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"The Craft of Wargaming is designed to support supervisors, planners, and analysts who use wargames to support their organizations' missions. The authors focus on providing analysts and planners with a clear methodology that allows them to initiate, design, develop, conduct and analyze wargames. Although the methodology is built around the analytic wargaming construct, organizations or individuals can easily adapt this methodology to construct educational and experiential wargames."--

The article of record as published may be found at http://dx.doi:10.3928/01477447-20120621-14 ; Although greater trochanteric pain syndrome is thought to be a common musculoskeletal disorder, little has been reported on the incidence rates of the disorder. The purpose of this study was to determine the incidence and demographic risk factors of greater trochanteric pain syndrome in a United States military population. Multivariate Poisson regression analysis was used to estimate the rate of greater trochanteric pain syndrome per 1000 person-years, controlling for sex, race, age, rank, and branch of service. The overall unadjusted incidence rate of greater trochanteric pain syndrome was 2.03 per 1000 person-years. Women had a significantly increased adjusted incidence rate ratio for greater trochanteric pain syndrome of 5.03 (95% confidence interval [CI], 4.91-5.16). The adjusted incidence rate ratio for White servicemembers compared with Black servicemembers was 1.36 (95% CI, 1.32-1.40). The adjusted incidence rate ratio for the 40+ age group compared with the 25 to 29 age group was 2.81 (95% CI, 2.68-2.95). Compared with junior officers, junior and senior enlisted ranks had an increased adjusted incidence rate ratio of 1.94 (95% CI, 1.84-2.04) and 1.17 (95% CI, 1.12-1.23), respectively. Compared with the Navy, each branch of service had an increased adjusted incidence rate ratio, with the Army at 2.90 (95% CI, 2.80-3.01), the Marines at 1.96 (95% CI, 1.87-2.07), and the Air Force at 1.33 (95% CI, 1.27-1.38). Female servicemembers had a five-fold greater incidence of greater trochanteric pain syndrome. Increasing age, enlisted rank groups, and service in the Army, Marines, or Air Force were also significant risk factors.

The article of record as published may be found at http://dx.doi.org/10.1177/1548512919850380 ; This article compares the entropy weight scheme to other subjective weighting schemes using various multi-attribute decision making criteria. We apply the entropy weighting scheme to improve the CARVER center of gravity analysis and targeting analysis that are currently used by Special Operations Forces. We also compare the entropy weighing schemes to other weighting schemes using the ranking of terrorist for targeting. Next, we apply several multi-attribute decision making (MADM) methods using our suggested various weighting schemes to obtain the rankings of the alternatives. We compare the results and provide sensitivity analysis to examine the robustness of each MADM analysis. We conclude that any decision methodology for CARVER and terrorist ranking that used the actual data collected to compute the weights might be a better method than subjective weights.

The article of record as published may be found at http://dx.DOI.org/10.1002/art.30498 ; To examine the incidence of osteoarthritis and the influence of demographic and occupational factors associated with this condition among active duty US service members between 1999 and 2008.

The article of record as published may be found at http://dx.doi.org/10.1097/TA.0b013e318250bfb4 ; The importance of characterizing the incidence and character of war injuries, as well their precipitating mechanisms, has been recognized since the 19th century, when such an endeavor was conducted at the end of the American Civil War. Since that time, catalogues of the types of combat wounds sustained by American military personnel in each major conflict have been published to varying degrees. At the present time, the US Armed Forces are engaged in the most prolonged military conflict in this nation's history. Moreover, the two fronts of the eponymous Global War on Terror, the Iraq and Afghanistan wars, have not only produced more combat-related casualties since the Vietnam era but also witnessed the wide-scale use of protective equipment for both military personnel and vehicles, as well as irregular enemy tactics, which have resulted in increased wound severity and concomitant disability. ; Approved for public release; distribution is unlimited.

The article of record as published may be found at http://dx.doi.org/10.1097/BRS.0b013e3181f40ddd ; To investigate the incidence and risk factors for developing low back pain in active duty military population to include age, sex, race, rank, and military service. ; Approved for public release; distribution is unlimited.

BACKGROUND: Medial patellofemoral ligament (MPFL) reconstruction for patellar instability is a commonly performed procedure with a reported high rate of return to preinjury activity. However, no previous study has assessed the functional outcomes of military servicemembers undergoing MPFL reconstruction. HYPOTHESIS: Primary MPFL reconstruction confers patellar stability, but with limited return to preinjury function and ability to maintain unrestricted military active duty status. STUDY DESIGN: Case series; Level of evidence, 4. METHODS: Using the Management Analysis and Reporting Tool database, we conducted a retrospective review of active duty servicemembers throughout the US Department of Defense Health System who underwent primary MPFL reconstruction between 2012 and 2015. Demographic variables were recorded as well as ability to return to impact activities—defined as running, jumping, rucking with a load >40 pounds (18 kg), and returning to airborne operations—and to remain on active duty status. The rates of recurrent instability and the need for subsequent surgeries were identified and assessed for statistical significance using uni- and multivariate analyses. Patients were evaluated for a minimum of 2 years postoperatively. RESULTS: Of the 213 patients who underwent primary MPFL reconstruction, including 34 with concomitant tibial tubercle osteotomy, 19 (8.9%) patients developed recurrent instability. The presence of bilateral patellar instability was associated with higher recurrence rate. Patients with bilateral instability comprised 47.3% of those with recurrence but only 24.9% of patients without recurrence (P = .019). Impact activity restrictions were present in 57.6% of patients (n = 121), with 86 patients (52.1%) undergoing medical separation from the military. Patients who were prescribed activity restriction before surgery were significantly more likely to have postoperative activity restrictions (64.5%; P = .019), and junior enlisted servicemembers were more likely to be medically separated ...

The article of record as published may be found at https://doi.org/10.1093/milmed/usy163 ; Femoral head avascular necrosis (AVN) is a debilitating disease with core decompression commonly performed for early stage disease. However, the ability to return to high-activity levels following treatment is largely unknown. Materials and Methods: Active military patients undergoing core decompression for femoral head AVN were reviewed. Demographic variables were identified and visual analog pain data was collected at a minimum of 2-year post-surgery or prior to total hip arthroplasty (THA). Patient outcomes, need for THA, and ability to remain on active service were recorded from chart review. Imaging studies were reviewed to classify the lesion stage and size for correlation with progression to THA or discharge from military service. Results: A total of 29 active duty patients met inclusion criteria (22 male, 7 female; 32.3 years). Seven patients (24%) progressed to THA and they were more likely to have bilateral disease (86%) and be older (35.4 years versus 31.2 years). At final follow-up, 86% of patients had significant hip-related activity restrictions, with only 6 (21%) remaining on active military service. Neither Steinberg stage nor modified Kerboul necrotic angle was associated with progression to THA or military discharge. Conclusion: Military servicemembers undergoing core decompression for femoral head AVN experienced mild clinical improvement with moderate survivorship from THA (74%) at mid-term follow-up. However, servicemembers have a low likelihood of returning to preoperative physical function and running activities (13.7%). Older patients and those with bilateral disease were at a higher risk of progressing to THA.

The article of record as published may be found at http://dx.doi.org/10.2106/JBJS.M.01050 ; Background: The extent to which musculoskeletal injuries and sociodemographic factors impact long-term out- come remains unknown. The purpose of this study was to provide a prognostic analysis of the influence of muscu- loskeletal conditions, behavioral health diagnoses, and patient-based characteristics on outcomes among a longitudinal cohort. Methods: This is a longitudinal observational study of the population of an Army brigade deployed to Iraq from 2006 to 2007. The 4087 soldiers who survived the deployment were followed for forty-eight months and were observed for the development of chronic musculoskeletal conditions, behavioral health disorders, and inability to remain in active service as indicated by the findings of the Physical Evaluation Board. The influence of demographic factors, behavioral health conditions, and deployment-related musculoskeletal injuries on the capacity to remain in the military was assessed using Poisson multivariate analysis and receiver operating characteristic curves. Results: The mean age of the cohort was twenty-seven years (range, eighteen to fifty-two years). One hundred and sixty- three soldiers sustained combat-related musculoskeletal trauma, and 587 soldiers had musculoskeletal injuries not related to battle. Three hundred and seventy-four soldiers (9%) were found to be unfit by the Physical Evaluation Board, with 236 soldiers (63%) referred for at least one musculoskeletal condition. Of these 236 soldiers, 116 (49%) also had a behavioral health diagnosis. Multivariate regression analysis revealed that junior enlisted rank (incidence rate ratio, 9.7 [95% confidence interval, 3.1 to 30.3]), senior enlisted rank (incidence rate ratio, 5.6 [95% confidence interval, 1.8 to 17.7]), behavioral health diagnosis (incidence rate ratio, 7.4 [95% confidence interval, 5.6 to 9.6]), age of eighteen to twenty-three years (incidence rate ratio, 1.6 [95% confidence interval, 1.2 to 2.3]), and male sex (incidence rate ratio, 2.5 [95% confidence interval, 1.2 to 5.0]) were significant predictors of referral to the Physical Evaluation Board for a musculoskeletal condition. A prognostic model developed using receiver operating characteristic curves and the risk factors of musculoskeletal injury, presence of a psychiatric condition, and lower rank explained 78% (95% confidence interval, 77% to 80%) of the risk of being found unfit by the Physical Evaluation Board. Conclusions: Musculoskeletal conditions, psychological diagnoses, and lower rank (socioeconomic status) were identified as potent predictors of inferior outcome in this study. Targeting at-risk patients within populations may improve results. Level of Evidence: Prognostic Level IV. See Instructions for Authors for a complete description of levels of evidence.

The article of record as published may be found at http://dx.doi.org/10.1016/j.spinee.2013.06.029 ; BACKGROUND CONTEXT: Although occupational driving has been associated with low back pain, little has been reported on the incidence rates for this disorder. PURPOSE: To determine the incidence rate and demographic risk factors of low back pain in an ethnically diverse and physically active population of US military vehicle operators. STUDY DESIGN/SETTING: Retrospective database analysis. PATIENT SAMPLE: All active-duty military service members between 1998 and 2006. OUTCOME MEASURES: Low back pain requiring visit to a health-care provider. METHODS: A query was performed using the US Defense Medical Epidemiology Database for the International Classification of Diseases, Ninth Revision, Clinical Modification code for low back pain (724.20). Multivariate Poisson regression analysis was used to estimate the rate of low back pain among military vehicle operators and control subjects per 1,000 person-years, while con- trolling for sex, race, rank, service, age, and marital status. RESULTS: A total of 8,447,167 person-years of data were investigated. The overall unadjusted low back pain incidence rate for military members whose occupation is vehicle operator was 54.2 per 1,000 person-years. Compared with service members with other occupations, motor vehicle operators had a significantly increased adjusted incidence rate ratio (IRR) for low back pain of 1.15 (95% con- fidence interval [CI] 1.13–1.17). Female motor vehicle operators, compared with males, had a signif- icantly increased adjusted IRR for low back pain of 1.45 (95% CI 1.39–1.52). With senior enlisted as the referent category, the junior enlisted rank group of motor vehicle operators had a significantly in- creased adjusted IRR for low back pain: 1.60 (95% CI 1.52–1.70). Compared with Marine service members, those motor vehicle operators in both the Army, 2.74 (95% CI 2.60–2.89), and the Air Force, 1.98 (95% CI 1.84–2.14), had a significantly increased adjusted IRR for low back pain. The adjusted IRRs for the less than 20-year and more than 40-year age groups, compared with the 30- to 39-year age group, were 1.24 (1.15–1.36) and 1.23 (1.10–1.38), respectively. CONCLUSIONS: Motor vehicle operators have a small but statistically significantly increased rate of low back pain compared with matched control population.

To examine the incidence of meniscal injuries and the influence of demographic and occupational factors among active-duty US service members between 1998 and 2006. ; Approved for public release; distribution is unlimited.