Timothy Mallon - Academia.edu (original) (raw)

Papers by Timothy Mallon

Research paper thumbnail of Response to Letter to the Editor Regarding Commentary “Hazardous Non-combat Exposures in the Department of Defense”

Military Medicine, Dec 30, 2022

Research paper thumbnail of Preparedness of Military Public Health for Epidemic and Pandemic Recognition and Response

Military Medicine

Disease epidemics have threatened American military preparedness and operational capabilities sin... more Disease epidemics have threatened American military preparedness and operational capabilities since 1775. The ongoing Severe Acute Respiratory Syndrome Coronavirus 2 (COVID-19) pandemic, which began in 2019, again demonstrates the significant potential for infectious diseases to impact military units and threaten military readiness. We reviewed the historical and continuing threats to the U.S. Military from infectious disease outbreaks, as well as changes in U.S. Military capabilities for conducting meaningful surveillance and response. We concluded that a structured review of military public health and preventive medicine capabilities should be conducted to assess the response to the COVID-19 pandemic and determine the capabilities necessary for infectious disease surveillance and response to future threats.

Research paper thumbnail of Maximizing the Capabilities of the DoD Serum Repository to Meet Current and Future Needs: Report of the Needs Panel

Military Medicine, 2015

hosted two panels of civilian and military public health and laboratory professionals to address ... more hosted two panels of civilian and military public health and laboratory professionals to address medical surveillance and primary care needs of the Department of Defense (DoD) that might be met by a biorepository that contained specimens that would be suitable for testing using emerging laboratory technologies. The first panel, the "needs panel," was asked to identify capabilities that were needed by the Military Medicine community to better perform their jobs but were either not presently available or not supported by specimens archived in the current DoD Serum Repository (DoDSR). A second panel, the "technology panel," considered whether current technology existed to support the needs identified by the first panel. This report summarizes the findings of the needs panel, to include recommendations regarding both current capabilities using the DoDSR and possible future capabilities.

Research paper thumbnail of Managing Federal Workersʼ Compensation Injuries and Costs

Journal of Occupational and Environmental Medicine, 2015

Background: Federal Employees' Compensation Act injury rates and claim costs benefit from injury ... more Background: Federal Employees' Compensation Act injury rates and claim costs benefit from injury prevention and case management efforts. The Department of Labor Protecting Our Workers and Ensuring Reemployment data on lost time injuries and illnesses do support injury prevention and case management activities. Methods: The management efforts of the Department of Defense, Veterans Administration, and Department of Labor were examined to determine whether more is needed to support injury prevention and case management efforts. Results: Data on Protecting Our Workers and Ensuring Reemployment goal 3 metrics should be provided to safety and occupational health (SOH) personnel to support injury prevention and case management efforts. Discussion: Injury prevention and case management data need to be made available to SOH team members to prevent injuries and lower claims costs. Conclusion: Actionable information must be provided to SOH that will facilitate case management and injury prevention programs and lower costs. I n 2010, 2.7 million civilian workers served in more than 70 different Federal agencies, and approximately 251,000 Federal agency employees received wage loss compensation, medical care, and vocational rehabilitation services under the Federal Employee Compensation Act (FECA).

Research paper thumbnail of Federal Workersʼ Compensation Program Basics

Journal of Occupational and Environmental Medicine, 2015

Primary health care providers may not be familiar with the Federal Employees&... more Primary health care providers may not be familiar with the Federal Employees' Compensation Act (FECA) and Department of Defense regulations that govern injured workers' rights, benefits, and procedures to follow when an injured employee is seen in the military medical treatment facility. The FECA program was examined and each section reviewed to facilitate provider involvement from time of injury to final disposition of a claim and employee return to work. The best practices in case management are highlighted as well. Several areas of the FECA program require coordination between members of the installation Federal Worker's Compensation team. Areas requiring extensive communication by all team members were emphasized. Successful installation FECA programs engage all members of the FECA team in a collaborative fashion to share information, prevent injuries, and keep costs low.

Research paper thumbnail of Federal Workersʼ Compensation Programs

Journal of Occupational and Environmental Medicine, 2015

Research paper thumbnail of Contract Case Managers Prove Cost Effective in Federal Workers' Compensation Programs

Military Medicine, 2008

Objective: This pilot study examined whether contract case managers are cost effective in reducin... more Objective: This pilot study examined whether contract case managers are cost effective in reducing workers' compensation (WC) costs and preventing injuries. Methods: We placed contract medical case managers at four installations where they employed private industry best practices. A needs assessment was performed and site-specific targeted interventions were developed. Case managers improved WC program effectiveness by ensuring command support, and strengthening the case management process. They minimized lost work time and provided the WC team resources to review the oldest cases. Results: Case managers cost 1.25millionandtheygenerated1.25 million and they generated 1.25millionandtheygenerated4.4 million in savings for a 3.52 return on investment. Case managers removed 73 workers from long-term rolls by making use of vocational rehabilitation, finding modified duty jobs, offering workers medical retirement, and terminating benefits when workers refused to work after being offered a job. Conclusions: This study of medical case managers demonstrates they can reduce WC costs.

Research paper thumbnail of Investigation of an outbreak of anemia cases at an Army trinitrotoluene munitions production plant from 2004 to 2005 and subsequent surveillance 2005-2013

Military medicine, 2014

Investigate an outbreak of anemia that occurred at an Army trinitrotoluene (TNT) munitions produc... more Investigate an outbreak of anemia that occurred at an Army trinitrotoluene (TNT) munitions production facility in 2004-2005 and describe subsequent medical surveillance efforts between 2005 and 2013. A retrospective, cross-sectional investigation of anemia cases and exposure levels was conducted to target corrective engineering and administrative changes needed to reduce TNT levels and anemia cases. Mean TNT exposure levels decreased from 1.2 to 0.08 mg/m(3) between 2004 and 2012, but the trend was not statistically significant. Anemia cases rose from 17 to 38 between 2004 and 2011 and cases declined from 4 to 0 between 2012 and 2013. The overall trend in cases was not statistically significant. TNT levels rose at a munitions plant until ventilation changes reduced exposures. Despite this, anemia cases continued to rise until the commander held workers accountable for failing to wear PPE and motivated them to wear respirators to avoid a loss in pay. The case definition of anemia was...

Research paper thumbnail of Progress in Implementing Recommendations in the National Academy of Sciences Reports: “Protecting Those Who Serve: Strategies to Protect the Health of Deployed U.S. Forces”

Military Medicine, 2011

Since the Institute of Medicine (IOM) and the National Research Council (NRC) published their rec... more Since the Institute of Medicine (IOM) and the National Research Council (NRC) published their recommendations to develop a national strategy to better protect the health of U.S. Forces, the Department of Defense has made efforts to achieve the goals and recommendations of the IOM and NRC in the four main areas identifi ed in their reports: assessment of health risks during deployments; technologies and methods for detection and tracking of exposures; physical protection and decontamination; and medical protection, health consequences and treatment, and medical record keeping. However, much more remains to be done and this underscores the need for a continued commitment to implement the long-term strategy for force health protection. This article summarizes some of the major improvements, highlights areas where more work is necessary, and identifi es obstacles that must be overcome to achieve the recommendations of the IOM and the NRC.

Research paper thumbnail of The In-Service Examination Score As a Predictor of Success on the American Board of Preventive Medicine Certification Examination

American Journal of Preventive Medicine, 2011

Background: To date, there has been no study correlating the American College of Preventive Medic... more Background: To date, there has been no study correlating the American College of Preventive Medicine (ACPM) in-service exam (ISE) with the American Board of Preventive Medicine (ABPM) certifıcation exam. Purpose: To validate the ACPM ISE as a predictor of success on the ABPM certifıcation exam. Methods: ISE and ABPM certifıcation exam scores were standardized by year using z-scores. The correlation between practicum year ISE scores and certifıcation exam scores for military preventive medicine residencies in the National Capital and Washington State areas (core component only) was analyzed. A multivariable linear regression model included adjustments for age, gender, Master of Public Health grade point average (GPA), prior specialty board certifıcation, and board deferral Ն1 year after graduation. Data were collected in 2010 and analyzed in 2011. Results: Performance on the ISE was correlated with performance on the ABPM certifıcation core exam (rϭ0.61, pϽ0.001). Performance on the ISE was still signifıcant after adjusting for relevant demographic and educational variables (pϽ0.001). Other signifıcant covariates included GPA (pϭ0.001) and board deferral (pϭ0.04) in the linear regression model. Conclusions: Performance on the ISE is moderately correlated with performance on the board certifıcation core exam, and this correlation remained signifıcant after adjustment in the linear regression model. These results serve to validate the ISE as a means for program directors to identify residents at academic risk and as encouragement for residents to take the certifıcation exam as soon as possible after graduation.

Research paper thumbnail of Occupational Effect on the Occurrence of Idiopathic Venous Thromboembolism

Military Medicine, 2012

Few studies have explored the effects of various occupations on venous thromboembolism occurrence... more Few studies have explored the effects of various occupations on venous thromboembolism occurrence. We examined idiopathic venous thromboembolism (IVTE) occurrence by occupation, body size, and age in the U.S. military. To capture idiopathic cases, exclusion criteria included recognized venous thromboembolism risk factors. Each case was matched to three controls on branch of service, sex, rank/grade, race, and education level. Body mass index, age, and occupation were analyzed with χ 2 and logistic regression. Of 2,167 cases, most were male (87%), white (69%), enlisted (78%), averaging 36 years old. IVTE odds increased with age (p 0.001). Every occupation showed greater odds than pilots/aircrew (p 0.001), especially infantry/artillery/combat arms, which showed twice the odds, followed by health care workers. Normal weight was protective, especially in pilots/aircrew (OR 0.52, p = 0.03) and repair/engineering (OR 0.72, p 0.001). Our analysis found a lower risk of IVTE among pilots and aircrew compared to other military occupations. Body size had less impact than expected in aircraft and vehicle operators. Greater odds in health care workers and infantry/artillery/combat arms than in pilots/aircrew and armor/motor transport occupational groups may reflect prolonged standing. Limitations include potential miscoding of health records and potential misclassification. Future IVTE research should explore job functions and worker characteristics.

Research paper thumbnail of Advances in Comprehensive Exposure Assessment

Journal of Occupational and Environmental Medicine

OBJECTIVE Review advances in exposure assessment offered by the exposome concept and new -omics a... more OBJECTIVE Review advances in exposure assessment offered by the exposome concept and new -omics and sensor technologies. METHODS Narrative review of advances, including current efforts and potential future applications by the US military. RESULTS Exposure assessment methods from both bottom-up and top-down exposomics approaches are advancing at a rapid pace, and the US military is engaged in developing both approaches. Top-down approaches employ various -omics technologies to identify biomarkers of internal exposure and biological effect. Bottom-up approaches use new sensor technology to better measure external dose. Key challenges of both approaches are largely centered around how to integrate, analyze, and interpret large datasets that are multidimensional and disparate. CONCLUSIONS Advances in -omics and sensor technologies may dramatically enhance exposure assessment and improve our ability to characterize health risks related to occupational and environmental exposures, including for the US military.

Research paper thumbnail of Managing workers' compensation costs in the military setting: the Army's story

Clinics in occupational and environmental medicine, 2004

Direct and indirect costs for the Army's workers' compensation payments have increased to... more Direct and indirect costs for the Army's workers' compensation payments have increased to more than 2 billion US dollars. Increasing attention is putting the spotlight on the problems at all levels, and a promising cooperative approach to injury prevention and case management is emerging. This article addresses the system within which the Army's workers' compensation program operates, provides some organizational history, gives an update on current status,and describes what is needed for sustained improvement. The onus is on the Army to develop and implement strategies that use available data to target high-risk occupations and employees to prevent accidents, injuries, and illnesses. Front-line managers bear the responsibility for educating the workforce and providing safe workplaces. Employees become the beneficiaries, not of medical and compensation benefits but of safe and healthy work environments.

Research paper thumbnail of Investigating the Relationship Between Worker Demographics and Nature of Injury on Federal Department of Defense Workers' Compensation Injury Rates and Costs From 2000 to 2008

Objective: This is the first study of workers' compensation injuries and costs in Department ... more Objective: This is the first study of workers' compensation injuries and costs in Department of Defense workers that examined whether any demographic factors including age, sex, occupation, and nature of injury altered the risks or costs of an injury or illness over time. Methods: Department of Defense Workers' Compensation claims for period 2000 to 2008 were analyzed (n = 142,115) using Defense Portal Analysis and Defense Manpower Data Center to calculate injury rates and costs. Regression analysis was done using SPSS to examine the change in the risk of injury or illness over time from 2000 to 2008. Results: The age group of 30 to 34 years had the lowest costs per claim and highest claims rate, 332 per 10,000. The age group of 65 to 70 years had the lowest claims rate of 188 per 10,000 but the highest costs per claim. Claims cost increased $69 for each 5-year group, and older workers had a threefold increase in costs per claim. Conclusion: Younger workers get hurt more oft...

Research paper thumbnail of Source Apportionment of Airborne Dioxins, Furans and Polycyclic Aromatic Hydrocarbons at A U.S. Forward Operating Air Base During the Iraq War

Objectives: The objective was to apportion the sources of the ambient polycyclic aromatic hydroca... more Objectives: The objective was to apportion the sources of the ambient polycyclic aromatic hydrocarbon (PAH), polychlorinated dibenzo-p-dioxin (PCDD) and polychlorinated dibenzofuran concentrations measured at Joint Base Balad in Iraq. Methods: Positive Matrix Factorization (PMF) was applied to the data to obtain the chemical profiles and contribution time series of the PAHs, PCDDs, and PCDFs. Conditional probability function (CPF) analyses were performed to assess the source directionality relative to the monitoring sites. Results: Three source types were identified and apportioned. The sources were: the burn pit, diesel vehicles and generators, and aircraft emissions. The CPF plots were consistent with the assigned source types. Conclusions: The PCDDs and PCDFs originated primarily from the burn pit. Higher molecular weight PAHs were associated with vehicle emissions while the aircraft emissions were enriched in low molecular weight PAHs.

Research paper thumbnail of Uniformed Services University Occupational and Environmental Medicine Residency Program

In 2019, the Uniformed Services University of the Health Sciences (USU) F. Edward Hébert School o... more In 2019, the Uniformed Services University of the Health Sciences (USU) F. Edward Hébert School of Medicine celebrated the 30th anniversary of its Occupational and Environmental Medicine (OEM) Residency program. This unique program is among the largest preventive medicine residency programs in the United States. Residents from the US Army, Navy, Air Force, other federal institutions, and the Canadian Forces come to Bethesda, Maryland, to become OEM specialists in a unique training program encompassing both military and civilian OEM settings. This publication describes the historical development and practice of OEM in the military leading to the development of the USU OEM Residency Program, along with the program's past accomplishments and current operation. Finally, the publication explores potential future directions for this relatively small but important preventive medicine specialty in the practice of military medicine, considering the impacts of reorganization of the Milita...

Research paper thumbnail of The effectiveness of occupational health and safety training in the Coast Guard

Research paper thumbnail of Training Occupational and Environmental Medicine (OEM) Residents at the Uniformed Services University

Journal of Occupational & Environmental Medicine

OBJECTIVE To develop an actionable plan to sustain and improve the quality of the USU OEM Residen... more OBJECTIVE To develop an actionable plan to sustain and improve the quality of the USU OEM Residency Program. METHODS Program metrics were collected and analyzed to assess strengths, weaknesses, opportunities and threats (SWOT Analysis). RESULTS Program strengths are stable funding, full-time faculty and large class size. Weaknesses are limited toxicology curriculum, and the lack of complex clinical cases. Opportunities include establishing an OEM referral clinic, collaborating with DoD toxicology programs, aligning OEM research priorities in DoD, and including DoD Civilian physicians in OEM residency training. Threats are Military Health System reorganization, budget and personnel cuts. CONCLUSIONS The USU OEM Residency is strong but must be flexible to adjust to personnel, fiscal and organizational changes. Aggregating the SWOT analyses for all the OEM residency programs may help identify strategies to sustain OEM training in the United States.

Research paper thumbnail of The Future of Military Occupational and Environmental Medicine in the Department of Defense

Journal of Occupational & Environmental Medicine

Research paper thumbnail of Exposure to Heptachlorodibenzo-p-dioxin (HpCDD) Regulates microRNA Expression in Human Lung Fibroblasts

Journal of Occupational and Environmental Medicine

OBJECTIVE Benzo(ghi)perylene (BghiP) and 1,2,3,4,6,7,8-Heptachlorodibenzo-p-dioxin (HpCDD) were e... more OBJECTIVE Benzo(ghi)perylene (BghiP) and 1,2,3,4,6,7,8-Heptachlorodibenzo-p-dioxin (HpCDD) were elevated in serum from personnel deployed to sites with open burn pits. Here, we investigated the ability of BghiP and HpCDD to regulate microRNA (miRNA) expression through the aryl hydrocarbon receptor (AHR). METHODS Human lung fibroblasts (HLFs) were exposed to BghiP and HpCDD. AHR activity was measured by reporter assay and gene expression. Deployment related miRNA were measured by quantitative polymerase chain reaction. AHR expression was depleted using siRNA. RESULTS BghiP displayed weak AHR agonist activity. HpCDD induced AHR activity in a dose-dependent manner. Let-7d-5p, miR-103-3p, miR-107, and miR-144-3p levels were significantly altered by HpCDD. AHR knockdown attenuated these effects. CONCLUSIONS These studies reveal that miRNAs previously identified in sera from personnel deployed to sites with open burn pits are altered by HpCDD exposure in HLFs.

Research paper thumbnail of Response to Letter to the Editor Regarding Commentary “Hazardous Non-combat Exposures in the Department of Defense”

Military Medicine, Dec 30, 2022

Research paper thumbnail of Preparedness of Military Public Health for Epidemic and Pandemic Recognition and Response

Military Medicine

Disease epidemics have threatened American military preparedness and operational capabilities sin... more Disease epidemics have threatened American military preparedness and operational capabilities since 1775. The ongoing Severe Acute Respiratory Syndrome Coronavirus 2 (COVID-19) pandemic, which began in 2019, again demonstrates the significant potential for infectious diseases to impact military units and threaten military readiness. We reviewed the historical and continuing threats to the U.S. Military from infectious disease outbreaks, as well as changes in U.S. Military capabilities for conducting meaningful surveillance and response. We concluded that a structured review of military public health and preventive medicine capabilities should be conducted to assess the response to the COVID-19 pandemic and determine the capabilities necessary for infectious disease surveillance and response to future threats.

Research paper thumbnail of Maximizing the Capabilities of the DoD Serum Repository to Meet Current and Future Needs: Report of the Needs Panel

Military Medicine, 2015

hosted two panels of civilian and military public health and laboratory professionals to address ... more hosted two panels of civilian and military public health and laboratory professionals to address medical surveillance and primary care needs of the Department of Defense (DoD) that might be met by a biorepository that contained specimens that would be suitable for testing using emerging laboratory technologies. The first panel, the "needs panel," was asked to identify capabilities that were needed by the Military Medicine community to better perform their jobs but were either not presently available or not supported by specimens archived in the current DoD Serum Repository (DoDSR). A second panel, the "technology panel," considered whether current technology existed to support the needs identified by the first panel. This report summarizes the findings of the needs panel, to include recommendations regarding both current capabilities using the DoDSR and possible future capabilities.

Research paper thumbnail of Managing Federal Workersʼ Compensation Injuries and Costs

Journal of Occupational and Environmental Medicine, 2015

Background: Federal Employees' Compensation Act injury rates and claim costs benefit from injury ... more Background: Federal Employees' Compensation Act injury rates and claim costs benefit from injury prevention and case management efforts. The Department of Labor Protecting Our Workers and Ensuring Reemployment data on lost time injuries and illnesses do support injury prevention and case management activities. Methods: The management efforts of the Department of Defense, Veterans Administration, and Department of Labor were examined to determine whether more is needed to support injury prevention and case management efforts. Results: Data on Protecting Our Workers and Ensuring Reemployment goal 3 metrics should be provided to safety and occupational health (SOH) personnel to support injury prevention and case management efforts. Discussion: Injury prevention and case management data need to be made available to SOH team members to prevent injuries and lower claims costs. Conclusion: Actionable information must be provided to SOH that will facilitate case management and injury prevention programs and lower costs. I n 2010, 2.7 million civilian workers served in more than 70 different Federal agencies, and approximately 251,000 Federal agency employees received wage loss compensation, medical care, and vocational rehabilitation services under the Federal Employee Compensation Act (FECA).

Research paper thumbnail of Federal Workersʼ Compensation Program Basics

Journal of Occupational and Environmental Medicine, 2015

Primary health care providers may not be familiar with the Federal Employees&... more Primary health care providers may not be familiar with the Federal Employees' Compensation Act (FECA) and Department of Defense regulations that govern injured workers' rights, benefits, and procedures to follow when an injured employee is seen in the military medical treatment facility. The FECA program was examined and each section reviewed to facilitate provider involvement from time of injury to final disposition of a claim and employee return to work. The best practices in case management are highlighted as well. Several areas of the FECA program require coordination between members of the installation Federal Worker's Compensation team. Areas requiring extensive communication by all team members were emphasized. Successful installation FECA programs engage all members of the FECA team in a collaborative fashion to share information, prevent injuries, and keep costs low.

Research paper thumbnail of Federal Workersʼ Compensation Programs

Journal of Occupational and Environmental Medicine, 2015

Research paper thumbnail of Contract Case Managers Prove Cost Effective in Federal Workers' Compensation Programs

Military Medicine, 2008

Objective: This pilot study examined whether contract case managers are cost effective in reducin... more Objective: This pilot study examined whether contract case managers are cost effective in reducing workers' compensation (WC) costs and preventing injuries. Methods: We placed contract medical case managers at four installations where they employed private industry best practices. A needs assessment was performed and site-specific targeted interventions were developed. Case managers improved WC program effectiveness by ensuring command support, and strengthening the case management process. They minimized lost work time and provided the WC team resources to review the oldest cases. Results: Case managers cost 1.25millionandtheygenerated1.25 million and they generated 1.25millionandtheygenerated4.4 million in savings for a 3.52 return on investment. Case managers removed 73 workers from long-term rolls by making use of vocational rehabilitation, finding modified duty jobs, offering workers medical retirement, and terminating benefits when workers refused to work after being offered a job. Conclusions: This study of medical case managers demonstrates they can reduce WC costs.

Research paper thumbnail of Investigation of an outbreak of anemia cases at an Army trinitrotoluene munitions production plant from 2004 to 2005 and subsequent surveillance 2005-2013

Military medicine, 2014

Investigate an outbreak of anemia that occurred at an Army trinitrotoluene (TNT) munitions produc... more Investigate an outbreak of anemia that occurred at an Army trinitrotoluene (TNT) munitions production facility in 2004-2005 and describe subsequent medical surveillance efforts between 2005 and 2013. A retrospective, cross-sectional investigation of anemia cases and exposure levels was conducted to target corrective engineering and administrative changes needed to reduce TNT levels and anemia cases. Mean TNT exposure levels decreased from 1.2 to 0.08 mg/m(3) between 2004 and 2012, but the trend was not statistically significant. Anemia cases rose from 17 to 38 between 2004 and 2011 and cases declined from 4 to 0 between 2012 and 2013. The overall trend in cases was not statistically significant. TNT levels rose at a munitions plant until ventilation changes reduced exposures. Despite this, anemia cases continued to rise until the commander held workers accountable for failing to wear PPE and motivated them to wear respirators to avoid a loss in pay. The case definition of anemia was...

Research paper thumbnail of Progress in Implementing Recommendations in the National Academy of Sciences Reports: “Protecting Those Who Serve: Strategies to Protect the Health of Deployed U.S. Forces”

Military Medicine, 2011

Since the Institute of Medicine (IOM) and the National Research Council (NRC) published their rec... more Since the Institute of Medicine (IOM) and the National Research Council (NRC) published their recommendations to develop a national strategy to better protect the health of U.S. Forces, the Department of Defense has made efforts to achieve the goals and recommendations of the IOM and NRC in the four main areas identifi ed in their reports: assessment of health risks during deployments; technologies and methods for detection and tracking of exposures; physical protection and decontamination; and medical protection, health consequences and treatment, and medical record keeping. However, much more remains to be done and this underscores the need for a continued commitment to implement the long-term strategy for force health protection. This article summarizes some of the major improvements, highlights areas where more work is necessary, and identifi es obstacles that must be overcome to achieve the recommendations of the IOM and the NRC.

Research paper thumbnail of The In-Service Examination Score As a Predictor of Success on the American Board of Preventive Medicine Certification Examination

American Journal of Preventive Medicine, 2011

Background: To date, there has been no study correlating the American College of Preventive Medic... more Background: To date, there has been no study correlating the American College of Preventive Medicine (ACPM) in-service exam (ISE) with the American Board of Preventive Medicine (ABPM) certifıcation exam. Purpose: To validate the ACPM ISE as a predictor of success on the ABPM certifıcation exam. Methods: ISE and ABPM certifıcation exam scores were standardized by year using z-scores. The correlation between practicum year ISE scores and certifıcation exam scores for military preventive medicine residencies in the National Capital and Washington State areas (core component only) was analyzed. A multivariable linear regression model included adjustments for age, gender, Master of Public Health grade point average (GPA), prior specialty board certifıcation, and board deferral Ն1 year after graduation. Data were collected in 2010 and analyzed in 2011. Results: Performance on the ISE was correlated with performance on the ABPM certifıcation core exam (rϭ0.61, pϽ0.001). Performance on the ISE was still signifıcant after adjusting for relevant demographic and educational variables (pϽ0.001). Other signifıcant covariates included GPA (pϭ0.001) and board deferral (pϭ0.04) in the linear regression model. Conclusions: Performance on the ISE is moderately correlated with performance on the board certifıcation core exam, and this correlation remained signifıcant after adjustment in the linear regression model. These results serve to validate the ISE as a means for program directors to identify residents at academic risk and as encouragement for residents to take the certifıcation exam as soon as possible after graduation.

Research paper thumbnail of Occupational Effect on the Occurrence of Idiopathic Venous Thromboembolism

Military Medicine, 2012

Few studies have explored the effects of various occupations on venous thromboembolism occurrence... more Few studies have explored the effects of various occupations on venous thromboembolism occurrence. We examined idiopathic venous thromboembolism (IVTE) occurrence by occupation, body size, and age in the U.S. military. To capture idiopathic cases, exclusion criteria included recognized venous thromboembolism risk factors. Each case was matched to three controls on branch of service, sex, rank/grade, race, and education level. Body mass index, age, and occupation were analyzed with χ 2 and logistic regression. Of 2,167 cases, most were male (87%), white (69%), enlisted (78%), averaging 36 years old. IVTE odds increased with age (p 0.001). Every occupation showed greater odds than pilots/aircrew (p 0.001), especially infantry/artillery/combat arms, which showed twice the odds, followed by health care workers. Normal weight was protective, especially in pilots/aircrew (OR 0.52, p = 0.03) and repair/engineering (OR 0.72, p 0.001). Our analysis found a lower risk of IVTE among pilots and aircrew compared to other military occupations. Body size had less impact than expected in aircraft and vehicle operators. Greater odds in health care workers and infantry/artillery/combat arms than in pilots/aircrew and armor/motor transport occupational groups may reflect prolonged standing. Limitations include potential miscoding of health records and potential misclassification. Future IVTE research should explore job functions and worker characteristics.

Research paper thumbnail of Advances in Comprehensive Exposure Assessment

Journal of Occupational and Environmental Medicine

OBJECTIVE Review advances in exposure assessment offered by the exposome concept and new -omics a... more OBJECTIVE Review advances in exposure assessment offered by the exposome concept and new -omics and sensor technologies. METHODS Narrative review of advances, including current efforts and potential future applications by the US military. RESULTS Exposure assessment methods from both bottom-up and top-down exposomics approaches are advancing at a rapid pace, and the US military is engaged in developing both approaches. Top-down approaches employ various -omics technologies to identify biomarkers of internal exposure and biological effect. Bottom-up approaches use new sensor technology to better measure external dose. Key challenges of both approaches are largely centered around how to integrate, analyze, and interpret large datasets that are multidimensional and disparate. CONCLUSIONS Advances in -omics and sensor technologies may dramatically enhance exposure assessment and improve our ability to characterize health risks related to occupational and environmental exposures, including for the US military.

Research paper thumbnail of Managing workers' compensation costs in the military setting: the Army's story

Clinics in occupational and environmental medicine, 2004

Direct and indirect costs for the Army's workers' compensation payments have increased to... more Direct and indirect costs for the Army's workers' compensation payments have increased to more than 2 billion US dollars. Increasing attention is putting the spotlight on the problems at all levels, and a promising cooperative approach to injury prevention and case management is emerging. This article addresses the system within which the Army's workers' compensation program operates, provides some organizational history, gives an update on current status,and describes what is needed for sustained improvement. The onus is on the Army to develop and implement strategies that use available data to target high-risk occupations and employees to prevent accidents, injuries, and illnesses. Front-line managers bear the responsibility for educating the workforce and providing safe workplaces. Employees become the beneficiaries, not of medical and compensation benefits but of safe and healthy work environments.

Research paper thumbnail of Investigating the Relationship Between Worker Demographics and Nature of Injury on Federal Department of Defense Workers' Compensation Injury Rates and Costs From 2000 to 2008

Objective: This is the first study of workers' compensation injuries and costs in Department ... more Objective: This is the first study of workers' compensation injuries and costs in Department of Defense workers that examined whether any demographic factors including age, sex, occupation, and nature of injury altered the risks or costs of an injury or illness over time. Methods: Department of Defense Workers' Compensation claims for period 2000 to 2008 were analyzed (n = 142,115) using Defense Portal Analysis and Defense Manpower Data Center to calculate injury rates and costs. Regression analysis was done using SPSS to examine the change in the risk of injury or illness over time from 2000 to 2008. Results: The age group of 30 to 34 years had the lowest costs per claim and highest claims rate, 332 per 10,000. The age group of 65 to 70 years had the lowest claims rate of 188 per 10,000 but the highest costs per claim. Claims cost increased $69 for each 5-year group, and older workers had a threefold increase in costs per claim. Conclusion: Younger workers get hurt more oft...

Research paper thumbnail of Source Apportionment of Airborne Dioxins, Furans and Polycyclic Aromatic Hydrocarbons at A U.S. Forward Operating Air Base During the Iraq War

Objectives: The objective was to apportion the sources of the ambient polycyclic aromatic hydroca... more Objectives: The objective was to apportion the sources of the ambient polycyclic aromatic hydrocarbon (PAH), polychlorinated dibenzo-p-dioxin (PCDD) and polychlorinated dibenzofuran concentrations measured at Joint Base Balad in Iraq. Methods: Positive Matrix Factorization (PMF) was applied to the data to obtain the chemical profiles and contribution time series of the PAHs, PCDDs, and PCDFs. Conditional probability function (CPF) analyses were performed to assess the source directionality relative to the monitoring sites. Results: Three source types were identified and apportioned. The sources were: the burn pit, diesel vehicles and generators, and aircraft emissions. The CPF plots were consistent with the assigned source types. Conclusions: The PCDDs and PCDFs originated primarily from the burn pit. Higher molecular weight PAHs were associated with vehicle emissions while the aircraft emissions were enriched in low molecular weight PAHs.

Research paper thumbnail of Uniformed Services University Occupational and Environmental Medicine Residency Program

In 2019, the Uniformed Services University of the Health Sciences (USU) F. Edward Hébert School o... more In 2019, the Uniformed Services University of the Health Sciences (USU) F. Edward Hébert School of Medicine celebrated the 30th anniversary of its Occupational and Environmental Medicine (OEM) Residency program. This unique program is among the largest preventive medicine residency programs in the United States. Residents from the US Army, Navy, Air Force, other federal institutions, and the Canadian Forces come to Bethesda, Maryland, to become OEM specialists in a unique training program encompassing both military and civilian OEM settings. This publication describes the historical development and practice of OEM in the military leading to the development of the USU OEM Residency Program, along with the program's past accomplishments and current operation. Finally, the publication explores potential future directions for this relatively small but important preventive medicine specialty in the practice of military medicine, considering the impacts of reorganization of the Milita...

Research paper thumbnail of The effectiveness of occupational health and safety training in the Coast Guard

Research paper thumbnail of Training Occupational and Environmental Medicine (OEM) Residents at the Uniformed Services University

Journal of Occupational & Environmental Medicine

OBJECTIVE To develop an actionable plan to sustain and improve the quality of the USU OEM Residen... more OBJECTIVE To develop an actionable plan to sustain and improve the quality of the USU OEM Residency Program. METHODS Program metrics were collected and analyzed to assess strengths, weaknesses, opportunities and threats (SWOT Analysis). RESULTS Program strengths are stable funding, full-time faculty and large class size. Weaknesses are limited toxicology curriculum, and the lack of complex clinical cases. Opportunities include establishing an OEM referral clinic, collaborating with DoD toxicology programs, aligning OEM research priorities in DoD, and including DoD Civilian physicians in OEM residency training. Threats are Military Health System reorganization, budget and personnel cuts. CONCLUSIONS The USU OEM Residency is strong but must be flexible to adjust to personnel, fiscal and organizational changes. Aggregating the SWOT analyses for all the OEM residency programs may help identify strategies to sustain OEM training in the United States.

Research paper thumbnail of The Future of Military Occupational and Environmental Medicine in the Department of Defense

Journal of Occupational & Environmental Medicine

Research paper thumbnail of Exposure to Heptachlorodibenzo-p-dioxin (HpCDD) Regulates microRNA Expression in Human Lung Fibroblasts

Journal of Occupational and Environmental Medicine

OBJECTIVE Benzo(ghi)perylene (BghiP) and 1,2,3,4,6,7,8-Heptachlorodibenzo-p-dioxin (HpCDD) were e... more OBJECTIVE Benzo(ghi)perylene (BghiP) and 1,2,3,4,6,7,8-Heptachlorodibenzo-p-dioxin (HpCDD) were elevated in serum from personnel deployed to sites with open burn pits. Here, we investigated the ability of BghiP and HpCDD to regulate microRNA (miRNA) expression through the aryl hydrocarbon receptor (AHR). METHODS Human lung fibroblasts (HLFs) were exposed to BghiP and HpCDD. AHR activity was measured by reporter assay and gene expression. Deployment related miRNA were measured by quantitative polymerase chain reaction. AHR expression was depleted using siRNA. RESULTS BghiP displayed weak AHR agonist activity. HpCDD induced AHR activity in a dose-dependent manner. Let-7d-5p, miR-103-3p, miR-107, and miR-144-3p levels were significantly altered by HpCDD. AHR knockdown attenuated these effects. CONCLUSIONS These studies reveal that miRNAs previously identified in sera from personnel deployed to sites with open burn pits are altered by HpCDD exposure in HLFs.