and Immediately 

when symptoms were noted, with Expected return to duty 

within 72 hours, and with Simplicity 

PM: Project Manager

PMB: papillomacular bundle

PPA: phenylpropanolamine 

PPE: personal protective equipment

Pr: Prandlt number 

PRL: preferred retinal location

PSDA: Probability of Survival Decision Aid

PSM: (Warfighter) Physiological Status Monitor

PTSD: posttraumatic stress disorder

PVT: psychomotor vigilance task

R

R: radiation heat exchange 

RAC: risk assessment code

Rb: long-wave radiation 

RCW: Ration, Cold Weather

RDA: Recommended Dietary Allowance

REM: rapid eye movement 

RH: relative humidity

RNFL: retinal nerve fiber layer

RPE: retinal pigmented epithelium

Rt: clothing vapor permeability resistance

RTD: resistance temperature device

S

SAFTE: Sleep, Activity, Fatigue, and Task Effectiveness

SCALP: Suit, Contamination Avoidance, Liquid Protective 

SCC: squamous cell carcinoma 

SCTM: six-cylinder thermoregulatory model

SEAL: (US Navy’s) Sea, Air, and Land (team)

SEM: standard error of the mean

SMS: sleep management system 

SNAP: Schedule for Nonadaptive and Adaptive Personality 

SNOMED-CT: Systematized Nomenclature of Medicine—Clinical 

Terms

SOP: standard operating procedure

SPF: sun (solar) protection factor

Sreq: required sweat rate 

SSBN: submersible ship ballistic missile, nuclear

SSN: submersible ship, nuclear

STANAG: Standardization Agreement 

STRESS: Standardized Tests for Research with Environmental 

Stressors

SURVIAC: Survivability/Vulnerability Information Analysis 

Center
xxi

Abbreviations and Acronyms

SWO: (US Air Force) Staff Weather Officer 

SWS: slow-wave sleep

T

Ta: air temperature or dry bulb air temperature 

TAP: Toxicological Agent Protective Tbg: black globe thermometer (also substituted globe temperature)

TBI: traumatic brain injury Tc: core temperature Tcl: mean clothing surface temperature 

TGAS: Toxic Gas Assessment Software

TIE: total intraocular energy

TMM: Textbooks of Military Medicine

TNT: trinitrotoluene Tnwb: “naturally aspirated” wet bulb thermometer To: operative temperature Toh: humid operative temperature Tr: radiant temperature 

TRL: technology readiness level Ts: body surface temperature or skin/surface temperature Tsk: mean skin temperature Tso: standard operative temperature Tsoh: standard humid operative temperature Twb: wet bulb air temperature U

URT: upper respiratory tract

USAARL: US Army Aeromedical Research Laboratory

USACHPPM: US Army Center for Health Promotion and Preven-

tive Medicine (US Army Public Health Command)

USAMRD: US Army Medical Research Detachment

USAMRMC: US Army Medical Research and Materiel Command

USARIEM: US Army Research Institute of Environmental 

Medicine 

USDA: US Department of Agriculture

UTC: Universal Time Code

UV: ultraviolet 

UVA: ultraviolet light ray A

UVB: ultraviolet light ray B

UVR: ultraviolet radiation

V

VA: (Department of) Veterans Affairs

VV&A: validation, verification, and accreditation W

WBGT: wet bulb global temperature

WCET: windchill equivalent temperature 

WCI: windchill index

WCT: windchill temperature 

WDI: wet-dry index Wk: work 

WPSM: Warfighter Physiological Status Monitor

WRAIR: Walter Reed Army Institute of Research 

WRE: Weather Running Estimate
xxii

Military Quantitative Physiology: Problems and Concepts in Military Operational Medicine
xxiii

Abbreviations and Acronyms Index

INDEX

A

Abbreviated Injury Scale, description and uses, 347

Abraham, P., Early Call sleep studies, 79

Accutane, deployment issues, 252–253

Acne

Accutane use and, 252–253

description, 252

Active strategies for injury control

description, 355, 356–357

deterrence strategies, 369

extrinsic factors and, 368–369

health belief model, 369–370

health locus of control model, 370

intrinsic factors and, 369

social contagion model, 371–372

social learning theory, 370

stage models, 371

theory of reasoned action, 370–371

ADEA. See US Army Development and Employment Agency

ADHD. See Attention-deficit hyperactivity disorder

Adolph, E.F.

dehydration studies, 182

sweat rate research, 213

Adolphus, Gustavus, load carriage and, 308

Advanced Total Body Model, development of, 282, 284–285

Aerobic capacity. See Physical training

AFCCC. See US Air Force Combat Climatological Center

Afghanistan. See Operation Enduring Freedom

Age factors

injury risk, 340

skin disease, 246

suicide risk, 349, 351

Aidman Vision Screener

description and uses, 134, 139, 152

figure depicting, 134

Air temperature

demonstration of time lag between ground and air temperatures 

because of differences in heat transfer and mass (figure), 232

sensors for, 231

AIS. See Abbreviated Injury Scale

AKO. See Army Knowledge Online

Alcohol, use on the battlefield, 94

ALICE. See All-Purpose Lightweight Individual Carrying Equipment

All-Purpose Lightweight Individual Carrying Equipment

description, 310

energy cost of marching with, 189

gender differences in carrying, 317

introduction of, 310

Altitude issues

altimeters, 237

antioxidant vitamin and mineral requirements, 163

breath pentane sampled at several time periods during field 

training at moderate altitude (figure), 164

data collection procedures in the 1988 USARIEM field study at 

the Marine Mountain Warfare Training Center, Pickle Meadows, CA (figure), 162

data collection techniques for the 1990 USARIEM study of carbohydrate supplementation at altitude (figure), 161

effects of altitude illness on appetite, 161

high carbohydrate diet, 162

hypoxia effects on thirst and water intake, 192

nutritional requirements, 161–163

sweating, 192

water delivery, 192

water requirements, 191–192

Aly, R., effects of skin occlusion, 246

Ambien. See Zolpidem

AMEDD. See US Army Medical Department

American Society of Heating, Refrigerating, and Air-Conditioning 

Engineers

new effective temperature calculation, 226

thermal models, 225–226

Amphetamines. See Stimulants; specific drugs

ANAM. See Automated Neuropsychological Assessment Metric

Antianxiety agents. See Sedative-hypnotics and antianxiety agents; 

specific drugs

Antihistamines. See also specific drugs

sedative effects, 100

uses for, 100

Antioxidant vitamins and minerals

breath pentane sampled at several time periods during field 

training at moderate altitude (figure), 164

dangers of oversupplementing with, 164

effects on immune function, 163–164

work at altitude and, 163

Antiperspirants, foot blisters and, 321, 326

ARDEC. See Armament, Research, Development, and Engineering 

Center

Arden, G.B., laser-induced injury studies, 152

Armament, Research, Development, and Engineering Center, collaboration with the US Army Medical Research and Materiel 

Command and the US Department of Transportation, and the National Institute of Justice, 281–282

Armodafinil, operational use of, 101, 102

Army Health Hazard Assessment program, tank operator and crew 

survivability, 11

Army Knowledge Online, exhibit describing, 248

ASHRAE. See American Society of Heating, Refrigerating, and AirConditioning Engineers

ASHRAE Handbook, 226

ATBM. See Advanced Total Body Model

Athletic injuries. See Sports and athletic injuries

Atmospheric pressure

description, 215

measurement of, 237

Atopic dermatitis

chronic eczema with a numular (coin-shaped) eruption on 

hands with itching and burning (figure), 258

description, presentation, and treatment, 258

Attention-deficit hyperactivity disorder, pharmacological treatment, 101, 102, 103

Automated Neuropsychological Assessment Metric

description, 26

development of for further use, 27

figure depicting, 26

review of, 28

Aviation, Space, and Environmental Medicine, article on the use of 

drugs during a combat mission, 95

AVS. See Aidman Vision Screener
xxiv

Military Quantitative Physiology: Problems and Concepts in Military Operational Medicine

B

Babkoff, H., methylphenidate and pemoline studies, 103–104

Backpacks

energy cost of carrying, 311

foot blisters and, 319

load placement issues, 313–314

low back injuries and, 311

pack frames and hip belts and, 312–313, 325

strap adjustments and, 314

Ballistic and Laser Protective Spectacles, description, 133

Bandura, Albert, social learning theory, 370

Barbiturates. See Sedative-hypnotics and antianxiety agents; specific drugs

duration of action, 96–97

literature review on the effects of barbiturates on combat performance, 97

Bass, David, cold exposure and nutrition requirements, 160

Batejat, D., effects of modafinil on performance, 105

Bean, W.B., MD, role of nutrition in World War II, 158

Beatrice, Col. Edwin S., laser safety studies, 130, 132–133

Belenky, G., hangover effects of benzodiazepines, 99–100

Belkin, Lt. Col. (Dr.) Michael, laser research, 132

Bell, C.R., Oxford index and, 45

Benson, P., overview of cold weather dermatology issues, 261

Benzodiazepines

adverse effects, 97, 99

antianxiety properties, 96, 97

compared with buspirone, 97

compared with melatonin, 100

hangover effects, 99–100

mechanism of action, 96, 97

memory impairment and, 98

military duty and, 98–99

operational scenarios and, 97–98

risks and benefits of use, 99–100

sleep-rest cycle and, 98

uses for, 97, 99

Biomedical models. See Physiological models

Black globe thermometers, description and uses, 233–234

Blast injuries. See also INJURY software; specific body systems

animals, physical surrogates, and mathematical models (figure), 271

blast-effect categories, 268

blast injury taxonomy, 269

Blast Test Device, 277–278, 279

Bowen curves and, 269, 276

classes of, 268

complication of exposure to nuclear explosions, 282

computational fluid dynamics, 278, 291

example of blast injury data retrieved and displayed using IISYS software (figure), 282

finite element modeling, 272, 275, 283–285, 288, 292

first-generation injury modeling, 272–278

fourth-generation injury modeling, 288–293

human volunteer study, 280–281

improvised explosive devices and, 268

integrated finite element model of the head, neck, thorax, and 

abdominal regions (figure), 288

Lobdell model and, 279, 284, 285

mach stem and triple point (figure), 276

mechanism of injury, 272

Military Operational Medicine Research Program and, 271–293

Military Standard 1474 and, 269, 279, 281

modified Lobdell model (figure), 279

occupational limits of blast exposure, 269, 271, 281

overview, 268–272

pattern of injury, 272–273

Physical and Cognitive Performance Modeling Project and, 288

post-World War II research, 269

probabilistic prediction of lung injury (figure), 280

problems addressed, 271–272

research objectives, 269

schematic diagram of circulatory and respiratory systems in the 

Dynamic Physiology Model (figure), 289

schematic diagram of mechanical response model for binding 

structures in neurological cells (figure), 293

second-generation injury modeling, 278–283

taxonomy of blast injury (table), 270

third-generation injury modeling, 283–288

torso loading issues, 276–277

traumatic brain injury, 288–293

ventilation response to acute carbon monoxide exposure (figure), 287

volunteers being exposed to simulated mortar blasts (figure), 

281

Z-line and, 271, 275, 279–281

Blast Test Device

description, 277

effects of blasts in enclosures and, 277–278

figure depicting, 277

full coupling to INJURY software, 279

Blast Test Site, Kirtland Air Force Base, blast injury research and, 

269, 272, 280–281, 283

BLPS. See Ballistic and Laser Protective Spectacles

Bluestein, M., windchill index and, 47

Body armor

blast effects and, 284–285, 287–288

influence on performance, 325

Interceptor Multipurpose Body Armor System with removable 

collar, throat protector, and groin protector (figure), 315

load carriage issues, 315

Body composition

body fat prediction algorithms in the 1990s for women in the 

services (figure), 17

body-fat standards, 17–18

energy requirements and, 170

height and weight studies, 7

load carriage and, 308–309, 316

Boer Wars, load carriage issues, 308

Borbély, A.A., sleep regulation model, 80

Botsford, J.H., equations for wet bulb globe temperature, 45

Brain injuries. See Traumatic brain injury

Breckenridge, J.R., solar load research, 210, 211

BTD. See Blast Test Device

Burton, A.C., clothing insulation requirements, 49

Buspirone

compared with benzodiazepines, 97

compared with zolpidem, 97

mechanism of action, 100

uses for, 100–101

Byrd Amendment

sanctioned use of drugs in the military and, 115, 117–119

special provisions for the military use of drugs (exhibit), 118–119

C

Caffeine

beneficial effects on performance, 110

caffeine-containing gum has been developed and tested in a 

series of studies and is currently in the DoD supply system 

(figure), 111

caffeine content of selected beverages and foods (table), 109

effects on mood, 110

effects on performance, 106, 107
xxv

Abbreviations and Acronyms Index

gum containing, 111–112

the latest version of the ambulatory vigilance monitor with all 

sensors, output devices, and push buttons identified (figure), 

114

levels contained in foods, 110

mechanism of action, 101, 109, 110

military coffee use through the eras (exhibit), 115–117

Navy SEAL trainees during marksmanship testing in a caffeine 

study (figure), 111

Navy SEAL trainees in boats attempt to cross the surf line during Hell Week (figure), 111

operational uses, 109–112

potential applications of, 114–115

sentry duty performance assessed using the Weaponeer M16 

rifle marksmanship simulator (figure), 110

U-2 reconnaissance aircraft in flight (figure), 112

vigilance effects, 114–115

withdrawal issues, 114

Caldwell, J.A., effects of modafinil, 105

Caldwell, J.L.

amphetamine studies, 102, 103

benzodiazepine use studies, 98–99

Canizares, O., climate effect on insect numbers, 246

Carbohydrates

altitude and, 162

data collection techniques for the 1990 USARIEM study of carbohydrate supplementation at altitude (figure), 161

effect of carbohydrates on performance (figure), 172

effect of several levels of long-term (14-day) carbohydrate intake on the performance of intermittent cycle ergometer work 

(figure), 168

effect of short-term carbohydrate intakes on the performance of 

intermittent work (figure), 168

ERGO carbohydrate beverage, 112–114

operational uses, 112–113

range recommended for optimal glycogen repletion and physical performance, 165

role in aerobic endurance performance, 165, 167–169

typical carbohydrate intakes during military field training exercises (figure), 169

Carpenter, Dr. Kenneth J., nutritional observations, 158

Carts, load carriage issues, 315–316, 325–326

Case studies, laser-induced retinal injuries, 140–148, 149, 150, 152

Cathcart, E.P., load carriage and, 304

Central nervous system injuries. See Traumatic brain injury

CFD. See Computational fluid dynamics

Cheeseman, J., sun protective headgear, 249

Circadian system, definition, 74

CIVD. See Cold-induced vasodilation

Civil War

blast injuries, 268

height and weight studies, 7

load carriage issues, 308

malnourishment contributed to the misery of Civil War soldiers 

(figure), 158

physiological models, 6–9

research teams were sent to Union camps to collect physiological data from a large sample of men (figure), 6

Clark, J.A., sweat rate research, 213

Clothing. See Personal equipment; Protective clothing and equipment

Cluydts, R., benzodiazepines in operational scenarios, 97–98

Coben, P., skin diseases during the Vietnam War, 259–260

Cold environments. See also Cold exposure; Cold strain models; 

Thermal environment evaluation; Thermal injuries

effects of clothing and footwear, 246–247

effects on the skin, 246–247

skin cleansing guidelines, 243

skin disease during deployment, 261

skin protection, 248

Cold exposure. See also Cold environments; Cold strain models; 

Heat exposure; Thermal environment evaluation; Thermal injuries

clothing insulation and, 49

cold-induced diuresis and, 190

cold strain models, 51, 53–55, 71

effects on individual and unit operational capabilities, 51

female soldiers and, 161

frostbite and, 47–49, 54

Generation III Extended Cold Weather Clothing System (exhibit), 191, 215

hypothermia and, 49

increase in total energy expenditure and, 160

indices for, 47–49

metabolic rate increase and, 160

nutrition issues, 159–161

provision of hot drinks and, 191

respiratory water loss and, 190

Six-Cylinder Thermoregulatory Model and, 51

tyrosine studies, 109

vitamin and mineral requirements and, 160

water delivery issues, 191

water requirements, 190–191

windchill index and windchill temperature and, 47–49, 54

Cold-induced vasodilation, description, 54

Cold strain models

assumptions and, 55, 57–60

cold digit compartment models, 54

cold-induced vasodilation, 54

compartment models, 51, 53, 59

dry or terrestrial cold exposure, 55

extremity/digital models, 53

finger-cooling model, 71

high-altitude and, 55

peripheral hypothermia models, 54

uses for, 51

validation of, 60–63

whole-body models, 53, 54

Combat Motivation: The Behavior of Soldiers in Battle (Kellett), 158

Committee on Military Nutrition Research, caffeine recommendations, 111

Compartment models

assumptions concerning, 59

cold strain models and, 51, 53

typical structure of, 59

Computational biology

applications of models, 28–29

criterion measures and militarily relevant endpoints, 16–17

description, 3

fatigue and performance models, 16–17

models for, 16

nomograms and, 9

Computational fluid dynamics, blast injuries and, 278, 291

Conant, R.T., weather forecast studies, 61

Conductance, description, 207

Confocal scanning laser ophthalmoscopy

comparison of range of confocal slice between the Rhesus monkey and the garter snake (figure), 137

contrast sensitivity measured using the CSLO technique (figure), 145

contrast sensitivity measured using the CSLO technique 

showed a long-term OD deficit in sensitivity for high-spatial 

frequency visual stimuli (figure), 145

contrast sensitivity test for the preferred retinal location for resolving fine-resolution targets (figure), 147
xxvi

Military Quantitative Physiology: Problems and Concepts in Military Operational Medicine

CSLO image of OD paramacular hole taken after stabilization 

surgery at 18 months postexposure (figure), 143

description, 137

fixation eye movements recorded at 4 years postexposure for 

fine-resolution targets (figure), 147

full-hole thickness fundus photograph of the macular hole at 3 

months postexposure (figure), 144

fundus photograph (figure), 146

image shows the shift in preferred retinal location for placing 

fine-resolution targets (figure), 148

imaging of visual function test target placement on a patient’s 

retina during measurement of contrast sensitivity (figure), 140

large exit port of the designator makes it possible for bilateral 

exposure at ocular distances of a few centimeters (figure), 148

laser-induced retinal injuries and, 137, 140, 141, 143, 145, 146, 

148, 149

macula hole diameter is reduced in size at about 12 months 

postexposure (figure), 145

Convection

boundary layer and, 208

calculating, 207–208

clothing issues, 208–209

description, 207

pendulum effect and, 208

practical significance of, 207

windchill index and, 208–209

Corbett, D., overview of cold weather dermatology issues, 261

Crimean War, load carriage issues, 304

Croft, A.M., skin disease during deployment in Bosnia, 261

CSLO. See Confocal scanning laser ophthalmoscopy

Curcio, C.A., laser-induced retinal injury research, 138, 147

D

Dalen, A., load carriage injuries and, 324

Danielsson, U., frostbite studies, 48

Darier’s disease, description and treatment, 259

Data mining

common reasons for not sharing data (table), 20

data enclaves and, 22

global grid approach, 23–24

information analysis centers and, 22

information technology solutions for managing data, 23–24

preserving and distributing data sets, 20–22

protection against sharing of sensitive or proprietary information, 22

sociological barriers to data sharing, 19–20

DCGS. See Distributed Common Ground System—Army

De Haven, Hugh, injury epidemiology and, 356

DeBakey, M.E., windchill data research, 223

Defense Technical Information Center, data archiving and, 22

Defense Women’s Health Research Program, description, 23

Dehydration

cardiovascular system effects, 186

cold environments and, 191

description, 185

effects on physical performance, 186–187

heat tolerance and, 187

symptoms, 185

thermoregulatory effects, 185–186

Desert environments. See also Heat exposure; Tropical environments

skin care in desert operations (exhibit), 252

skin disease during deployments, 260–261

skin protection, 247–248

Dexedrine. See Dextroamphetamine

Dextroamphetamine

compared with methamphetamine, 101

compared with modafinil, 105

effects as a fatigue countermeasure, 103

effects on subsequent sleep, 102

go/no-go use during aviation mission, 95

half-life, 102

medical applications, 102

side effects, 102

use during the Vietnam War, 94

Diazepam, compared with buspirone, 101

DiClemente, C.C., stage models and, 371

Diffey, B.L., sun protective headgear, 249

Dill, D.B., blood gas analysis, 9

Dinges, D.F., Psychomotor Vigilance Task development, 78

Discoid lupus erythematosus

description, 258–259

treatment, 259

Dissecting cellulitis, description, 253

Distributed Common Ground System—Army

description, 50–51

heat strain models and, 51

Double packs

foot blisters and, 319

low back injuries and, 324

a Marine with a double pack at a forward operating base (figure), 314

strap adjustments and, 314

usefulness in military operations, 311

DPM. See Dynamic Physiological Model

Drugs. See Performance-maintaining and performance-enhancing 

drugs and food components; specific drugs and classes of drugs

DTIC. See Defense Technical Information Center

DuoDERM dressings, foot blisters and, 322

Dynamic Physiological Model

blast injuries and, 287, 288, 292, 293

schematic diagram of circulatory and respiratory systems (figure), 289

E

Eardrum rupture. See Tympanic membrane

Edholm, O.G., clothing insulation requirements, 49

Effective temperature

description, 44

nomogram for corrected effective temperature for light, indoor 

clothing (figure), 44

Eichna, L.W., dehydration studies, 182, 186

Eissing, G., Oxford index and, 45

Electronic data acquisition systems

description, 223–224

limitations of, 224–225

wet bulb globe temperature sensors and, 224, 225

Elliott, L., effects of secobarbital on combat performance, 97

ELTEP. See Emerging Laser Threat Eye Protection program

Emerging Laser Threat Eye Protection program, description, 133

EMS. See Eosinophilia-myalgia syndrome

English, J.C., skin disease during operations in Panama, 260

Environmental Medicine Genome Bank, description, 22

Eosinophilia-myalgia syndrome, tryptophan and, 108

Ephedra

adverse effects, 104

safety concerns regarding, 101–102

Ephedrine

adverse effects, 104

safety concerns regarding, 101–102

Epidemiological triangle

agents, 355

environmental factors, 355

epidemiological triangle: a traditional epidemiological hostenvironment-agent model (figure), 354
xxvii

Abbreviations and Acronyms Index

host factors, 354–355

vehicles, vectors, and equipment, 355

Equivalent temperatures, description, 43

ERGO carbohydrate beverage

composition of, 113

mean differences from baseline in auditory vigilance reaction 

times over the 10 hours of the ERGO drink study (figure), 114

photo and description (figure), 113

studies regarding benefits of, 112–113

US Army Ranger ingesting the ERGO drink (figure), 114

US Army Rangers marching during an ERGO drink study (figure), 113

ET. See Effective temperature

Ethical considerations

sanctioned use of drugs in the military, 115–119

studies of human performance limits, 11–12

Eye injuries. See Laser-induced retinal injuries

F

Falkland Islands War

load carriage issues, 304

temazepam use report, 99

Fano-Schultz, J., skin disease during operations in Panama, 260

Fatigue. See also Harvard Fatigue Laboratory

criterion measures, 16–17

definition, 74

Psychomotor Vigilance Test, 17

Feet. See also Foot blisters

carriage of loads on, 314

stress fractures, 323–324

FEM. See Finite element modeling

Fenfluramine, adverse effects, 104

Finite element modeling, blast injuries and, 272, 275, 283–285, 288, 

292

First-generation blast injury modeling

Blast Test Device, 277

blasts in enclosures, 277–278

computational fluid dynamics, 278

exploratory injury models, 273

gastrointestinal injury modeling, 274

INJURY software versions 1.0 to 4.3, 275–276

lung injury, 274–275

observed blast injuries, 272–273

organ systems considered in, 272

simple, free-field blast waves, 276–277

tracheal-laryngeal injury modeling, 273

tympanic membrane injury modeling, 273

Flumazenil, operational use, 99–100

Flurazepam

effects on sleepiness, performance, and mood, 98

half-life, 98

FM 100 Hue test

description, 139

laser-induced retinal injuries and, 139, 142, 144, 149

metrics for a human subject with normal color discrimination 

function (figure), 139

scores for the affected eye (OD) show a shift from a large fundamental indicating a large average error (figure), 142

scores show no trends in total error scores (figure), 144

Food constituents

association between nutrition and behavior, 107

blood–brain barrier and, 107–108

caffeine, 101, 106, 107, 109–112, 114–115

carbohydrate foods, 112–113

pressure suit worn by U-2 pilots prevents consumption of ordinary food (figure), 112

tryptophan, 108

tyrosine, 108–109

Foot blisters. See also Feet

antiperspirants and, 321, 326

causes, 318

complications from, 318

drainage of, 322

friction blister on the feet (figure), 321

friction blisters showing suggested puncture sites to drain the 

blister (figure), 322

“hot spots” and, 321

other ways of protecting blisters (figure), 323

risk factors, 318–319

skin coverings to prevent, 321–322

sock types and, 321, 326

Spenco insoles and, 319, 326

sudden increases in march intensity and, 319, 321

treatment for, 322

treatment for smaller blisters (figure), 322

Fort Knox Armored Medical Research Laboratory

health hazards in tanks, 10–11

protective clothing studies, 11

Fortney, S.M., dehydration studies, 185

Fourth-generation blast injury modeling

biomechanical and physiological response models, 293

blast traumatic brain injury mechanisms, 290–293

central nervous system injury, 288–290

performance endpoints, 288

Freund, Col. Beau, Warfighter Physiological Status Monitor and, 26

Friedl, Col. Karl

effects of reduction in body weight caused by reduced food intake on muscle strength and aerobic capacity, 169

identification of materials of value at the Blast Test Site, 283

vitamins’ role in physical performance, 165

Frisch, G., laser-induced injury studies, 143

Frostbite

clothing insulation and, 49

cold digit compartment models and, 54

equation for predicting time to frostbite for exposed faces, 47

psychological effects, 54

skin surface temperature and, 48

windchill index and, 48

G

Gagge, A.P.

humidity measurement, 236–237

initial capability decision aid and, 51

Oxford index and, 45

thermal models, 225–226

Gastrointestinal system

blast injury modeling, 274

gastrointestinal injury resulting from blast (figure), 274

integrated finite element model of the head, neck, thorax, and 

abdominal regions (figure), 288

liver injury resulting from blast (figure), 273

observed blast injury: GI (figure), 273

Gender factors. See also Women

load carriage, 317

sex differences in energy requirements (exhibit), 170–171

skin disease, 246

summary of energy expenditure studies using doubly labeled 

water measurements and involving men and women in militarily relevant environments (table), 171

Generation III Extended Cold Weather Clothing System

cold exposure and, 191

description, 215

snow and, 215

GI system. See Gastrointestinal system
xxviii

Military Quantitative Physiology: Problems and Concepts in Military Operational Medicine

Givoni, B.

energy cost of load carriage, 317–318

predicted four-hour sweat rate and, 46

Gleeson, M., effects of antioxidant supplementation on immune 

function, 163–164

Goldman, R.F.

energy cost of load carriage, 317–318

frostbite studies, 48

Gordon, John, injury epidemiology and, 356

Gould, Dr. Benjamin Apthorp, height and weight studies, 7

Greenleaf, J.E., water intake and sweating studies, 190

Grenada mission, load carriage issues, 304, 305

H

Habek, D., skin disease during deployment in Bosnia, 261

Haddon, William, Jr.

Haddon matrix for injury control, 357, 358–361

injury epidemiology and, 356

10 strategies for injury control, 357–358, 361–368

Haddon matrix for injury control

column components, 359–360

description, 358

Haddon matrix illustrated with examples of the Army Safety 

Center and other Army proponent responsibilities (figure), 358

Haddon matrix of interventions to reduce wartime motor-vehicle crashes (table), 360

proposed third axis for, 360–361

uses for, 358–359

Haddon’s 10 strategies for control of hazards of all types

begin to counter damage already done by the environmental 

hazard, 367

make that which is to be protected more resistant to damage 

from the hazard, 365

modify relevant basic qualities of the hazard, 364–365

modify the rate or spatial distribution of the release of a hazard 

from its source, 363–364

prevent the creation of the hazard in the first place, 361–362

prevent the inappropriate release of a hazard that already exists, 362–363

reduce the amount of the hazard brought into being, 362

separate, in time or space, the hazard and that which is to be 

protected, 364

separate the hazard and that which is to be protected by the 

interposition of a material barrier, 364

stabilize, repair, and rehabilitate the object of the damage, 367–

368

Hand carriage of loads, energy costs of, 315

Hand dermatitis

description and treatment, 259

prevention of hand dermatitis in deployed service members 

(exhibit), 260

Harvard Fatigue Laboratory

amphetamine use research, 10

D.B. Dill and his favorite experimental tools (figure), 9

description, 9

40-40-40 Club, 11

mobilization to military research activities, 9–11

Haslam, D.R., Early Call sleep studies, 79

Head carriage of loads, benefits and risks of, 311

Health belief model, description and uses, 369–370

Health Hazard Assessment Program, blast injury and, 280

Health Insurance Portability and Accountability Act, data sharing 

and, 22

Health locus of control, description and uses, 370

Heat exposure. See also Cold exposure; Desert environments; Thermal 

environment evaluation; Thermal injuries; Tropical environments

clothing issues, 189, 190, 191

effective temperature and, 44

fluid requirements, 189–190

heat strain models, 49–51, 57–60, 62

heat strain tables, 12

inclusion of carbohydrates in rehydrating fluids, 163

nutritional effects, 163

skin protection and, 240

water delivery issues, 190

Heat strain models

assumptions and, 55, 57–60

body armor effects, 315

compartment models, 59

Distributed Common Ground System—Army and, 50–51

drawbacks to, 50

family of thermal stress monitoring systems proposed by 

USARIEM (table), 62

graphic representation of the risk of heat injury generated by 

the Integrated Weather Effects Decision Aid (figure), 58

implementation of, 50

Integrated Weather Effects Decision Aid and, 51, 58

MERCURY/OMEGA system and, 50–51, 54

mobile heat stress monitor, 50

mobile heat stress monitor guide (exhibit), 52–53

pocket calculator for, 50

predicted casualty rate and, 60

SCENARIO, 51, 56–57, 63

strengths of, 49–50

summary comparisons between mean measured and predicted 

core temperatures from different heat studies (figure), 57

uses of, 50

validation of, 60–63

Hegge, Frederick

data preservation and, 23

Defense Women’s Health Research Program and, 23

task-embedded neuropsychological assessment, 26

Warfighter Physiological Status Monitor and, 24

Helmets. See Protective clothing and equipment

Henderson, Lawrence J., Harvard Fatigue Laboratory and, 9

Hepburn, N.C., skin disease during Operation Desert Shield, 260

HHA. See Health Hazard Assessment Program

Hidradenitis suppurativa

clinical features, 253

deployment issues, 257

environmental conditions and, 253

HIPAA. See Health Insurance Portability and Accountability Act

Historical background

blast injuries, 268–272

body composition studies of US male soldiers in various eras 

(figure), 7

brief history of rations (exhibit), 166–167

Civil War, 3, 6–9

during World War II, troops slept under mosquito netting (figure), 261

importance of food in military operations, 158–159

injuries in recent conflicts and wars, 347

laser-induced retinal injuries, 130, 131–135

load carriage, 304–309

military coffee use through the eras (exhibit), 115–117

nomograms and slide rules are graphical analog computational 

devices that were common tools before the advent of electronic computers (figure), 8

Operation Overlord (exhibit), 220–221

performance-maintaining and performance-enhancing drugs 

and food components, 94–95

sleep studies, 79–80

thermal models and indices, 43–49

World War I, 7

World War II, 9–11
xxix

Abbreviations and Acronyms Index

Holmér, I., required clothing insulation index and, 49

Hoyt, Reed

energy metabolism studies, 170

vitamins’ role in physical performance, 165

wearable physiological sensors and, 24

HSDA models. See Heat strain models

Human Genome Project, data sharing and, 20, 22

Humidity

aspirated psychrometers and, 237

challenges in measuring, 236

cold environments and, 247

demonstration of the relationship between measurements of air 

temperature and relative humidity (figure), 217

description, 236

dew-point thermometers and, 237

hydration issues, 189

measurement of, 236–237

skin diseases and, 246, 247–248

sling psychrometers and, 236–237

thermal environment evaluation and, 216–217

wet bulb globe temperature and, 236–237

Hydration issues

barriers to rehydration, 193–194

biomechanics of thirst, 183–184

body size and gender, 188

carbonated drinks, 196

changes in body weight of one researcher during a day in the 

desert (figure), 195

clothing, 189, 190, 191, 197

cold environments, 190–191

criteria and dietary reference intake values for total water (table), 184

daily water requirements, 182

dangers of dehydration, 182

dehydration, 185–187

distribution of water in the body, 182–183

drink temperature, 196–197

education soldiers about, 197

E.F. Adolph stands alongside a military jeep in the desert in 

1943 (figure), 182

environment, 188

estimates of daily sodium requirements for varied weather conditions and energy expenditures (figure), 194

estimates of daily water requirements for range of environmental conditions and energy expenditures (figure), 189

estimates of minimal daily water losses and production (table), 

183

factors influencing daily water requirements, 188–189

fluid replacement and work/rest guidelines for warm weather 

training conditions (table), 196

gastric emptying, 194

Generation III Extended Cold Weather Clothing System (exhibit), 191

hands-free drinking (figure), 193

high altitudes, 191–192

high humidity, 189

hot environments, 189–190

hydration status has been a key variable in USARIEM field nutrition studies (figure), 163

hydration-sustaining strategies, 194–197

hyperhydration, 187–188

inclusion of carbohydrates in rehydrating fluids, 163

load carriage, 189

lost solutes, 194

making time to drink, 195

minimizing body water losses, 197

nutrient-on-the-move delivery system attached to standard 

Army hydration devices (figure), 195

palatability of water, 193–194, 195–197

physical activity, 188

physiological consequences of body water imbalance, 185–188, 

197

role of unpleasant oral sensations in thirst, 184–185

skipping meals, 194–195

sodium depletion, 188

sweating, 183, 190, 192

thirst and satiation, 183–185

US Army Air Force personnel in Tunisia consuming their rations from defensive positions (figure), 195

water availability, 193

water delivery issues, 190, 191, 192

water-electrolyte balance, 182–183

water immersion, 193

World War II soldier using a steel helmet to hold water and to 

bathe (figure), 183

Hyperhydration

effects of overdrinking, 187

prevention, 188

symptoms and etiology, 187–188

water intoxication or hyponatremia, 187

Hypnotics. See Sedative-hypnotics and antianxiety agents; specific 

drugs

I

IACs. See Information analysis centers

ICD-9-CM. See International Classification of Diseases, Ninth Revision, 

Clinical Modification

ICDA. See Initial capability decision aid

IEDs. See Improvised explosive devices

Immune function, nutrition issues, 163–164, 171, 174

Impairment, definition, 74

Improvised explosive devices

estimated deaths in Iraq from, 268

traumatic brain injury and, 289, 291

Impulse noise

acoustic hazard standards, 15

World War II studies, 11

Infantry Combat Developments Agency, “load echeloning” concept and, 306

Information analysis centers, data storage and, 22

Initial capability decision aid

description, 51

thermal prediction model (exhibit), 56–57

Injury control. See also specific types of injuries

accident concept, 342

active strategies, 355–356, 368–372

after tragedy, relief in Oklahoma City (figure), 366

costs associated with injuries, 340

crashworthy fuel systems (figure), 363

“designed to crash,” the UH-60 Black Hawk helicopter was developed to the military’s specifications with consideration of 

the decades of crash data and to maximize survivability on 

impact (figure), 365

destruction of antipersonnel mines (figure), 362

environmental hazards, 349

epidemiological triangle: a traditional epidemiological hostenvironment-agent model (figure), 354

epidemiological triangle and, 353–355

estimates of injuries among military personnel, 340

goal of, 353–354

Haddon matrix, 357, 375

Haddon’s 10 strategies for injury control, 357–358, 361–368, 375

health promotion interventions, 369–372

injury classification, 342–344

“injury” definition, 340–342, 375
xxx

Military Quantitative Physiology: Problems and Concepts in Military Operational Medicine

injury incidence in the Army (figure), 340

injury risk after redeployment, 351–353

injury severity determination, 347

intentional versus unintentional injuries, 344–346

in the military, 353–357

International Classification of Diseases, Ninth Revision, Clinical 

Modification and, 343–344

intervention strategies, 355–357

lessons of history (exhibit), 372

long-range management of injury, 374–375

long-term care needs (exhibit), 374

management of injuries in the field and access to care, 372–375

medium-range management of injury, 374

military environment and, 340, 347–353

military personnel exposed to open air testing (figure), 344

Navy rates of aviation fatalities (figure), 353

parachute landing fall allows the jumper to distribute the energy across five separate body regions rather than one (figure), 363

passive strategies, 355, 356–357, 368

peacetime injuries and unit readiness (exhibit), 348

physical training exercises (figure), 366

pioneers in injury epidemiology (exhibit), 356

planning injury prevention programs, 357–372

postwar injury mortality, 352

potential explanations for the association between deployment 

and increased risk of injury (figure), 352

psychiatric conditions and, 349, 351

reasons why injuries receive too little attention from commanders, 341–342

risk compensation and, 357

severity scales used to classify general trauma (table), 346

short-range management of injury, 373

South Vietnam—medical evacuation patients on the deck of the 

amphibious assault ship USS Tripoli await transfer to the 22nd 

Casualty Station in Danang from which they will be sent to 

the States (figure), 373

special environmental circumstances, 347–351

sports and athletic injuries, 351

stress and, 349, 351

this Air Force technician is outfitted in full protective gear as he 

checks the fins of a sidewinder missile (figure), 364

troop transportation issues, 349

two examples of high-risk military training (figure), 350

unintended consequences and, 357

US Army UH-60 Medical Evacuation (MEDEVAC) helicopter 

lands on the USS New Orleans during a joint-service, masscasualty exercise held in Somalia during Operation Restore 

Hope (figure), 367

various methods of energy transfer and the injuries that may 

result from them (table), 343

weapons issues, 348–349

weather watchers give parachute training the all clear (figure), 

361

worldwide hospitalization, US Army, 1995 (table), 341

Injury Severity Score, description and uses, 347

INJURY software

description, 3

effects of multiple exposures, 279

full coupling to the Blast Test Device, 279

INJURY correlation of lethality, blast overpressure (figure), 291

INJURY software, version 8.2, used to estimate lung injury from 

blast exposure (figure), 285

maintenance and followup issues, 27

peer review and, 28

pleural surface model, 276

probabilistic prediction, 279

replacement of the Z-line and, 275, 279–281

spiral development of, 24

total work on the lung and, 278

version 8, 285

versions 1.0 to 4.3, 275–276

versions 5.0 to 7.1, 278–279

whole-body loading and, 278–279

Institute of Medicine

Committee on Military Nutrition, environmental stress and nutrient requirements, 159

dietary reference intakes for water, 182

Instruments and methods for measuring parameters of the thermal 

environment

air temperature, 231

altimeters, 237

barometers, 237

comparison of air-to-ground temperatures measured at two 

heights to ground temperature at the US Marine Corps 

Mountain Warfare Training Center, California (figure), 231

electronic sensors, 235–236

humidity measurement, 236–237

precipitation measurement, 237–238

pressure and altitude measurement, 237

radiation measurement instruments, 233–234

surface temperature, 231–232

temperature measurement instruments, 232–233

wind speed measurement, 234–235

Integrated Individual Fighting System, description, 311

Integrated Weather Effects Decision Aid

description, 51

graphic representation of the risk of heat injury generated by 

the Integrated Weather Effects Decision Aid (figure), 58

operational use of, 63

Interceptor Multipurpose Body Armor System

depiction of soldier wearing (figure), 315

description and uses, 315

Interim Total Body Model

development of, 281–282

skull fracture criterion and, 284

International Classification of Diseases, Ninth Revision, Clinical 

Modification

coding and, 343–344

compared with STANAG, 345–346

injury research using hospitalization files: coding for highquality research (exhibit), 344

Injury Severity Score and, 347

STANAG codes and, 344

Iphicrates of Ancient Greece, load carriage and, 307–308

Iraq. See Operation Iraqi Freedom

IREQ. See Required clothing insulation index

ISS. See Injury Severity Score

Issekutz, B.J., Jr., short-term nutritional deficiencies, 159

ITBM. See Interim Total Body Model

Ivy, A.C., stimulant studies, 106

IWEDA. See Integrated Weather Effects Decision Aid

J

Jaycor, Inc. See also INJURY software

blast injury mathematical model development, 272

cellular-based model of the response of the immune system to 

ionizing radiation and, 282–283

data storage and, 22

lung injury model development and, 275

Toxic Gas Assessment Software and, 286–287

traumatic brain injury models, 291

Jet lag

melatonin and, 100
xxxi

Abbreviations and Acronyms Index

stimulants and, 106

tryptophan and, 108

JNLWD. See Joint Non-Lethal Weapon Directorate

Johnson, R.E.

caffeine studies, 110

review of post-World War II reports on military feeding problems, 158

Joint Non-Lethal Weapon Directorate, blast injury modeling and, 

281–282, 284

Joint Theater Trauma Registry database, description, 22

Jones, F.D., buspirone use in combat, 100–101

K

Kark, R.M., review of post-World War II reports on military feeding problems, 158

Keeling, J.H., sun protective headgear, 249–250

Kellett, Anthony, Combat Motivation: The Behavior of Soldiers in Battle, 158

Keys, Ancel, Minnesota Starvation Study, 10, 166

Killgore, W. Scott, effects of modafinil, caffeine, and amphetamine 

on performance, 107

Knee pain, load carriage and, 324

Kornfield, B.W., skin disease during Operation Desert Shield, 260

L

Lader, M., buspirone study, 101

Lagarde, D., effects of modafinil on performance, 105, 106–107

LaPiana, Col. Francis, laser research, 132

Larrey, Baron Dominique Jean, effects of cold on soldiers, 158

Laser eye exposure. See also Laser-induced retinal injuries

physiological models and, 28

standards for, 15–16

Laser-induced retinal injuries. See also Laser eye exposure

Aidman Vision Screener, 134, 139, 152

assessing in vivo retinal morphology, 137–138

assessing visual function, 138–139

Ballistic and Laser Protective Spectacles and, 133

case studies, 135, 140–148, 149, 152

comparison of range of confocal slice between the Rhesus monkey and the garter snake (figure), 137

confocal scanning laser ophthalmoscopy, 137, 140, 141, 143, 145, 

146, 148, 149

Emerging Laser Threat Eye Protection program and, 133

exposure guideline development, 151

fixation eye movements changed significantly from 3 months to 

12 months postexposure (figure), 146

FM 100 Hue test, 139, 142, 144, 149

future research needs, 151, 152

historical background, 130

integrating imaging with visual function, 140

laser dazzlers and, 151

measurements of stationary and dynamic contrast sensitivity 

(figure), 141

multiple exposures about the fovea and IRSF between two of 

these lesion sites (figure), 141

normal eye movement map (figure), 140

optical coherence tomography, 138, 145, 147, 149

structure–function relationship complexity and, 149

summary of case findings, 150

summary of military laser ocular hazards and protection (exhibit), 136

treatment options, 135, 151

US Army Medical Department’s role in development, deployment, and use of lasers by the military (exhibit), 131–135

visual acuity and, 149

visual function issues, 130–137

Leishmaniasis

clinical diagnoses/reports of leishmaniasis at US military medical treatment facilities and estimated leishmaniasis infection 

incidence rates among US service members (figure), 262

leishmaniasis is a parasitic infection transmitted to humans 

from rodents by sand flies (figure), 242

Persian Gulf War incidence, 246, 261

Letterman Army Institute of Research, laser studies, 131–135

Lichen planus, description, presentation, and treatment, 258

Lieberman, H.R., caffeine studies, 109, 111

Lind, A.R., Oxford index and, 45

Live Fire Test Program, blast injury and, 285

Load carriage

ALICE pack and, 310–311

an airman being transported using a two-man carry in a training exercise (figure), 307

an Army relief team carries an Army tent in a box to a waiting 

truck following a major earthquake on November 23, 1980 

(figure), 312

average loads carried by light infantry soldiers during dismounted operations in Afghanistan in April and May 2003 

(table), 309

backpacks and, 311–314, 319, 325

body armor and, 315

body stature and body mass and, 308–309

carts for, 315–316, 325–326

double packs and, 311–314, 319, 324

effects of load distribution within the pack on energy cost (figure), 314

effects of terrain on energy cost, 318

foot blisters, 318–319, 321–322, 326

gender differences, 317

hand carriage, 315

heavy loads in military history (exhibit), 305

historical background, 304–309

a “hot spot” on the medial aspect of a soldier’s foot during a 

road march (figure), 321

influence on performance, 325

injuries among 218 infantry soldiers during a 5-day, 161-km 

road march (table), 319

injuries among 355 infantry soldiers during a 20-km maximal 

effort road march (table), 319

knee pain and, 324

load distribution and, 309–311, 326

“load echeloning” concept, 306

loads carried on the march by various infantry unity throughout history (figure), 306

low back injuries and, 311, 324

Marines carry a stretcher bearing a sniper victim on Guadalcanal in World War II, 313

Mars Task Force mule skinners (2nd Battalion, 475th Infantry 

Regiment) lead mules through the swift river that impeded 

their progress to Bhamo, Burma, November 17, 1944 (figure), 

307

medical problems associated with, 318–325, 326

meralgia paresthetica and, 325

metatarsalgia, 322

methods of load carriage investigated in various studies (figure), 311

MOLLE pack and, 310–311, 326

motorized vehicles for, 316

on feet, 314

on the thighs, 314–315

overview, 304

physical characteristics of soldiers and recruits (table), 310

physical training and, 308, 316–317, 326

physiological and biomechanical aspects, 309–318

physiological factors associated with, 316
xxxii

Military Quantitative Physiology: Problems and Concepts in Military Operational Medicine

placement of load and, 313–314

Polaris Sportsman Military Vehicle (figure), 317

predicting the energy cost of, 317–318

rifle carriage, 315

rucksack palsy and, 324–325

strap adjustments and, 314

stress fractures and, 323–324, 326

summary of common load carriage-related injuries with prevention and treatment strategies (table), 320

US Army research, 305–307

ways to improve, 325

worst case loads and projected weights because of new technologies (including clothing and personal equipment) for nine 

US Army light infantry positions (table), 308

Lobdell model, blast injuries and, 279, 284, 285

Lormetazepam, operational scenarios and, 97–98

Lotens, W.A., solar load research, 210

Lothian, N.V., load carriage research, 304

Love, A.G., association between weight gain and abdominal obesity with heart disease, 7

Low back injuries, load carriage and, 311, 324

Luckett, CPT, pictured wearing a modern prosthetic (figure), 342

Lungs

blast injuries, 274–275, 284

cumulative injury to from blast, 279

example of blast injury data retrieved and displayed using IISYS software (figure), 282

exposure standards for blast injuries, 274

finite element modeling, 284–285

INJURY software, version 8.2, used to estimate lung injury from 

blast exposure (figure), 285

integrated finite element model of the head, neck, thorax, and 

abdominal regions (figure), 288

lung contusion levels, 279

lung injury resulting from blast (figure), 275

mechanism of action of, 274–275

pleural surface model of chest–lung interaction (figure), 276

probabilistic prediction of lung injury (figure), 280

schematic diagram of circulatory and respiratory systems in the 

Dynamic Physiological Model (figure), 289

ventilation response to acute carbon monoxide exposure (figure), 287

M

MAIS. See Maximum Abbreviated Injury Scale

MANPRINT program, description, 29

Maximum Abbreviated Injury Scale, description and uses, 347

Mayo, Elton, Harvard Fatigue Laboratory and, 9

McIntyre, D.A.

asymmetry of radiation sources and, 218

Oxford index and, 45

predicted four-hour sweat rate and, 46

McKenzie, R., effects of secobarbital on combat performance, 97

McMichael, S.R., load carriage and, 308

Medical Surveillance Monthly Report, diagnosis for dermatological 

diseases, 261

Medications. See Performance-maintaining and performance-enhancing drugs and food components; specific medications

Melatonin

compared with benzodiazepines, 100

compared with tryptophan, 108

compared with zaleplon, zopiclone, and temazepam, 99

dietary supplement use, 100

dosages, 100

half-life, 100

jet lag and, 100

mechanism of action, 100

Meralgia paresthetica, causes and symptoms, 325

MERCURY/OMEGA system

description, 50

Integrated Weather Effects Decision Aid and, 51

schematic diagram of the MERCURY/Ranger Test Bed (figure), 

54

Metatarsalgia

description and treatment, 322

sites of metatarsalgia (figure), 323

Methamphetamine

compared with dextroamphetamine, 101

effects as a fatigue countermeasure, 103

effects on subsequent sleep, 102

half-life, 102

side effects, 102

Methylphenidate

compared with pemoline, 103–104

mechanism of action, 101

physiological effects, 103

use during the Vietnam War, 94

uses for, 101, 103

Military Gator

figure depicting, 316

US Army soldiers assigned to the 86th Combat Support Hospital using a Military Gator to transport a litter patient at an 

undisclosed location in Iraq in support of Operation Iraqi 

Freedom (figure), 316

Military Operational Medicine Research Program

blast injury research, 268–293

collaboration with the National Highway Traffic Safety Administration, 282

key physiology models (table), 4–5

primary products, 3

program description, 268

Military Operations on Urban Terrain, need to train on weapons 

fired from buildings and, 277

Military Standard 1474, blast injuries and, 269, 279, 281

Miller, C.W., nutrient composition of rations in World War I, 159

Minnesota Starvation Study

data sharing and, 20

description, 10, 169

figure depicting, 21

Modafinil

compared with dextroamphetamine, 105

mechanism of action, 104

operational use of, 101, 102, 105, 106, 107

side effects, 104–105

Modeling of the Non-Auditory Response to Blast Overpressure: Characterization and Modeling of Thoraco-Abdominal Response to Blast 

Waves, 274

Modular Lightweight Load-Carrying Equipment packs

description, 310–311, 326

gender differences in carrying, 317

soldier wearing the Modular Lightweight Load-Carrying Equipment pack (figure), 313

MOLLE packs. See Modular Lightweight Load-Carrying Equipment packs

MOMRP. See Military Operational Medicine Research Program

Montain, S.J., dehydration studies, 185

Moran, D.S.

dry or terrestrial cold exposure model, 55

initial capability decision aid and, 51

solar load research, 212

Moskowitz, H., buspirone and diazepam study, 101

Motorized vehicles

load carriage issues, 316

the Military Gator (figure), 316

Polaris Sportsman Military Vehicle, 316, 317
xxxiii

Abbreviations and Acronyms Index

US Army soldiers assigned to the 86th Combat Support Hospital using a Military Gator to transport a litter patient at an 

undisclosed location in Iraq in support of Operation Iraqi 

Freedom (figure), 316

MOUT. See Military Operations on Urban Terrain

Murlin, Maj. John R., nutritional requirements studies, 7, 159

N

Naitoh, Paul, stimulant studies, 107

NAMRL. See Naval Aviation Medical Research Laboratory

Napping issues

effects of napping on the quality and quantity of subsequent 

sleep, 87

operational factors, 86

pharmacological substances taken to sustain alertness and, 87

sleep inertia or sleep drunkenness and, 86–87

tactical napping description, 86

waking process, 86

Narcolepsy, pharmacological treatment, 102, 103, 105

NASA. See National Aeronautics and Space Administration

Natick Labs. See also US Army Natick Soldier Research, Development and Engineering Center

clothing issues, 11

National Aeronautics and Space Administration, technology readiness levels, 18–19

National Center for Health Statistics, data collection efforts, 22

National Health and Nutrition Examination Survey, data storage, 22

National Highway Traffic Safety Administration

blast injury research and, 282, 284

neck biomechanics studies, 14

National Institute of Justice, collaboration with the Armament, 

Research, Development, and Engineering Center, the US Army 

Medical Research and Materiel Command, and the US Department of Transportation, 281–282

National Institutes of Health, data sharing, 19–20

National Library of Medicine, Visible Human Project, 279

National Research Council

Committee on Hearing, Bioacoustics, and Biomechanics, blast 

injury research, 269, 271

protective clothing studies, 11

NATO STANAG. See North Atlantic Treaty Organization Standardization Agreement 2050

Naval Aviation Medical Research Laboratory, fatigue countermeasure research, 94

Naval Medical Research Laboratory, tyrosine studies, 109

Neck biomechanics, studies of, 13–15

NHTSA. See National Highway Traffic Safety Administration

NIH. See National Institutes of Health

Nishi, Y.

humidity measurement, 236–237

Oxford index and, 45

North Atlantic Treaty Organization Standardization Agreement 

2050

compared with ICD-9-CM, 345–346

description of STANAG codes and frequency (cause of hospitalized injury) for US Army: 23-year summary (1980-2002) 

(table), 345

injury coding, 344–346

NATO STANAG trauma codes (table), 345

Nose, H., distribution of water in the body, 183

Not Eating Enough—Overcoming Underconsumption of Military Operational Rations, 174

Nutrition. See also Food constituents

altitude effects, 161–163

antioxidant vitamin and mineral requirements, 163–164

association between nutrition and behavior, 107

basic ration system factors, 164–165

brief history of rations (exhibit), 166–167

carbohydrates’ role in aerobic endurance performance, 165, 

167–169

cold exposure and, 159–161

criteria and dietary reference intake values for total water (table), 

184

data collection for the 1986 USARIEM field study of MREs 

(figure), 161

data collection procedures in the 1988 USARIEM field study at 

the Marine Mountain Warfare Training Center, Pickle Meadows, CA (figure), 162

data collection techniques for the 1990 USARIEM study of carbohydrate supplementation at altitude (figure), 161

effect of a restricted vitamin intake on functional performance 

in humans (figure), 168

effect of carbohydrates on performance (figure), 172

effect of military field diet on respiratory exchange ratio (figure), 

172

effect of several levels of long-term (14-day) carbohydrate intake on the performance of intermittent cycle ergometer work 

(figure), 168

effect of short-term carbohydrate intakes on the performance of 

intermittent work (figure), 168

effects on military performance, 158–174

energy provision importance, 169–174

environmental stress and nutrient requirements, 159–174

extreme environments and their influence on physiological 

function (figure), 160

female soldiers and, 159

generalized relationship between body weight loss and maintenance of strength, based on analyses of several military field 

studies (figure), 173

generalized relationship between body weight loss and maximal aerobic capacity (figure), 173

grip strength and, 169–170

heat exposure and, 163

historical role of the importance of food in military operations, 

158–159

hydration status has been a key variable in USARIEM field nutrition studies (figure), 163

immune function and, 163–164, 171, 174

K ration study, 10

loss of muscle mass and muscle strength and, 171

malnourishment contributed to the misery of Civil War soldiers 

(figure), 158

Minnesota Starvation Study, 10, 20, 21, 169

muscle glycogen depletion and perceived exertion during strenuous training (figure), 168

respiratory exchange ratio and, 169

sex differences in energy requirements (exhibit), 170–171

sophisticated laboratory metabolic studies have been conducted 

with the Army at the Pennington Biomedical Research Center 

in Baton Rouge, Louisiana (figure), 172

sports nutrition and military nutrition comparison, 164–174

strength measurements in USARIEM field studies of Ranger 

training (figure), 173

stress of military training, oxidative stress, and immune function, 159, 163–164, 171, 174

“stripping” rations and, 165, 167

summary of energy expenditure studies using doubly labeled 

water measurements and involving men and women in militarily relevant environments (table), 171

types of rations and their functions, 166–167

typical carbohydrate intakes during military field training exercises (figure), 169

vitamins’ role in physical performance, 165

World War I studies, 7

NWS. See US National Weather Service
xxxiv

Military Quantitative Physiology: Problems and Concepts in Military Operational Medicine

O

OCT. See Optical coherence tomography

O’Donnell, V.M., effects of triazolam on performance and sleep, 98

Office of the Surgeon General

load carriage studies and, 306

Minnesota Starvation Study and, 10

Oken, J.S., methylphenidate effects, 103

Operation Desert Shield. See Persian Gulf War

Operation Desert Storm. See Persian Gulf War

Operation Enduring Freedom

average loads carried by light infantry soldiers during dismounted operations in Afghanistan in April and May 2003 

(table), 309

load carriage issues, 304, 305, 307

use of go/no-go medications and, 95

Operation Iraqi Freedom, US Army soldiers assigned to the 86th 

Combat Support Hospital using a Military Gator to transport a 

litter patient at an undisclosed location in Iraq in support of Operation Iraqi Freedom (figure), 316

Operative temperature, description, 43–44

Optical coherence tomography

description, 138

images show the progression of OD wound healing (figure), 148

laser-induced retinal injuries and, 138, 145, 147, 149

vertical scan through the fovea, OCT image (figure), 138

vertical scan through the fovea (figure), 138

Osczevski, R.J.

frostbite studies, 47, 49

windchill index and, 47

Overdrinking. See Hyperhydration

Oxford index

shortcomings of, 43

uses for, 45

P

Palinkas, L.A., skin diseases during the Vietnam War, 259–260

Pandolf, K.B., energy cost of load carriage, 317–318

Passel, C.F., frostbite studies, 48–49

Passive strategies for injury control, 355, 356–357, 368

Paul, M.A., study comparing sleep-inducing compounds, 99, 100

PB. See Pyridostigmine bromide

PBPK. See Physiologically based pharmacokinetic models

Pehr, K., skin disease during Operation Desert Shield, 260

Pemoline

adverse effects, 103

compared with methylphenidate, 103–104

half-life, 103

mechanism of action, 101, 103

uses for, 101, 104

Peneter, D.M., effects of triazolam on performance and sleep, 98

Performance-maintaining and performance-enhancing drugs and 

food components

alcohol, 94

Byrd Amendment and, 115, 117–119

caffeine, 94, 109–112, 114–115

carbohydrate foods, 112–113

ethical issues, 115–119

food constituents, 107–114

“go/no-go” medication use during aviation missions, 95

the latest version of the ambulatory vigilance monitor with all 

sensors, output devices, and push buttons identified (figure), 

114

overview, 94–95

sedative-hypnotics and antianxiety agents, 95–101

stimulants, 94, 95, 101–107

these technologically advanced aircraft permit long duration 

missions that push the limits of human endurance, requiring 

special consideration to fatigue countermeasures for the crew 

(figure), 94

tryptophan, 108

tyrosine, 108–109

Persian Gulf War

Byrd Amendment special provisions for the military use of 

drugs (exhibit), 118–119

history of inadequate sleep in Gulf War operations (exhibit), 75

leishmaniasis incidence, 246, 261

load carriage issues, 305

provision of bottled water to combat palatability issues, 194

recreation-related injuries, 351

sequence of events from the 100-hour ground war—friendly 

fire incident (figure), 75

skin disease during deployments, 260–261

traumatic brain injury data, 289

unintentional injuries and, 347

use of go/no-go medications and, 95

Personal equipment. See also Protective clothing and equipment

load carriage equipment, 29

rifle load carriage issues, 315

Warfighter Physiological Status Monitor, 24

water-cooled vest development, 15

World War II studies, 11

Phenobarbital, duration of action, 97

Phenylpropanolamine

adverse effects, 104

mechanism of action, 104

safety concerns regarding, 101–102

Phillips, P.A., thirst studies, 185

Physical training

load carriage and, 308, 316–317, 326

physical training exercises (figure), 366

Physiological models

assumptions and, 55, 57–60

“black box” approach, 42

challenges of, 63

computational biology and, 16–19

differences between predicted variables and measured values 

and, 61

differential equations and, 42

effectiveness of, 64

inflated expectations and “failure” of, 61

iterative process, 24–26

linking models to users, 40

material design options and, 15–16

military uses, 28–29

model development methods, 41

operational use of, 63

parametric multiple regression techniques and, 41

peer review and, 28

prevalence of, 40–41

products and software applications for, 41

project management and, 63–64

psychological testing (figure), 26

representations for, 41

responsibilities to maintain, improve, and supervise use of, 

26–27

spiral development, 24–26

strategies for formulating, 41–42

technical problems and, 63

testing in realistic environments, 18–19

transitioning to use, 24–29

US Army computational biology applications, 28–29

uses of, 12–16

validation, verification, and accreditation, 27–28, 58, 60–63
xxxv

Abbreviations and Acronyms Index

virtual prototyping and, 29

virtual training and, 29

Physiologically based pharmacokinetic models, blast injuries and, 

286–287

Pielke, R.A., weather forecast studies, 61

Pierce Laboratory, protective clothing studies, 11

Pieters, A.M.J., solar load research, 210

Pigeau, Ross, stimulant studies, 107

Polaris Sportsman Military Vehicle

description and uses, 316

figure depicting, 317

Polysomnography, description and uses, 75, 80

Poortmans, J., hyperhydration studies, 187–188

Posttraumatic stress disorder

injuries and, 349, 351

redeployment and, 352

suicide risk and, 351

traumatic brain injury and, 290

Powell, J.W., Psychomotor Vigilance Task development, 78

PPA. See Phenylpropanolamine

Pratt, R.L., solar load research, 210, 211

Predicted four-hour sweat rate

basis for, 46

nomogram for (figure), 46

required sweat rate and, 46–47

Prochaska, J.O., stage models and, 371

Protective clothing and equipment. See also Personal equipment

battle dress uniforms and protection from the sun, 246

blast effects behind body armor, 284–285, 287–288

clothing properties are tested on a thermal manikin (figure), 251

cold environments and, 190, 191

cold exposure and, 49

effects of clothing and footwear on the skin, 246–247

Generation III Extended Cold Weather Clothing System (exhibit), 191, 215

laser-induced injuries, 133

men and horses fitted with gas masks, circa 1917-1918 (figure), 

343

percentage of UVA and UVB transmission and UPF values for 

three camouflage fabrics (table), 247

socks to protect feet from blisters, 321, 326

solar protection of different head covers (figure), 253

Suit, Contamination Avoidance, Liquid Protective ensemble, 209

sun protective headgear, 247–250

this Air Force technician is outfitted in full protective gear as he 

checks the fins of a sidewinder missile (figure), 364

Toxicological Agent Protective ensemble, 209

Vapor-Barrier boots, 247

water vapor permeability and insulation of US Army uniforms 

(table), 251

World War II studies, 11

Pseudofolliculitis, pseudofolliculitis barbae (PFB) is a common form 

of skin irritation on the face in men with curly hair (figure), 240

Psoriasis

description, presentation, and treatment, 242, 257–258

narrow-beam UVB and, 258

psoriasis in a military contractor serving in Afghanistan (figure), 258

P4SR. See Predicted four-hour sweat rate

Psychomotor Vigilance Task

description, 17, 78

exhibit depicting, 81

PTSD. See Posttraumatic stress disorder

Pugh, L.G.C.E.

views on commanders’ opinion of physiologists, 158

water loss in high altitudes, 192

PVT. See Psychomotor Vigilance Task

Pyranometers

description and uses, 234

pyranometer—a radiometer for measuring global solar radiation (figure), 233

Pyridostigmine bromide, DoD distribution of during the Persian 

Gulf War, 118–119

Q

Quantitative physiology

biophysical testing models, such as the copper foot, have been 

highly refined by the US Army for thermal insulating and vapor transmissibility properties (figure), 10

classic examples, 2–3

computational biology, 3, 9, 16–19

data mining, 19–24

ethical considerations in studies of human performance limits, 

11–12

historical background, 3–12

Military Operational Medicine research program, 3

overview, 2–3

physiological stressors encountered by soldiers and marines affect health and performance (figure), 2

soldiers and marines today face many of the same physiological challenges presented to their counterparts in previous centuries (figure), 3

technology readiness levels, 18–19

three examples of Army application of medical research models 

that contribute to the safety of systems and better protection 

of teams and individuals (figure), 14

transitioning predictive models to use, 24–29

uses of physiological models, 12–16

Quartermaster Climatic Research Laboratory, clothing issues 

and, 11

R

Rabin, J., FM 100 Hue test research, 139

Radiation

black globe thermometers and, 233–234

components, 209

ground thermal radiation, 211–212

long-wave, 209

measurement instruments, 233–234

natural ionizing radiation, 209

net radiometers and, 234

pyranometers and, 234

short-wave, 209

skin protection, 247–252

solar load component, 209–212

Stefan-Boltzman constant and, 209–212

Rain

measurement of, 237

thermal consequences of, 215

Red Bull, caffeine amount, 110

Redmond, Col. Daniel P., wrist-mounted actigraphy studies, 78

Reed, L.J., association between weight gain and abdominal obesity 

with heart disease, 7

Rehydration

gastric emptying and, 194

lost solutes and, 194

palatability of water and, 193–194

water availability and, 193

Required clothing insulation index, description, 49

Retinal injuries. See Laser-induced retinal injuries

Rifle carriage, load carriage issues, 315

Ritalin. See Methylphenidate

Rodahl, K., short-term nutritional deficiencies, 159
xxxvi

Military Quantitative Physiology: Problems and Concepts in Military Operational Medicine

Rolls, B.J., water palatability studies, 196

Rolls, E.T., water palatability studies, 196

Rucksack palsy

backpack frames and hip belts and, 325

description, 324

incidence, 324

risk factors, 325

scapular winging (figure), 325

sensorimotor deficits from, 324–325

symptoms, 324

S

Saletu, B., effects of modafinil on performance and mood, 105

SCENARIO model

description, 51

initial capability decision aid and, 51

initial capability decision aid thermal prediction model (exhibit), 

56–57

operational use of, 63

Schissel, D.J.

cost savings of intratheater dermatology support to deployed 

units, 262

sun protective headgear, 249

Schmeisser, E., laser-induced injury studies, 152

Schnakenberg, Col. (Ret.) David D., comments on military rations, 

174

SCTM. See Six-Cylinder Thermoregulatory Model

Secobarbital, go/no-go use during aviation mission, 95

Second-generation blast injury modeling

Advanced Total Body Model development, 282, 284–285

cellular-based model of the response of the immune system to 

ionizing radiation and, 282–283

closing of the Blast Test Site, 283

combined injury modeling, 282–283

INJURY software, versions 5.0 to 7.1, 278–279

interagency collaboration, 281–282

Interim Total Body Model development, 281–282, 284

Joint Non-Lethal Weapon Directorate and, 281–282

replacement of the Z-line in Military Standard 1474, 279–281

secondary blast injury modeling, 281–282

tertiary blast injury modeling, 282

Sedative-hypnotics and antianxiety agents. See also Sleep issues; 

specific drugs

antihistamines, 100

benzodiazepines and related compounds, 97–100

buspirone, 100–101

Marines sleeping on a transport aircraft (figure), 96

mechanism of action, 96

melatonin, 100

uses for, 95–96

Seidel, W.F., effects of triazolam and flurazepam on sleepiness, performance, and mood, 98

Shapiro, Y., solar load research, 212

Shappell, S., methamphetamine effects on performance, 102–103

Ship operations, effect of skin disease on, 259

Shitzer, A., cold strain model, 54

Shoulder biomechanics, studies of, 13

Siple, P.A., frostbite studies, 48–49

Six-Cylinder Thermoregulatory Model

description, 51, 54

Probability of Survival Decision Aid and, 72

water immersion models and, 72

Skin cancer

battle dress uniforms and, 246

benign neoplasms are the second most frequent dermatological 

cases in recent deployments (figure), 240

prevention of, 245–246

recreational and occupational exposure to sunlight and, 245

types of, 243, 245

vitamin D versus skin cancer (exhibit), 244–245

Skin care and protection

atopic dermatitis (chronic eczema) with a numular (coin-shaped) 

eruption on hands with itching and burning (figure), 258

benign neoplasms are the second most frequent dermatological 

cases in recent deployments (figure), 240

climate and, 246

clinical diagnoses/reports of leishmaniasis at US military medical treatment facilities and estimated leishmaniasis infection 

incidence rates among US service members (figure), 262

clothing properties are tested on a thermal manikin (figure), 251

commanders’ role in, 263

contact dermatitis on the foot of a 29-year-old seaman aboard 

ship (figure), 259

dermatology information available through Army Knowledge 

Online (exhibit), 248

during World War II, troops slept under mosquito netting (figure), 261

effect of skin disease on operations during deployment, 259–

261

factors that affect skin disease (table), 247

factors that contribute to skin disease during deployment, 

246–247

general care recommendations, 243–246

general EPA guidelines for protective measures against overexposure to UVR based on the UVI (table), 254–257

granulomatous tattoo reaction in a deployed 34-year-old military contractor (figure), 241

heat injuries and, 240

inexperienced care providers and, 240

leishmaniasis is a parasitic infection transmitted to humans 

from rodents by sand flies (figure), 242

melanin role, 242

overview, 240–241

percentage of UVA and UVB transmission and UPF values for 

three camouflage fabrics (table), 247

prevention of hand dermatitis in deployed service members 

(exhibit), 260

prevention of skin disease for sailors (exhibit), 250

pseudofolliculitis barbae (PFB) is a common form of skin irritation on the face in men with curly hair (figure), 240

psoriasis in a military contractor serving in Afghanistan (figure), 258

sample data sheet of the National Oceanic and Atmospheric 

Administration (NOAA)/Environmental Protection Agency 

(EPA) Ultraviolet Index (UVI) forecast for US cities (figure), 

256

seasonal variation in ultraviolet index values for Albuquerque, 

New Mexico (figure), 255

skin and its contribution to health, 241–243

skin care in desert operations (exhibit), 252

skin cleansing and lubrication guidelines, 243

skin disease and medical planning, 261–262

skin diseases affected by deployment, 252–259

skin layers, 241–242

skin protection during deployment, 247–252

skin protection for tropical deployments (exhibit), 250

skin reactions caused by different classes of drugs (table), 249

solar protection and skin cancer, 243–246

specialty training and, 261–262

Sun Smart Cards (figure), 257

sunscreen guidelines, 250–251

sweating and, 242

tanning myths, 251–252

teledermatology consultations and, 262
xxxvii

Abbreviations and Acronyms Index

tinea pedis with secondary bacterial infection in a 45-year-old 

seaman aboard ship (figure), 249

ultraviolet index (exhibit), 254

vigorous response to smallpox immunization in a 25-year-old 

airman during deployment to Afghanistan (figure), 241

vitamin D versus skin cancer (exhibit), 244–245

water vapor permeability and insulation of US Army uniforms 

(table), 251

Skin issues during deployment

effect of skin disease on operations, 259–261

factors that contribute to skin disease during deployment, 

246–247

skin disease and medical planning, 261–262

skin diseases affected by deployment, 252–259

skin protection, 247–252

Sleep issues. See also Sedative-hypnotics and antianxiety agents

artillery fire operations simulation, 79

average daily sleep amounts obtained from soldiers during 58 

days of US Army Ranger School (figure), 80

average daily sleep amounts of military personnel during military exercises conducted at the National Training Center (figure), 80

benefits of good sleep management, 87–88

cascade of degradation in sleep deprivation, 74

commanders’ views of how much sleep their soldiers need, 

76–77

comparison of one-step and two-step model approaches using 

data obtained from airline pilots (figure), 85

comparison of the one-step and two-step approaches (figure), 82

current models, 78–86

definitions of terms, 74, 87

Early Call studies, 79

example of sleep-related guidelines provided to commanders 

and soldiers (figure), 77

field sleep measures, 76–78, 87

focus for future studies, 88

history of inadequate sleep in Gulf War operations (exhibit), 75

jet lag, 100, 106, 108

laboratory sleep measures, 75–76, 87

limitations of current models, 83, 85–86

mathematical models for prediction, 78–80, 87

measuring performance in the field, 78, 87

measuring sleep and performance, 75–78, 87

military effectiveness factors, 74

napping issues, 86–89

one-step models for, 80–81, 83

one type of wrist-worn actigraph for the measurement of movement during field operations (figure), 78

operational context, 74, 76–78, 87

operational example of interindividual differences and models 

(exhibit), 84–85

practical model use, 80–83

predicting sleep and performance, 78–86

Psychomotor Vigilance Task, 78, 81

recovery from chronic sleep deprivation, 85–86

recovery sleep, 76

schematic diagram of the general shift, due to active sleep management, from a less safe/effective distribution of soldier capacity to a more safe/effective one (figure), 78

schematic diagram of the two-process model of sleep regulation 

and the subsequent fatigue/alertness addition (figure), 82

schematic representation of the psychological and physical 

degradation associated with increasing sleepiness (figure), 74

“sleep” definition, 74, 87

stages of sleep, 75–76

studies to investigate the impact of sleep loss on operational 

effectiveness (exhibit), 79

tactical use of sleep, 86–89

two-step models for, 83

underestimation of fatigue in sleep-deprivation studies, 83

validation of studies, 83

wrist-mounted actigraphy, 77, 78

Sleepiness, definition, 74

Smiley, A., buspirone and diazepam study, 101

Smith, A.P., caffeine studies, 109

Smith, H.R., skin disease during deployment in Bosnia, 261

Snow

measurement of, 237–238

thermal consequences of, 215

Social contagion model, description and uses, 371–372

Social learning theory, description and uses, 370

Sohar, E., carbonated drink studies, 196

Solar load

clothing issues, 211, 212

description, 209

exhibit concerning, 210–211

importance of, 210

solar load for direct solar radiation for a standing figure without clothing (figure), 212

Solar radiation. See Radiation

Spenco shoe insoles, foot blisters and, 319, 326

Sperling, H.G., laser-induced injury studies, 152

Sports and athletic injuries, injury control issues, 351

Stage models, description and uses, 371

STANAG. See North Atlantic Treaty Organization Standardization 

Agreement 2050

Stanny, R.R., methamphetamine effects on performance, 103

Stimulants. See also specific drugs

abuse potential, 104

comparative effects of stimulants in sleep-deprived soldiers 

(exhibit), 106–107

dextroamphetamine, 101, 102–103

ephedra, 101–102, 104

ephedrine, 101–102, 104

fenfluramine, 104

historical combat use, 94

mechanism of action, 101

methamphetamine, 101, 102–103

methylphenidate, 94, 101, 103

modafinil, 101, 102, 104–105

overview, 101–102, 104

pemoline, 101, 103–104

phenylpropanolamine, 101–102, 104

socio-political issues associated with combat use of, 104

uses of, 10, 101

Stress fractures

causes, 323

risk factors, 323

symptom of metatarsal stress fracture (figure), 323

treatment, 323–324

x-ray films of a metatarsal stress fracture when the patient first 

presented to the clinician and 3 weeks later (figure), 324

Strydom, N.B., dehydration studies, 186

Stuhmiller, Dr. James, physiological models and, 29, 40

Suicide, posttraumatic stress disorder and, 351

Suit, Contamination Avoidance, Liquid Protective ensemble, humidity and, 209

Surface temperature, description and role, 231–232

Sutton, E.L., metatarsalgia incidence research, 322

Sweating

hydration issues, 183, 190, 192

predicted four-hour sweat rate, 46–47

skin care and protection and, 242

skin-wettedness and, 213–214

thermal environment and, 213–215
xxxviii

Military Quantitative Physiology: Problems and Concepts in Military Operational Medicine

T

Tanks and armored vehicles

air conditioning systems, 15

health hazard studies, 10–11

Taylor, Capt. H.W., “payload plan” for load carriage, 304

TBI. See Traumatic brain injury

Technology readiness levels

description, 18–19

technology readiness levels and physiological modeling analogs (table), 18

usefulness of, 19

Temazepam

compared with zaleplon, zopiclone, and melatonin, 99

effects on sleep and performance, 99

Temperature measurement instruments

black globe thermometers, 233–234

categories of, 232

ground or soil thermometers, 232

minimum-maximum thermometers, 232

resistance temperature devices, 232

thermistors, 232

thermocouples, 232

wet bulb globe temperature sensors, 233

10 strategies for control of hazards of all types. See Haddon’s 10 

strategies for control of hazards of all types

TGAS. See Toxic Gas Assessment Software

Theory of reasoned action, description and uses, 370–371

Thermal environment evaluation. See also Cold exposure; Heat exposure

acclimatization process and, 213

atmospheric pressure, 215

basic psychrometric chart (figure), 214

biophysical/environmental variables, 209–212

clothing issues, 208–209, 211, 212, 215, 218–219

collaboration with civilian scientists and, 227

common versus special environmental factors, 215

comparison of a solar collector to alpine circues, depressions 

that can act as natural solar collectors (figure), 213

complexity of the environment and, 216–219

conductance and, 207

convection and, 207–209

demonstration of the relationship between measurements of air 

temperature and relative humidity (figure), 217

effect of cloud cover on direct and diffuse solar radiation measured at the US Marine Corps Mountain Warfare Training 

Center, California (figure), 217

electronic data acquisition system and, 223–225

energy balance equation, 206–207

“environment” definition, 206

factors in measurements, 216–225, 227

fire weather instrument kits and, 225

handheld Kestrel 4000 unit (figure), 224

humid operative temperature and, 226

humidity and, 216–217

insensible heat exchange, 213–215

instruments and methods for measuring parameters of the 

thermal environment, 231–238

interior environments and, 218–219

linking meteorology to models and users, 225–226

local needs relevance, 222

long-term planning and, 221–222

measurement objectives, 221–222

mesoscale and microscale weather and, 219, 221

meteorological parameters, 216

meteorological scale, 219, 221

military interior environments, 219

new effective temperature and, 226

nomogram for the “new” effective temperature (figure), 226

nonurban environments, 219

Operation Overlord (exhibit), 220–221

operative temperature and, 225–226

parameter measurements, 222–223

performance optimization and, 227

portable computers and, 224

precipitation, 215, 237–238

primary environmental parameters and instruments, 222–223

radiation and, 209–212, 233–234

real-time or near real-time weather data and forecasts, 222

role in military operations, 206

site exposure relative to the sun and, 216

site heterogeneity (landscape) and, 217

solar load and, 209–212

stations and instrument packages, 223–225

sweating issues, 213–215

synoptic weather and, 219

temperature of bodies of water and, 216

“thermal environment” definition, 206

urban environments and, 217–218

WeatherPod miniature weather station (figure), 224

wind and, 216

windchill index and, 208–209, 223

Thermal injuries. See also Cold exposure; Heat exposure

cold water immersion tables, 12

equivalent temperatures and, 43

general environmental indices and, 43–44

heat exposure indices, 44–45

historical overview of thermal models and indices, 43–49

hyponatremia and, 15

initial capability decision aid thermal prediction model (exhibit), 56–57

linking models to users, 40

National Weather Service indices and, 45

nomogram for corrected effective temperature for light, indoor 

clothing (figure), 44

operative temperature and, 43–44

Oxford index and, 43, 45

personal equipment developments, 15

predicted four-hour sweat rate and, 46–47

safe heat exposure studies, 15

wet bulb globe temperature and, 43, 45

windchill index and, 43, 45, 47–49, 54

World War II studies, 10–11

Thigh carriage of loads, energy costs of, 314–315

Third-generation blast injury modeling

blast effects behind body armor, 284–285, 287–288

Dynamic Physiological Model, 287, 288, 292, 293

finite element modeling, 283–285

INJURY software, version 8, 285

Live Fire Test Program, 285

physiologically based pharmacokinetic models, 286–287

Toxic Gas Assessment Software, 286–287

toxic gas inhalation, 285–287

Thorax. See also Lungs

finite element modeling in blast injury, 284–285

integrated finite element model of the head, neck, thorax, and 

abdominal regions (figure), 288

Tikuisis, P., frostbite studies, 47, 49, 54

Toxic Gas Assessment Software, blast injuries and, 286–287

Toxicological Agent Protective ensemble, humidity and, 209

Tracheal injuries

tracheal injury resulting from blast (figure), 274

tracheal-laryngeal injury modeling, 273

Training, Overuse Injury, and Performance model, uses of, 13
xxxix

Abbreviations and Acronyms Index

Traumatic brain injury

acceleration effects, 291–292

biomechanical and physiological response models, 293

blast-induced, 288–293

blast TBI mechanisms, 290–293

causal links, 290

characterization of blast exposure, 290–291

deformation of the skull coupled with head acceleration can 

create regions of high stress concentration within the brain 

(figure), 292

electromagnetic pulse, 292–293

hypoxic effects, 292

integrated finite element model of the head, neck, thorax, and 

abdominal regions (figure), 288

magnetic resonance imaging studies and, 290

mechanical pathway, 288–289

mild TBI issues, 289

pathway of internal disturbances, 291–293

posttraumatic stress disorder and, 290

Predictive Model, 288–289, 290

schematic diagram of mechanical response model for binding 

structures in neurological cells (figure), 293

vascular surge, 292

Triazolam

effects on performance and sleep, 98–99

half-life, 98

TRLs. See Technology readiness levels

Tropical environments. See also Desert environments; Heat exposure

effect of skin disease on operations during deployment, 259–

260

skin cleansing and lubrication guidelines, 243

skin diseases and, 246

skin protection for tropical deployments (exhibit), 250

Troychock, J., skin cleansing and lubrication, 243

Tryptophan

compared with melatonin, 108

eosinophilia-myalgia syndrome and, 108

mechanism of action, 108

operational uses, 108

sedative-like effects, 108

Tympanic membrane

blast injuries and, 272, 284

finite element modeling and, 284

Tyrosine

behavioral effects, 108

beneficial effects, 108–109

mechanism of action, 108

U

Upper respiratory tract, tracheal-laryngeal blast injury modeling, 

273

URT. See Upper respiratory tract

US Air Force

Combat Climatological Center climatological summaries, 222

School of Aerospace Medicine, 94, 99

this Air Force technician is outfitted in full protective gear as he 

checks the fins of a sidewinder missile (figure), 364

weather forecasting responsibilities, 223

US and Canadian Joint Action Group for Thermal Indices, windchill index and, 47

US Army

description of STANAG codes and frequency (cause of hospitalized injury) for US Army: 23-year summary (1980-2002) 

(table), 345

Field Board No. 3 load carriage studies, 306

Health Hazard Assessment Program, 280

Infantry Combat Developments Agency, 306

injury incidence in the Army (figure), 340

injury incidence pyramid, 340

Integrated Meteorological System, 222

US Army UH-60 Medical Evacuation (MEDEVAC) helicopter 

lands on the USS New Orleans during a joint-service, masscasualty exercise held in Somalia during Operation Restore 

Hope (figure), 367

worldwide hospitalization, US Army, 1995 (table), 341

US Army Aeromedical Research Laboratory, fatigue countermeasure research, 94

US Army Center for Health Promotion and Preventive Medicine, 

lung injury assessment and, 280

US Army Development and Employment Agency, “load echeloning” concept and, 306–307

US Army Materiel Command Joint Laser Safety Team, laser research, 130

US Army Medical Department

role in development, deployment, and use of lasers by the military (exhibit), 131–135

teledermatology consultations and, 262

US Army Medical Research and Development Command

laser research, 130

skin care recommendations, 243

US Army Medical Research and Materiel Command

blast injury research, 268–293

collaboration with the Armament, Research, Development, and 

Engineering Center and the US Department of Transportation, and the National Institute of Justice, 281–282

US Army Natick Soldier Research, Development and Engineering 

Center

effects of body armor on blast injury, 287–288

rations studies, 166

tyrosine studies, 109

US Army Research Institute of Environmental Medicine

clothing issues, 11

data collection for the 1986 USARIEM field study of MREs (figure), 161

data collection procedures in the 1988 USARIEM field study at 

the Marine Mountain Warfare Training Center, Pickle Meadows, CA (figure), 162

data collection techniques for the 1990 study of carbohydrate 

supplementation at altitude (figure), 161

data preservation and, 23

heat exposure studies, 15

heat strain tables, 12

hydration status has been a key variable in USARIEM field nutrition studies (figure), 163

models for predicting consequences of exposure to environmental stressors, 49–63

strength measurements in USARIEM field studies of Ranger 

training (figure), 173

thermal models developed by, 225–226

thermoregulatory models and research, 40–72

tyrosine studies, 109

Warfighter Physiological Status Monitor, 24–26

US Corps of Engineers, weather data, 222

US Department of Defense

body circumference equations, 17–18

Combat Feeding Directorate, 166

data preservation efforts, 22

distribution of pyridostigmine bromide during the Persian 

Gulf War, 118–119

laser research, 131, 135

neck biomechanics studies, 14–15

VV&A Recommended Practices Guide, 27–28

US Department of Transportation, collaboration with the Armament, Research, Development, and Engineering Center, the US 
xl

Military Quantitative Physiology: Problems and Concepts in Military Operational Medicine

Army Medical Research and Materiel Command, and the National Institute of Justice, 281–282

US National Weather Service

indices based on temperature and humidity, 45

windchill calculation chart (figure), 48

US Navy, rates of aviation fatalities (figure), 353

USAMRMC. See US Army Medical Research and Materiel Command

V

van der Beek, E.J., vitamins’ role in physical performance, 165

Van Dongen, H.P., sleep studies, 83

Vidmar, D.A., skin disease during cold weather deployments, 247, 

259

Vietnam War

blast injuries, 268

recreation-related injuries, 351

skin diseases and, 259–260

suicide risk among veterans, 351

use of amphetamines to enhance performance in combat, 94

Vision injuries. See Laser-induced retinal injuries

Vitamin D

role of the skin in synthesis of, 242–243

vitamin D versus skin cancer (exhibit), 244–245

Vogt, J.J., predicted four-hour sweat rate and, 46

VV&A Recommended Practices Guide, 27–28

W

Wallace, R.F., heat injury studies, 61

Walter Reed Army Institute of Research

blast injuries to the lungs, 274

caffeine studies, 110–111

dextroamphetamine study, 102

Interim Total Body Model testing, 281

laser-induced retinal injury studies, 140

sleep management system, 77

Warden, Dr. Deborah, traumatic brain injury and, 289

Warfighter Physiological Status Monitor

concept for (figure), 25

description, 24

prototype for, 26

Wasserman, G.M., skin disease during Operation Desert Shield, 260

Water Consumption Planning Factors, 190, 191, 192

Water immersion

body heat loss and, 208

cold water immersion tables, 12

effect on water requirements, 193

Six-Cylinder Thermoregulatory Model and, 72

temperature of bodies of water and, 216

Water requirements. See Hydration issues

WBGT. See Wet bulb globe temperature

WCI. See Windchill index

WDI. See Oxford index

Weather issues. See Cold environments; Cold exposure; Desert environments; Heat exposure; Thermal environment evaluation; 

Tropical environments

Wesensten, N.J., effects of modafinil and caffeine on performance, 

105, 111

Wet bulb globe temperature

battery-operated sensors, 225

correlations between distant to local WBGT, 62

description, 43, 45

electronic data acquisition systems and, 224

inputting values for, 61–62

shortcomings of, 43

sources for guidance on, 45

Wet-dry index. See Oxford index

Whayne, T.F., windchill data research, 223

Whitmore, J.N., study of zaleplon as a sleep aid, 99

Wilde, J.L., cost savings of intratheater dermatology support to deployed units, 262

Wilson, O., frostbite relationship to skin surface temperature, 48

Wind speed measurement

Beaufort Wind Scale (table), 236

cup anemometer, which measures wind speed in a horizontal 

plane (figure), 235

cup anemometers, 235–236

hot-wire or heated-bead anemometers, 234

mechanical anemometers, 234

wind parameters, 235

wind vanes, 235

Windchill index

calculating the windchill temperature, 45

cold exposure and, 47–49

comparison of air temperature and windchill equivalent temperatures (figure), 47

convection and, 208–209

criticisms of, 47

description, 43, 47

limitations of, 54

local data on, 223

shortcomings of, 43

windchill calculation chart (figure), 48

windchill equivalent temperature and, 47

Women

body fat prediction algorithms in the 1990s for women in the 

services (figure), 17

daily fluid requirements, 188

Defense Women’s Health Research Program, 23

iron supplementation and, 159, 161, 162–163, 164

load carriage issues, 317

neck biomechanics studies, 13–14

nutritional considerations, 159, 161, 162–163

sex differences in energy requirements (exhibit), 170–171

summary of energy expenditure studies using doubly labeled 

water measurements and involving men and women in militarily relevant environments (table), 171

World War I

load carriage issues, 308

men and horses fitted with gas masks, circa 1917–1918 (figure), 

343

nutritional requirements studies, 7

psychological testing (figure), 26

role of nutrition, 159

soldier eating rations in the field (figure), 159

World War II

American soldiers marching to relieve troops encircled in the 

Ardennes Forest during the Battle of the Bulge (figure), 307

amputee receiving therapy (figure), 342

during World War II, troops slept under mosquito netting (figure), 261 

environmental heat and cold exposure studies, 10–11

Harvard Fatigue Laboratory studies, 9–11

impulse noise studies, 11

K ration study, 10

load carriage issues, 304, 305, 306, 309

Marines carry a stretcher bearing a sniper victim on Guadalcanal in World War II, 313

Mars Task Force mule skinners (2nd Battalion, 475th Infantry 

Regiment) lead mules through the swift river that impeded 

their progress to Bhamo, Burma, November 17, 1944 (figure), 307

Minnesota Starvation Study, 10

Operation Overlord (exhibit), 220–221

personal equipment studies, 11
xli

Abbreviations and Acronyms Index

role of nutrition, 158–159

use of amphetamines to enhance performance in combat, 94, 

106–107

X

Xu, X., cold strain model, 54

Z

Zaleplon

adverse effects, 99

compared with zopiclone, temazepam, and melatonin, 99

mechanism of action, 96

study of use as a sleep aid, 99

Zecher, J., windchill index and, 47

Zola, Irving, injury prevention comments, 359

Zolpidem

compared with buspirone, 97

mechanism of action, 96, 97

operational scenarios and, 97–98

Zopiclone, compared with zaleplon, temazepam, and melatonin, 99

Zwick, H., laser-induced injury studies, 143, 152
xlii

Military Quantitative Physiology: Problems and Concepts in Military Operational Medicine

Top graphic: US Army Medical Research and Development Command, 1979–1994. Shoulder patch shows an 

upright sword surrounded by flames and the serpent from the medical caduceus.

Bottom graphic: US Army Medical Research and Materiel Command, 1994–present. When the command was 

renamed, a new emblem was created with the caduceus and the words “protect, project, sustain.”

PROTECT

P R OJE CT - SU STAI N