Repetitive Low-level Blast Exposure and Neurocognitive Effects in Army Ranger Mortarmen

ABSTRACT Introduction Occupational exposure to repetitive, low-level blasts in military training and combat has been tied to subconcussive injury and poor health outcomes for service members. Most low-level blast studies to date have focused on explosive breaching and firing heavy weapon systems; ho...

Full description

Saved in:
Bibliographic Details
Published inMilitary medicine Vol. 188; no. 3-4; pp. e771 - e779
Main Authors Woodall, Julia l.a, Sak, Jordyn a, Cowdrick, Kyle R, Bove Muñoz, Brady m, McElrath, Jessica h, Trimpe, Grace r, Mei, Yajun, Myhre, Remington l, Rains, James k, Hutchinson, Charles r
Format Journal Article
LanguageEnglish
Published US Oxford University Press 20.03.2023
Subjects
Online AccessGet full text
ISSN0026-4075
1930-613X
1930-613X
DOI10.1093/milmed/usab394

Cover

Abstract ABSTRACT Introduction Occupational exposure to repetitive, low-level blasts in military training and combat has been tied to subconcussive injury and poor health outcomes for service members. Most low-level blast studies to date have focused on explosive breaching and firing heavy weapon systems; however, there is limited research on the repetitive blast exposure and physiological effects that mortarmen experience when firing mortar weapon systems. Motivated by anecdotal symptoms of mortarmen, the purpose of this paper is to characterize this exposure and its resulting neurocognitive effects in order to provide preliminary findings and actionable recommendations to safeguard the health of mortarmen. Materials and Methods In collaboration with the U.S. Army Rangers at Fort Benning, blast exposure, symptoms, and pupillary light reflex were measured during 3 days of firing 81 mm and 120 mm mortars in training. Blast exposure analysis included the examination of the blast overpressure (BOP) and cumulative exposure by mortarman position, as well as comparison to the 4 psi safety threshold. Pupillary light reflex responses were analyzed with linear mixed effects modeling. All neurocognitive results were compared between mortarmen (n = 11) and controls (n = 4) and cross-compared with blast exposure and blast history. Results Nearly 500 rounds were fired during the study, resulting in a high cumulative blast exposure for all mortarmen. While two mortarmen had average BOPs exceeding the 4 psi safety limit (Fig. 2), there was a high prevalence of mTBI-like symptoms among all mortarmen, with over 70% experiencing headaches, ringing in the ears, forgetfulness/poor memory, and taking longer to think during the training week (n ≥ 8/11). Mortarmen also had smaller and slower pupillary light reflex responses relative to controls, with significantly slower dilation velocity (P < 0.05) and constriction velocity (P < 0.10). Conclusion Mortarmen experienced high cumulative blast exposure coinciding with altered neurocognition that is suggestive of blast-related subconcussive injury. These neurocognitive effects occurred even in mortarmen with average BOP below the 4 psi safety threshold. While this study was limited by a small sample size, its results demonstrate a concerning health risk for mortarmen that requires additional study and immediate action. Behavioral changes like ducking and standing farther from the mortar when firing can generally help reduce mortarmen BOP exposure, but we recommend the establishment of daily cumulative safety thresholds and daily firing limits in training to reduce cumulative blast exposure, and ultimately, improve mortarmen’s quality of life and longevity in service.
AbstractList Occupational exposure to repetitive, low-level blasts in military training and combat has been tied to subconcussive injury and poor health outcomes for service members. Most low-level blast studies to date have focused on explosive breaching and firing heavy weapon systems; however, there is limited research on the repetitive blast exposure and physiological effects that mortarmen experience when firing mortar weapon systems. Motivated by anecdotal symptoms of mortarmen, the purpose of this paper is to characterize this exposure and its resulting neurocognitive effects in order to provide preliminary findings and actionable recommendations to safeguard the health of mortarmen.INTRODUCTIONOccupational exposure to repetitive, low-level blasts in military training and combat has been tied to subconcussive injury and poor health outcomes for service members. Most low-level blast studies to date have focused on explosive breaching and firing heavy weapon systems; however, there is limited research on the repetitive blast exposure and physiological effects that mortarmen experience when firing mortar weapon systems. Motivated by anecdotal symptoms of mortarmen, the purpose of this paper is to characterize this exposure and its resulting neurocognitive effects in order to provide preliminary findings and actionable recommendations to safeguard the health of mortarmen.In collaboration with the U.S. Army Rangers at Fort Benning, blast exposure, symptoms, and pupillary light reflex were measured during 3 days of firing 81 mm and 120 mm mortars in training. Blast exposure analysis included the examination of the blast overpressure (BOP) and cumulative exposure by mortarman position, as well as comparison to the 4 psi safety threshold. Pupillary light reflex responses were analyzed with linear mixed effects modeling. All neurocognitive results were compared between mortarmen (n = 11) and controls (n = 4) and cross-compared with blast exposure and blast history.MATERIALS AND METHODSIn collaboration with the U.S. Army Rangers at Fort Benning, blast exposure, symptoms, and pupillary light reflex were measured during 3 days of firing 81 mm and 120 mm mortars in training. Blast exposure analysis included the examination of the blast overpressure (BOP) and cumulative exposure by mortarman position, as well as comparison to the 4 psi safety threshold. Pupillary light reflex responses were analyzed with linear mixed effects modeling. All neurocognitive results were compared between mortarmen (n = 11) and controls (n = 4) and cross-compared with blast exposure and blast history.Nearly 500 rounds were fired during the study, resulting in a high cumulative blast exposure for all mortarmen. While two mortarmen had average BOPs exceeding the 4 psi safety limit (Fig. 2), there was a high prevalence of mTBI-like symptoms among all mortarmen, with over 70% experiencing headaches, ringing in the ears, forgetfulness/poor memory, and taking longer to think during the training week (n ≥ 8/11). Mortarmen also had smaller and slower pupillary light reflex responses relative to controls, with significantly slower dilation velocity (P < 0.05) and constriction velocity (P < 0.10).RESULTSNearly 500 rounds were fired during the study, resulting in a high cumulative blast exposure for all mortarmen. While two mortarmen had average BOPs exceeding the 4 psi safety limit (Fig. 2), there was a high prevalence of mTBI-like symptoms among all mortarmen, with over 70% experiencing headaches, ringing in the ears, forgetfulness/poor memory, and taking longer to think during the training week (n ≥ 8/11). Mortarmen also had smaller and slower pupillary light reflex responses relative to controls, with significantly slower dilation velocity (P < 0.05) and constriction velocity (P < 0.10).Mortarmen experienced high cumulative blast exposure coinciding with altered neurocognition that is suggestive of blast-related subconcussive injury. These neurocognitive effects occurred even in mortarmen with average BOP below the 4 psi safety threshold. While this study was limited by a small sample size, its results demonstrate a concerning health risk for mortarmen that requires additional study and immediate action. Behavioral changes like ducking and standing farther from the mortar when firing can generally help reduce mortarmen BOP exposure, but we recommend the establishment of daily cumulative safety thresholds and daily firing limits in training to reduce cumulative blast exposure, and ultimately, improve mortarmen's quality of life and longevity in service.CONCLUSIONMortarmen experienced high cumulative blast exposure coinciding with altered neurocognition that is suggestive of blast-related subconcussive injury. These neurocognitive effects occurred even in mortarmen with average BOP below the 4 psi safety threshold. While this study was limited by a small sample size, its results demonstrate a concerning health risk for mortarmen that requires additional study and immediate action. Behavioral changes like ducking and standing farther from the mortar when firing can generally help reduce mortarmen BOP exposure, but we recommend the establishment of daily cumulative safety thresholds and daily firing limits in training to reduce cumulative blast exposure, and ultimately, improve mortarmen's quality of life and longevity in service.
ABSTRACT Introduction Occupational exposure to repetitive, low-level blasts in military training and combat has been tied to subconcussive injury and poor health outcomes for service members. Most low-level blast studies to date have focused on explosive breaching and firing heavy weapon systems; however, there is limited research on the repetitive blast exposure and physiological effects that mortarmen experience when firing mortar weapon systems. Motivated by anecdotal symptoms of mortarmen, the purpose of this paper is to characterize this exposure and its resulting neurocognitive effects in order to provide preliminary findings and actionable recommendations to safeguard the health of mortarmen. Materials and Methods In collaboration with the U.S. Army Rangers at Fort Benning, blast exposure, symptoms, and pupillary light reflex were measured during 3 days of firing 81 mm and 120 mm mortars in training. Blast exposure analysis included the examination of the blast overpressure (BOP) and cumulative exposure by mortarman position, as well as comparison to the 4 psi safety threshold. Pupillary light reflex responses were analyzed with linear mixed effects modeling. All neurocognitive results were compared between mortarmen (n = 11) and controls (n = 4) and cross-compared with blast exposure and blast history. Results Nearly 500 rounds were fired during the study, resulting in a high cumulative blast exposure for all mortarmen. While two mortarmen had average BOPs exceeding the 4 psi safety limit (Fig. 2), there was a high prevalence of mTBI-like symptoms among all mortarmen, with over 70% experiencing headaches, ringing in the ears, forgetfulness/poor memory, and taking longer to think during the training week (n ≥ 8/11). Mortarmen also had smaller and slower pupillary light reflex responses relative to controls, with significantly slower dilation velocity (P < 0.05) and constriction velocity (P < 0.10). Conclusion Mortarmen experienced high cumulative blast exposure coinciding with altered neurocognition that is suggestive of blast-related subconcussive injury. These neurocognitive effects occurred even in mortarmen with average BOP below the 4 psi safety threshold. While this study was limited by a small sample size, its results demonstrate a concerning health risk for mortarmen that requires additional study and immediate action. Behavioral changes like ducking and standing farther from the mortar when firing can generally help reduce mortarmen BOP exposure, but we recommend the establishment of daily cumulative safety thresholds and daily firing limits in training to reduce cumulative blast exposure, and ultimately, improve mortarmen’s quality of life and longevity in service.
Occupational exposure to repetitive, low-level blasts in military training and combat has been tied to subconcussive injury and poor health outcomes for service members. Most low-level blast studies to date have focused on explosive breaching and firing heavy weapon systems; however, there is limited research on the repetitive blast exposure and physiological effects that mortarmen experience when firing mortar weapon systems. Motivated by anecdotal symptoms of mortarmen, the purpose of this paper is to characterize this exposure and its resulting neurocognitive effects in order to provide preliminary findings and actionable recommendations to safeguard the health of mortarmen. In collaboration with the U.S. Army Rangers at Fort Benning, blast exposure, symptoms, and pupillary light reflex were measured during 3 days of firing 81 mm and 120 mm mortars in training. Blast exposure analysis included the examination of the blast overpressure (BOP) and cumulative exposure by mortarman position, as well as comparison to the 4 psi safety threshold. Pupillary light reflex responses were analyzed with linear mixed effects modeling. All neurocognitive results were compared between mortarmen (n = 11) and controls (n = 4) and cross-compared with blast exposure and blast history. Nearly 500 rounds were fired during the study, resulting in a high cumulative blast exposure for all mortarmen. While two mortarmen had average BOPs exceeding the 4 psi safety limit (Fig. 2), there was a high prevalence of mTBI-like symptoms among all mortarmen, with over 70% experiencing headaches, ringing in the ears, forgetfulness/poor memory, and taking longer to think during the training week (n ≥ 8/11). Mortarmen also had smaller and slower pupillary light reflex responses relative to controls, with significantly slower dilation velocity (P < 0.05) and constriction velocity (P < 0.10). Mortarmen experienced high cumulative blast exposure coinciding with altered neurocognition that is suggestive of blast-related subconcussive injury. These neurocognitive effects occurred even in mortarmen with average BOP below the 4 psi safety threshold. While this study was limited by a small sample size, its results demonstrate a concerning health risk for mortarmen that requires additional study and immediate action. Behavioral changes like ducking and standing farther from the mortar when firing can generally help reduce mortarmen BOP exposure, but we recommend the establishment of daily cumulative safety thresholds and daily firing limits in training to reduce cumulative blast exposure, and ultimately, improve mortarmen's quality of life and longevity in service.
Author McElrath, Jessica h
Trimpe, Grace r
Hutchinson, Charles r
Woodall, Julia l.a
Sak, Jordyn a
Mei, Yajun
Cowdrick, Kyle R
Rains, James k
Myhre, Remington l
Bove Muñoz, Brady m
Author_xml – sequence: 1
  givenname: Julia l.a
  orcidid: 0000-0003-2279-1694
  surname: Woodall
  fullname: Woodall, Julia l.a
– sequence: 2
  givenname: Jordyn a
  surname: Sak
  fullname: Sak, Jordyn a
– sequence: 3
  givenname: Kyle R
  orcidid: 0000-0003-2236-6137
  surname: Cowdrick
  fullname: Cowdrick, Kyle R
– sequence: 4
  givenname: Brady m
  surname: Bove Muñoz
  fullname: Bove Muñoz, Brady m
– sequence: 5
  givenname: Jessica h
  surname: McElrath
  fullname: McElrath, Jessica h
– sequence: 6
  givenname: Grace r
  surname: Trimpe
  fullname: Trimpe, Grace r
– sequence: 7
  givenname: Yajun
  surname: Mei
  fullname: Mei, Yajun
– sequence: 8
  givenname: Remington l
  surname: Myhre
  fullname: Myhre, Remington l
– sequence: 9
  givenname: James k
  surname: Rains
  fullname: Rains, James k
– sequence: 10
  givenname: Charles r
  surname: Hutchinson
  fullname: Hutchinson, Charles r
BackLink https://www.ncbi.nlm.nih.gov/pubmed/34557921$$D View this record in MEDLINE/PubMed
BookMark eNqFkEtv1DAUhS1URKeFLUvkJV2kY8ePxMtSDQ9pAKkCwS66Tm6qIMcOttMy_55UmW6QUFd3833n6J4zcuKDR0Jec3bJmRHbcXAjdts5gRVGPiMbbgQrNBc_T8iGsVIXklXqlJyl9IsxLk3NX5BTIZWqTMk35McNTpiHPNwh3Yf7wuEdOvrOQcp092cKaY5IwXf0C84xtOHWr-yu77HNiQ6eXsXxQG_A32Kkn0PMEEf0L8nzHlzCV8d7Tr6_3327_ljsv374dH21L1qhTS5qLaBXloO1RgppbSlKrUqly6qqK9513CxPdHVX6woYlrUU3AL2UhllTQfinGzX3NlPcLgH55opDiPEQ8NZ8zBRs07UHCdajLerMcXwe8aUFyC16Bx4DHNqSlVpLetamgV9c0Rn-xDxmPw43wJcrkAbQ0oR-6fL5T9CO2TIQ_A5wuD-r12sWpinpyr-Ao1Qpe4
CitedBy_id crossref_primary_10_1089_neu_2022_0284
crossref_primary_10_1089_neu_2022_0192
crossref_primary_10_1089_neu_2023_0444
crossref_primary_10_1007_s00193_024_01170_9
crossref_primary_10_3390_s24217064
crossref_primary_10_1093_milmed_usae082
crossref_primary_10_1093_milmed_usad429
crossref_primary_10_3389_fneur_2023_1237647
Cites_doi 10.1093/milmed/usaa439
10.1097/01376517-200502000-00006
10.1007/s00193-017-0766-0
10.1093/milmed/usx186
10.1097/HTR.0000000000000417
10.1097/HTR.0000000000000064
10.3389/fneur.2019.00949
10.1007/s00193-017-0755-3
10.1007/BF00868811
10.1093/milmed/usaa332
10.3389/fneur.2015.00221
10.1001/jamanetworkopen.2021.6445
10.1111/j.1749-6632.1968.tb11972.x
10.1016/j.bbr.2011.12.015
10.1089/neu.2012.2683
10.1115/IMECE2013-65138
10.1080/02699052.2016.1195922
10.3171/2013.7.JNS121822
10.1016/S1474-4422(16)30057-6
10.1007/s12028-018-0607-8
10.1080/02699052.2016.1192220
10.7205/MILMED-D-15-00137
10.3389/fneur.2019.00797
10.1007/s00193-017-0738-4
10.1002/jnr.22161
ContentType Journal Article
Copyright The Association of Military Surgeons of the United States 2021. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com. 2021
The Association of Military Surgeons of the United States 2021. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.
Copyright_xml – notice: The Association of Military Surgeons of the United States 2021. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com. 2021
– notice: The Association of Military Surgeons of the United States 2021. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.
DBID AAYXX
CITATION
CGR
CUY
CVF
ECM
EIF
NPM
7X8
ADTOC
UNPAY
DOI 10.1093/milmed/usab394
DatabaseName CrossRef
Medline
MEDLINE
MEDLINE (Ovid)
MEDLINE
MEDLINE
PubMed
MEDLINE - Academic
Unpaywall for CDI: Periodical Content
Unpaywall
DatabaseTitle CrossRef
MEDLINE
Medline Complete
MEDLINE with Full Text
PubMed
MEDLINE (Ovid)
MEDLINE - Academic
DatabaseTitleList MEDLINE - Academic

MEDLINE
Database_xml – sequence: 1
  dbid: NPM
  name: PubMed
  url: https://proxy.k.utb.cz/login?url=http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed
  sourceTypes: Index Database
– sequence: 2
  dbid: EIF
  name: MEDLINE
  url: https://proxy.k.utb.cz/login?url=https://www.webofscience.com/wos/medline/basic-search
  sourceTypes: Index Database
– sequence: 3
  dbid: UNPAY
  name: Unpaywall
  url: https://proxy.k.utb.cz/login?url=https://unpaywall.org/
  sourceTypes: Open Access Repository
DeliveryMethod fulltext_linktorsrc
Discipline Medicine
EISSN 1930-613X
EndPage e779
ExternalDocumentID 10.1093/milmed/usab394
34557921
10_1093_milmed_usab394
Genre Research Support, Non-U.S. Gov't
Journal Article
GroupedDBID ---
.GJ
.HR
04C
0R~
123
1CY
29M
36B
48X
53G
5RE
5WD
7RV
7X7
88E
88I
8AF
8AO
8C1
8FI
8FJ
8R4
8R5
96U
AABZA
AACZT
AAJQQ
AAMZS
AAPGJ
AAPQZ
AAPXW
AARHZ
AAUAY
AAUOS
AAUQX
AAVAP
AAWDT
AAWTL
ABDBF
ABDFA
ABEJV
ABGNP
ABIVO
ABJNI
ABKEB
ABNHQ
ABPQP
ABPTD
ABQNK
ABUWG
ABVGC
ABWST
ABXVK
ABXVV
ACBNA
ACFRR
ACGFS
ACGOD
ACIHN
ACOZV
ACUHS
ACUTJ
ACYHN
ACZBC
ADAES
ADBBV
ADBKU
ADGZP
ADIPN
ADLOL
ADQBN
ADQIT
ADRTK
ADVEK
AEAQA
AEJER
AENEX
AETBJ
AFAZI
AFFQV
AFFZL
AFKRA
AFOFC
AFYAG
AGINJ
AGKRT
AGMDO
AGQXC
AGUTN
AHMBA
AHMMS
AJEEA
AJNCP
ALIPV
ALMA_UNASSIGNED_HOLDINGS
APJGH
AQDSO
AZQEC
B0M
BAYMD
BCR
BCRHZ
BCU
BEC
BENPR
BEYMZ
BHZBG
BKEYQ
BKNYI
BLC
BMSDO
BOXDG
BPHCQ
BTRTY
BVXVI
C45
CCPQU
CDBKE
DAKXR
DWQXO
EAP
EBC
EBD
EBS
ECIRT
EHN
EIHBH
EIHJH
EIS
EJD
EMB
EMI
EMK
EMOBN
ENC
ENERS
EPL
EPT
ESX
ETYVG
EX3
EYXSX
F5P
F8P
FECEO
FLUFQ
FOEOM
FOTVD
FQBLK
FYUFA
GAUVT
GJXCC
GNUQQ
H13
HCIFZ
HMCUK
K9-
KBUDW
KOP
KSI
KSN
L7B
LOXHT
M0R
M1P
M1Q
M2M
M2P
M2Q
MBLQV
MHKGH
MJWOD
MXSPP
NAPCQ
NJ-
NOMLY
NOYVH
NVLIB
O9-
OAUYM
OCZFY
ODMLO
OHT
OJZSN
OK1
OPAEJ
OVD
OWPYF
OXVUA
PAFKI
PCD
PEA
PHGZT
PLIXB
PQQKQ
PROAC
PSQYO
PSYQQ
Q-A
Q2X
Q~Q
ROX
RUSNO
RWL
RXW
S0X
SJFOW
SJN
SV3
TAE
TEORI
THA
TMA
TUS
U5U
UAP
UKHRP
UNMZH
WH7
WOW
YADRA
YAJVU
YAYTL
YCJ
YKOAZ
YXANX
ZGI
ZXP
~8M
~SN
AAYXX
ADNBA
ADYLA
AEMQT
AFVSF
AFXAL
AHGBF
AJBYB
ALXQX
ATGXG
CITATION
JXSIZ
NU-
CGR
CUY
CVF
ECM
EIF
NPM
7X8
AAMOW
ABJHR
ACVCV
ADMTO
ADTOC
AGORE
AICVH
AJDVS
AVNTJ
OBFPC
PHGZM
PJZUB
PPXIY
UNPAY
ID FETCH-LOGICAL-c369t-863af5b1abb9434bb23265256277871dd19002d8d867a0e28431baef4595b9da3
IEDL.DBID UNPAY
ISSN 0026-4075
1930-613X
IngestDate Tue Aug 19 19:59:53 EDT 2025
Sun Sep 28 11:49:32 EDT 2025
Thu Apr 03 07:05:58 EDT 2025
Wed Oct 01 00:24:05 EDT 2025
Thu Apr 24 22:54:50 EDT 2025
Wed Mar 05 08:08:53 EST 2025
IsDoiOpenAccess true
IsOpenAccess true
IsPeerReviewed true
IsScholarly true
Issue 3-4
Language English
License This article is published and distributed under the terms of the Oxford University Press, Standard Journals Publication Model (https://academic.oup.com/pages/standard-publication-reuse-rights)
https://academic.oup.com/pages/standard-publication-reuse-rights
The Association of Military Surgeons of the United States 2021. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.
LinkModel DirectLink
MergedId FETCHMERGED-LOGICAL-c369t-863af5b1abb9434bb23265256277871dd19002d8d867a0e28431baef4595b9da3
Notes ObjectType-Article-1
SourceType-Scholarly Journals-1
ObjectType-Feature-2
content type line 23
ORCID 0000-0003-2279-1694
0000-0003-2236-6137
OpenAccessLink https://proxy.k.utb.cz/login?url=https://academic.oup.com/milmed/advance-article-pdf/doi/10.1093/milmed/usab394/40434837/usab394.pdf
PMID 34557921
PQID 2576648849
PQPubID 23479
ParticipantIDs unpaywall_primary_10_1093_milmed_usab394
proquest_miscellaneous_2576648849
pubmed_primary_34557921
crossref_primary_10_1093_milmed_usab394
crossref_citationtrail_10_1093_milmed_usab394
oup_primary_10_1093_milmed_usab394
ProviderPackageCode CITATION
AAYXX
PublicationCentury 2000
PublicationDate 2023-03-20
PublicationDateYYYYMMDD 2023-03-20
PublicationDate_xml – month: 03
  year: 2023
  text: 2023-03-20
  day: 20
PublicationDecade 2020
PublicationPlace US
PublicationPlace_xml – name: US
– name: England
PublicationTitle Military medicine
PublicationTitleAlternate Mil Med
PublicationYear 2023
Publisher Oxford University Press
Publisher_xml – name: Oxford University Press
References Hall (2023033100410615500_) 2018; 8
Boutté (2023033100410615500_) 2021; 4
Carr (2023033100410615500_) 2016; 181
Skotak (2023033100410615500_) 2019; 10
U.S. Department of the Army (2023033100410615500_) 2007
Duckworth (2023033100410615500_) 2018
Defense and Veterans Brain Injury Center (DVBIC) (2023033100410615500_)
Engel (2023033100410615500_) 2019
Woodson (2023033100410615500_) 2015
Carr (2023033100410615500_) 2017; 27
Shively (2023033100410615500_) 2016; 15
Ong (2023033100410615500_) 2019; 30
Winn (2023033100410615500_) 1994; 35
LaValle (2023033100410615500_) 2019; 10
Vartanian (2023033100410615500_) 2021; 186
Capó-Aponte (2023033100410615500_) 2013; 4
Carr (2023033100410615500_) 2015; 30
Kamimori (2023033100410615500_) 2017; 27
Shultz (2023033100410615500_) 2012; 229
Nakashima (2023033100410615500_) 2021
Bailie (2023033100410615500_) 2015
Miller (2023033100410615500_) 2016
Truong (2023033100410615500_) 2016; 30
Kamimori (2023033100410615500_) 2018; 183
Wiri (2023033100410615500_) 2017; 27
King (2023033100410615500_) 1995; 242
Meeker (2023033100410615500_) 2005; 37
U.S. Department of the Army (2023033100410615500_) 2010
Shepherd Center (2023033100410615500_)
Fish (2023033100410615500_) 2018
Hirsch (2023033100410615500_) 1968; 152
Yuen (2023033100410615500_) 2009; 87
Regasa (2023033100410615500_) 2019; 34
U.S. Department of Veterans Affairs and Department of Defense (2023033100410615500_) 2016
Bailes (2023033100410615500_) 2013; 119
Courtney (2023033100410615500_) 2015; 6
Ostertag (2023033100410615500_)
Tate (2023033100410615500_) 2013; 30
References_xml – year: 2021
  ident: 2023033100410615500_
  article-title: Repeated occupational exposure to low-level blast in the Canadian armed forces: effects on hearing, balance, and ataxia
  publication-title: Mil Med
  doi: 10.1093/milmed/usaa439
– volume-title: Understanding potential neurological consequences and mechanisms of repeated blast exposure. Oral presentation at the International State-of-the-Science Meeting on the Neurological Effects of Repeated Exposure to Military Occupational Blast: implications for prevention and health
  year: 2018
  ident: 2023033100410615500_
– volume-title: Symptoms and recovery of mTBI and concussion
  ident: 2023033100410615500_
– volume: 37
  start-page: 34
  issue: 1
  year: 2005
  ident: 2023033100410615500_
  article-title: Pupil examination: validity and clinical utility of an automated pupillometer
  publication-title: J Neurosci Nurs
  doi: 10.1097/01376517-200502000-00006
– volume: 27
  start-page: 829
  issue: 6
  year: 2017
  ident: 2023033100410615500_
  article-title: Perspectives on repeated low-level blast and the measurement of neurotrauma in humans as an occupational exposure risk
  publication-title: Shock Waves
  doi: 10.1007/s00193-017-0766-0
– volume: 183
  start-page: 28
  issue: Suppl 1
  year: 2018
  ident: 2023033100410615500_
  article-title: Longitudinal investigation of neurotrauma serum biomarkers, behavioral characterization, and brain imaging in soldiers following repeated low-level blast exposure (New Zealand Breacher Study)
  publication-title: Mil Med
  doi: 10.1093/milmed/usx186
– volume: 34
  start-page: 21
  issue: 1
  year: 2019
  ident: 2023033100410615500_
  article-title: Traumatic brain injury following military deployment: evaluation of diagnosis and cause of injury
  publication-title: J Head Trauma Rehabil
  doi: 10.1097/HTR.0000000000000417
– volume-title: DOD TBI worldwide numbers (2000-2020)
  ident: 2023033100410615500_
– volume: 35
  start-page: 1132
  issue: 3
  year: 1994
  ident: 2023033100410615500_
  article-title: Factors affecting light-adapted pupil size in normal human subjects
  publication-title: Invest Ophthalmol Vis Sci
– volume: 30
  start-page: 47
  issue: 1
  year: 2015
  ident: 2023033100410615500_
  article-title: Relation of repeated low-level blast exposure with symptomology similar to concussion
  publication-title: J Head Trauma Rehabil
  doi: 10.1097/HTR.0000000000000064
– volume: 10
  year: 2019
  ident: 2023033100410615500_
  article-title: Neurocognitive performance deficits related to immediate and acute blast overpressure exposure
  publication-title: Front Neurol
  doi: 10.3389/fneur.2019.00949
– volume: 27
  start-page: 849
  issue: 6
  year: 2017
  ident: 2023033100410615500_
  article-title: Computational modeling of blast exposure associated with recoilless weapons combat training
  publication-title: Shock Waves
  doi: 10.1007/s00193-017-0755-3
– volume: 242
  start-page: 587
  issue: 9
  year: 1995
  ident: 2023033100410615500_
  article-title: The rivermead post concussion symptoms questionnaire: a measure of symptoms commonly experienced after head injury and its reliability
  publication-title: J Neurol
  doi: 10.1007/BF00868811
– year: 2019
  ident: 2023033100410615500_
  article-title: The neurological effects of repeated exposure to military occupational blast: implications for prevention and health
– volume: 186
  start-page: e393
  issue: 3–4
  year: 2021
  ident: 2023033100410615500_
  article-title: Neuropsychological, neurocognitive, vestibular, and neuroimaging correlates of exposure to repetitive low-level blast waves: evidence from four nonoverlapping samples of Canadian breachers
  publication-title: Mil Med
  doi: 10.1093/milmed/usaa332
– volume: 6
  year: 2015
  ident: 2023033100410615500_
  article-title: The complexity of biomechanics causing primary blast-induced traumatic brain injury: a review of potential mechanisms
  publication-title: Front Neurol
  doi: 10.3389/fneur.2015.00221
– volume-title: Traumatic brain injury: updated definition and reporting, pp 2–3
  year: 2015
  ident: 2023033100410615500_
– volume-title: Mortar simulators: indirect fire: precision and accuracy with three mortar simulators. InVeris Training Solutions
  year: 2016
  ident: 2023033100410615500_
– volume: 4
  issue: 4
  year: 2021
  ident: 2023033100410615500_
  article-title: Neurotrauma biomarker levels and adverse symptoms among military and law enforcement personnel exposed to occupational overpressure without diagnosed traumatic brain injury
  publication-title: JAMA Netw Open
  doi: 10.1001/jamanetworkopen.2021.6445
– volume-title: Protecting warfighters from blast injury
  year: 2018
  ident: 2023033100410615500_
– volume: 152
  start-page: 147
  issue: 1
  year: 1968
  ident: 2023033100410615500_
  article-title: Effects of overpressure on the ear—a review
  publication-title: Ann N Y Acad Sci
  doi: 10.1111/j.1749-6632.1968.tb11972.x
– volume: 229
  start-page: 145
  issue: 1
  year: 2012
  ident: 2023033100410615500_
  article-title: Sub-concussive brain injury in the Long-Evans rat induces acute neuroinflammation in the absence of behavioral impairments
  publication-title: Behav Brain Res
  doi: 10.1016/j.bbr.2011.12.015
– volume: 30
  start-page: 1620
  issue: 19
  year: 2013
  ident: 2023033100410615500_
  article-title: Serum brain biomarker level, neurocognitive performance, and self-reported symptom changes in soldiers repeatedly exposed to low-level blast: a breacher pilot study
  publication-title: J Neurotrauma
  doi: 10.1089/neu.2012.2683
– volume-title: Technical manual 3-23.25: shoulder fired munitions, pp 55–6
  year: 2010
  ident: 2023033100410615500_
– volume-title: ASME International Mechanical Engineering Congress and Exposition 2014: IMECE2013-65138
  ident: 2023033100410615500_
  article-title: The blast gauge™ system as a research tool to quantify blast overpressure in complex environments
  doi: 10.1115/IMECE2013-65138
– volume: 30
  start-page: 1378
  issue: 11
  year: 2016
  ident: 2023033100410615500_
  article-title: Comparison of pupillary dynamics to light in the mild traumatic brain injury (mTBI) and normal populations
  publication-title: Brain Inj
  doi: 10.1080/02699052.2016.1195922
– year: 2015
  ident: 2023033100410615500_
  article-title: Blast exposure from shoulder mounted rocket launchers
– volume: 119
  start-page: 1235
  issue: 5
  year: 2013
  ident: 2023033100410615500_
  article-title: Role of subconcussion in repetitive mild traumatic brain injury
  publication-title: J Neurosurg
  doi: 10.3171/2013.7.JNS121822
– volume: 15
  start-page: 944
  issue: 9
  year: 2016
  ident: 2023033100410615500_
  article-title: Characterisation of interface astroglial scarring in the human brain after blast exposure: a post-mortem case series
  publication-title: Lancet Neurol
  doi: 10.1016/S1474-4422(16)30057-6
– volume: 30
  start-page: 316
  issue: 2
  year: 2019
  ident: 2023033100410615500_
  article-title: The effect of ambient light conditions on quantitative pupillometry
  publication-title: Neurocrit Care
  doi: 10.1007/s12028-018-0607-8
– volume: 30
  start-page: 1372
  issue: 11
  year: 2016
  ident: 2023033100410615500_
  article-title: Quantifying pupillary asymmetry through objective binocular pupillometry in the normal and mild traumatic brain injury (mTBI) populations
  publication-title: Brain Inj
  doi: 10.1080/02699052.2016.1192220
– volume: 181
  start-page: 28
  issue: Suppl 5
  year: 2016
  ident: 2023033100410615500_
  article-title: Repeated low-level blast exposure: a descriptive human subjects study
  publication-title: Mil Med
  doi: 10.7205/MILMED-D-15-00137
– volume: 10
  year: 2019
  ident: 2023033100410615500_
  article-title: Occupational blast wave exposure during multiday 0.50 caliber rifle course
  publication-title: Front Neurol
  doi: 10.3389/fneur.2019.00797
– volume-title: Field manual 3-34.214: explosives and demolitions
  year: 2007
  ident: 2023033100410615500_
– volume-title: VA/DoD clinical practice guideline for the management of concussion-mild traumatic brain injury
  year: 2016
  ident: 2023033100410615500_
– volume: 27
  start-page: 837
  issue: 6
  year: 2017
  ident: 2023033100410615500_
  article-title: Occupational overpressure exposure of breachers and military personnel
  publication-title: Shock Waves
  doi: 10.1007/s00193-017-0738-4
– volume: 87
  start-page: 3620
  issue: 16
  year: 2009
  ident: 2023033100410615500_
  article-title: Sodium channelopathy induced by mild axonal trauma worsens outcome after a repeat injury
  publication-title: J Neurosci Res
  doi: 10.1002/jnr.22161
– volume: 4
  start-page: 1
  issue: 2
  year: 2013
  ident: 2023033100410615500_
  article-title: Pupillary light reflex as an objective biomarker for early identification of blast-induced mTBI
  publication-title: J Spine
– volume: 8
  issue: 1
  year: 2018
  ident: 2023033100410615500_
  article-title: Eyeing up the future of the pupillary light reflex in neurodiagnostics
  publication-title: Diagnostics (Basel)
SSID ssj0014981
Score 2.4148738
Snippet ABSTRACT Introduction Occupational exposure to repetitive, low-level blasts in military training and combat has been tied to subconcussive injury and poor...
Occupational exposure to repetitive, low-level blasts in military training and combat has been tied to subconcussive injury and poor health outcomes for...
SourceID unpaywall
proquest
pubmed
crossref
oup
SourceType Open Access Repository
Aggregation Database
Index Database
Enrichment Source
Publisher
StartPage e771
SubjectTerms Blast Injuries - complications
Blast Injuries - diagnosis
Explosions
Humans
Military Personnel - psychology
Quality of Life
Title Repetitive Low-level Blast Exposure and Neurocognitive Effects in Army Ranger Mortarmen
URI https://www.ncbi.nlm.nih.gov/pubmed/34557921
https://www.proquest.com/docview/2576648849
https://academic.oup.com/milmed/advance-article-pdf/doi/10.1093/milmed/usab394/40434837/usab394.pdf
UnpaywallVersion publishedVersion
Volume 188
hasFullText 1
inHoldings 1
isFullTextHit
isPrint
journalDatabaseRights – providerCode: PRVEBS
  databaseName: EBSCOhost Academic Search Ultimate
  customDbUrl: https://search.ebscohost.com/login.aspx?authtype=ip,shib&custid=s3936755&profile=ehost&defaultdb=asn
  eissn: 1930-613X
  dateEnd: 20241002
  omitProxy: true
  ssIdentifier: ssj0014981
  issn: 0026-4075
  databaseCode: ABDBF
  dateStart: 20030801
  isFulltext: true
  titleUrlDefault: https://search.ebscohost.com/direct.asp?db=asn
  providerName: EBSCOhost
– providerCode: PRVEBS
  databaseName: EBSCOhost International Security & Counter Terrorism Reference Center
  customDbUrl:
  eissn: 1930-613X
  dateEnd: 20241002
  omitProxy: false
  ssIdentifier: ssj0014981
  issn: 0026-4075
  databaseCode: EIS
  dateStart: 20030801
  isFulltext: true
  titleUrlDefault: https://search.ebscohost.com/login.aspx?authtype=ip,uid&profile=ehost&defaultdb=tsh
  providerName: EBSCOhost
link http://utb.summon.serialssolutions.com/2.0.0/link/0/eLvHCXMwtV3fTxQxEJ7gkaA-oCjqgZJqTPClx-72x20fwUCQICHoxeNp017bhHjsXbjdID77hzu9_SGQGHjhdXfSzbbdmW92vvkK8NGLPncidPRIpimPeUyVN45aGXkR9M2Em7N8j-T-gB8MxXABRk0vjK5Z4b2mpQGzfAwLW3VFvKGL0an1_8QHFGvMypk2TPGtoBkTtNKbCz20fwSLMlShOrA4ODrePq3IHxIzqLkcLyKZkEixYSvteHvUG6HrRjvcNVT6FB6X-VRfXerx-Fqk2nsGf5p3rAgqP3tlYXqj37fkHx94Ep7Dco10yXY1ygosuPwFLH2ta_kv4Qdi_9Dihu6WHE4u6TjQl8gOovmC7P6aTsKvS6JzS-b6IS3NiVR6yzNyluPY51fkZN65TAJrWF-cu3wVBnu73z_v0_qYBzpiUhU0xV3ihYm1MUGszhgEeVIgFEv66E1iaxGzRIlNbSr7OnIYT1lstPNcKGGU1ewVdPJJ7t4AsQwNpUyl8-iZlEu9E9yqyNugWSR4F2izgtmo1kAPR3GMs6oWz7JqCrN6xrqw2dpPK_WP_1p-wMW60-h9s1_wziyUZnTuJuUsC2mfRF_KVRdeVxupHYtxIfoqibvwqd1Zdzxo7f6m6_AkQdwWaHVJ9BY6xUXp3iHOKswG5hZfvm3UX8tfRm4ptw
linkProvider Unpaywall
linkToUnpaywall http://utb.summon.serialssolutions.com/2.0.0/link/0/eLvHCXMwtV1NT9wwEB3RRaLtgZZC2y2lMlUluHg3iT82PtIKhBAgVHXV5RTZa1uqumRXbCJKz_3hHW8-CkgVXLgmo4liO543mTfPAJ-8GHAnQkePZJrymMdUeeOolZEXQd9MuAXL91QeDvnRSIyWYNz0wuiaFd5rWhowy8ew0K8r4g1djM6s_yc-oFhjVs61YYr3g2ZM0EpvLvTQ_gksy1CF6sDy8PRs77wif0jMoBZyvIhkQiLFRq20412vt0LXrXa4G6j0OTwt85m-vtKTyY1IdfAC_jTvWBFUfvbKwvTGv-_IPz7yILyE1Rrpkr3KyxosufwVrJzUtfx1-I7YP7S44XZLjqdXdBLoS-QzovmC7P-aTcOvS6JzSxb6IS3NiVR6y3PyI0ffF9fk66JzmQTWsL68cPkGDA_2v305pPUxD3TMpCpoiqvECxNrY4JYnTEI8qRAKJYMcDeJrUXMEiU2takc6MhhPGWx0c5zoYRRVrPX0MmnuXsLxDI0lDKVzuPOpFzqneBWRd4GzSLBu0CbGczGtQZ6OIpjklW1eJZVQ5jVI9aFndZ-Vql__NfyI07WvUbbzXrBO_NQmtG5m5bzLKR9EvdSrrrwplpIrS_GhRioJO7Cbruy7nnQu4ebbsKzBHFboNUl0XvoFJel20KcVZgP9XfyF1G9KLU
openUrl ctx_ver=Z39.88-2004&ctx_enc=info%3Aofi%2Fenc%3AUTF-8&rfr_id=info%3Asid%2Fsummon.serialssolutions.com&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.atitle=Repetitive+Low-level+Blast+Exposure+and+Neurocognitive+Effects+in+Army+Ranger+Mortarmen&rft.jtitle=Military+medicine&rft.au=Woodall%2C+Julia+l.a&rft.au=Sak%2C+Jordyn+a&rft.au=Cowdrick%2C+Kyle+R&rft.au=Bove+Mu%C3%B1oz%2C+Brady+m&rft.date=2023-03-20&rft.pub=Oxford+University+Press&rft.issn=0026-4075&rft.eissn=1930-613X&rft.volume=188&rft.issue=3-4&rft.spage=e771&rft.epage=e779&rft_id=info:doi/10.1093%2Fmilmed%2Fusab394&rft.externalDocID=10.1093%2Fmilmed%2Fusab394
thumbnail_l http://covers-cdn.summon.serialssolutions.com/index.aspx?isbn=/lc.gif&issn=0026-4075&client=summon
thumbnail_m http://covers-cdn.summon.serialssolutions.com/index.aspx?isbn=/mc.gif&issn=0026-4075&client=summon
thumbnail_s http://covers-cdn.summon.serialssolutions.com/index.aspx?isbn=/sc.gif&issn=0026-4075&client=summon