The purpose of this study was to examine the feasibility and acceptability of an auricular acupuncture (AA) insomnia regimen among Operation Iraqi Freedom and Operation Enduring Freedom veterans with post-traumatic stress disorder and sleep disturbance. Secondarily, this study examined the effect of an AA insomnia regimen on objective sleep times by wrist actigraphy, subjective sleep times by sleep diary, and sleep quality ratings utilizing the Pittsburg Sleep Quality Index. Veterans (n = 30) were randomized to receive a 3-week AA insomnia regimen. Veterans receiving the AA insomnia regimen reported it as a more acceptable treatment for sleep disturbance than subjects in the control group (AA group median = 5 vs. control group median = 3, p = 0.004). Significant differences between groups were found on the sleep quality and daytime dysfunction components of the Pittsburgh Sleep Quality Index (p = 0.003, p = 0.004). No other significant differences between groups were found for objective and subjective sleep measures. These results suggest that an AA insomnia regimen may improve sleep quality and daytime dysfunction among veterans with post-traumatic stress disorder. Future, large-scale, prospective clinical trials are needed to examine AA effects on sleep.

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Blast exposure is a prevalent cause of mild traumatic brain injury (mTBI) in military personnel in combat. However, it is more common for a service member to be exposed to a low-level blast (LLB) that does not result in a clinically diagnosable mTBI. Recent research suggests that repetitive LLB exposure can result in symptomology similar to symptoms observed after mTBI. This manuscript reports on the use of an Android-based smartphone application (AccWalker app) to capture changes in neuromotor functioning after blast exposure. Active duty U.S. Navy personnel (N = 59) performed a stepping-in-place task before repetitive LLB exposure (heavy weapons training), and again immediately after, 24 hours after, and 72 to 96 hours after the completion of the training. The AccWalker app revealed that there are changes in neuromotor functioning after LLB exposure (slower self-selected movement pace and increased stride time variability) in participants who experienced neurocognitive decline. These data suggest that neurocognitive and neuromotor decline can occur after repeated LLB exposure.

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Mount Etna is Europe's largest and most active volcano. In recent years, it has displayed enhanced explosive activity, causing concern amongst local inhabitants who frequently have to live with, and clean up, substantial ashfall. Basaltic volcanic ash is generally considered unlikely to be a respiratory health hazard due to its often coarse nature (with few particles sub-10 μm diameter) and lack of crystalline silica. However, a previous study by the authors showed the capability of basaltic ash to generate the hydroxyl radical, a highly-reactive species which may cause cell damage. That study investigated a single sample of Etna ash, amongst others, with data giving an early indication that the Etnean ash may be uniquely reactive. In this study, we analyse a suite of Etnean samples from recent and historical eruptions. Deposits indicate that Etna's past history was much more explosive than current activity, with frequent sub-plinian to plinian events. Given the recent increase in explosivity of Etna, the potential hazard of similarly, or more-explosive, eruptions should be assessed. A suite of physicochemical analyses were conducted which showed recent ash, from 2001 and 2002 explosive phases, to be of similar composition to the historical deposits (trachy-basaltic) but rather coarser (< 2.4 c.v.% sub-10 μm material and <11.5 c.v.% sub-10 μm material, respectively), but the potential for post-depositional fragmentation by wind and vehicles should not be ignored. One recent sample contained a moderate number of fibre-like particles, but all other samples were typical of fine-grained ash (blocky, angular with electrostatic or chemical aggregation of finer particles on larger ones). The surface reactivity analyses (Fenton chemistry, on samples from recent eruptions only) showed that Etnean ash is more reactive in hydroxyl radical generation than other basaltic ash, and samples of intermediate composition. This high reactivity suggests that Etnean ash could promote oxidative stress in exposed cells. Therefore, further investigation of the potential toxicity, through cellular tests, is now warranted in order to provide a comprehensive health hazard assessment.

Background: Clinical recommendations for concussion management encourage reduced cognitive and physical activities immediately after injury, with graded increases in activity as symptoms resolve. Empirical support for the effectiveness of such recommendations is needed. Purpose: To examine whether training medical providers on the Defense and Veterans Brain Injury Center’s Progressive Return to Activity Clinical Recommendation (PRA-CR) for acute concussion improves patient outcomes. Study Design: Cohort study; Level of evidence, 2. Methods: This study was conducted from 2016 to 2018 and compared patient outcomes before and after medical providers received an educational intervention (ie, provider training). Patients, recruited either before or after intervention, were assessed at ≤72 hours, 1 week, 1 month, 3 months, and 6 months after a concussion. The participant population included 38 military medical providers and 106 military servicemembers with a diagnosed concussion and treated by one of the military medical providers: 58 patient participants received care before the intervention (ie, provider training) and 48 received care after intervention. The primary outcome measure was the Neurobehavioral Symptom Inventory. Results: The patients seen before and after the intervention were predominantly male (89.7% and 93.8%, respectively) of military age (mean ± SD, 26.62 ± 6.29 years and 25.08 ± 6.85 years, respectively) and a mean ± SD of 1.92 ± 0.88 days from injury. Compared with patients receiving care before intervention, patients receiving care after intervention had smaller increases in physical activities (difference in mean change; 95% CI, 0.39 to 6.79) and vestibular/balance activities (95% CI, 0.79 to 7.5) during the first week of recovery. Although groups did not differ in symptoms at ≤72 hours of injury ( d = 0.22; 95% CI, –2.21 to 8.07), the postintervention group reported fewer symptoms at 1 week ( d = 0.61; 95% CI, 0.52 to 10.92). Postintervention patients who completed the 6-month study had improved recovery both at 1 month ( d = 1.55; 95% CI, 5.33 to 15.39) and 3 months after injury ( d = 1.10; 95% CI, 2.36 to 11.55), but not at 6 months ( d = 0.35; 95% CI, 5.34 to 7.59). Conclusion: Training medical providers on the PRA-CR for management of concussion resulted in expedited recovery of patients.